Refusing milk from a cup

The Pediatric Insider

© 2009 Roy Benaroch, MD

 

Analise is trying to get her daughter to continue drinking milk: “My daughter is 14 months old and will only drink milk from a bottle. We introduced a sippy cup at 9 months but made the mistake of only putting water in it. Now she associates the cup with water and the bottle with milk. We’re in the process of weaning her from the bottle but don’t know how to convince her to drink milk from a cup. Do you have any tips or is it just try, try again until she accepts it? Thanks for any behavioral insight or advice!”

 

First, let me get myself in trouble with the dairy council and moms everywhere by letting this secret out: there is no essential need for toddlers to drink milk. It’s a good source of protein and calcium, sure, but there are plenty of other good sources. Lots of children stop drinking milk, and many adults never touch the stuff. There’s no reason to consider milk something crucial for children to drink once they’re outside of the young baby years and able to take solids well.

 

At fourteen months, whether or not your child is willing to drink milk from a cup, you ought to stop using baby bottles. They’re bad for her teeth, and they’re preventing her from developing normal eating habits. Don’t worry that your child won’t get enough fluids—she’ll drink water, and she will not become dehydrated without milk.

 

Though milk isn’t essential, it’s handy and most children continue to drink it. There are, of course, tricks worth trying to get her to drink milk from a cup:

 

• Add a little milk to the water in a cup, and day-by-day start adding more milk and less water. In a few weeks, you can wean up to full strength milk. Do this gradually and maybe she won’t notice.
• Add something to the milk to make it extra tasty: chocolate syrup, or maybe a mashed-up, very soft banana. Little girls (and boys) deserve a little chocolate in their lives.
• Try a different sort of cup, like one with a straw—maybe even a crazy bendy cool straw.
• Make sure she sees you and dad drinking milk from a cup. You two can even use sippy cups for a little while. If parents don’t drink milk, children are far less likely to want it.
• If you’ve been using whole milk, give 2% or skim a try. Older advice did recommended whole milk, but that’s not necessary.
• Try a different sort of milk, like soy or almond milk. These provide similar amounts of protein and calcium as cow’s milk. Rice milk, on the other hand, is a low-protein beverage more similar to juice than milk—stay away from it if you’re looking for something with nutritional value for your children.

 

What to do during the transition? Don’t worry about it. There is no reason a child can’t go weeks or months or even years without milk. If your daughter gets the impression that milk is something very special and important, she’s less likely to touch the stuff—this is called “yanking your parents’ chain,” a skill that all children learn sooner or later. Don’t get caught up in the drama by letting her know you’re worried about this. Win the chain-yanking match by dropping your end.

 

If in the long run your daughter still won’t touch milk, you’ll need some other good calcium sources:

 

• Any other dairy: cottage cheese, yogurt, cheese, ice cream
• Calcium fortified juices
• Calcium supplements, like the little chocolate squares marketed for women as Viactive
• Non fat dry milk powder. Don’t mix this in water to try to drink it—blecch—but sprinkle it in casseroles, soups, eggs, sauces, that kind of thing. Once it mixes in it’s just about impossible to taste. Think of it as cheap calcium –n- protein powder.

 

Try some simple tricks to see if you can get your daughter back on milk, but remember there is no hurry here, and this is not a crucial or even a very important issue. Milk is easy and cheap, but there are many other nutritious things your daughter can take that can replace milk if she’s decided she just won’t drink it any more.

I am not drinking that

Susan posted, “My 19-month old does not like whole milk. He nursed exclusively for a year. Then I would nurse him and pump. I would mix the pumped breastmilk with whole milk for when he went to daycare. Now I am trying to wean him completely but am reluctant to because he does not like to drink anything. He still nurses when he wakes up and just before he goes to bed. I feel like I need to keep doing this so that he gets some hydration. He does not like to drink in general, only taking sips of water or juice from a sippy cup at mealtime. He has had lots of problems with constipation and I have to give him Miralax in small doses every day. I can’t force him to drink but I don’t know what to do. I have also tried soy milk and giving the milk a flavor like chocolate or strawberry. He still has no interest. Help!”

You’re going to have to take a leap of faith here: when your son is thirsty, he will drink. If he’s neurologically normal, his hypothalamus will provide him with an irresistible desire to drink when his body needs fluids. He may not drink as much as you think he needs, but he will drink enough to stay healthy.

Organic infant formula? One brand is a bad idea

As reported by the New York Times, parents thinking that Similac Organic Infant Formula is healthier than conventional formulas are in for a surprise. The company that makes it, Ross, decided to use cane sugar as a sweetener. This makes Similac Organic taste sweeter than other infant formulas, and much sweeter than human milk. It’s riskier for a baby’s teeth, and is very likely to lead to over-eating. Worse still, it may help imprint a desire for sweeter foods starting at a very young age.

As discussed in this post, I’m not a proponent of organic foods. They’re more expensive, and I’m not convinced that they’re healthier or better for children. In the case of this particular infant formula, parents are paying about 30% more for a product that’s very likely to be less healthful than non-organic alternatives. You can’t assume that organic = more healthful.

Ending the night bottle routine

A question from Cameron: “I have made the mistake of letting my daughter keep her bottle when she goes to bed. She is now almost 3 1/2 and her sister is about to turn one. Do you have any suggestions as to how to how to wean both of them off the bottle?”

For the one year old, I suggest you just do it all at once. Change your bedtime routine to include a snack, like some banana slices, plus a cup of whole milk. After the snack, give her a bath, read some books, and put her down in her crib. Do this consistently, and stop offering or even mentioning a bottle at bedtime. She’ll develop a better routine that’s healthier for her teeth and will reinforce good independent sleeping through the night.

For the 3 ½ year old, it’s going to be more difficult.

How much formula needed at 10 mos?

Katie posted: “My daughter’s 10 months old. She takes 4 bottles a day, about 20oz. I want to ease into the 1 year – weaning – thing. What is the minimum amount of formula I should give her? Can I go ahead and supplement with milk, or is it best to wait until she is 1 year old?”

By 10 months, your daughter should be eating solids at least three times a day, and solid meals should include a good variety of ordinary table foods that you share with her at family meals together. This can include almost any sorts of foods, except nuts, peanuts, and raw honey. All of these foods ought to be soft enough for her to “gum them.” Good examples are noodles, well-cooked veggies, beans, crumbly meat, cottage cheese—almost anything can be ripped apart so it’s soft enough for a 10 month old.