Dietitians New Zealand believes it is important to clarify the current guidelines in New Zealand with regards to cow’s milk versus formula for infants from six months of age.

This is in response to updates reported in the World Health Organisation Global Feeding Guidelines for Children Under Two, as reported across various media outlets in the last week.

The New Zealand infant feeding guidelines were reviewed and updated in 2021 in line with the latest scientific evidence.

The recommendation from these guidelines is that exclusive breastfeeding is considered the best nutrition for babies for the first six months and breastfeeding is continued up to two years or beyond, in addition to appropriately textured nutritious diet, says a Dietitian New Zealand spokesperson.

"If an infant is not breastfed, a commercial infant formula from ages 0-6 months and follow-on formula from 6 – 12 months, are the only suitable alternatives to breast milk under one year of age."

Dietitians New Zealand says it recognises the challenges faced by many parents in a cost-of-living crisis, particularly when making decisions about household expenses, such as food.

"However, before considering switching from infant formula to standard cow’s milk, we encourage parents and caregivers to think about some key considerations."

These are:

• The main aim of the review was to evaluate the effect of cow’s milk from 6 months on infant growth and development. Here, the WHO reported no difference in infants receiving cow’s milk. However, researchers found an increase in iron deficiency anaemia in infants fed cow’s milk.
• The study did not look at the impact of the high protein content of cow’s milk on infant growth and development.
• The studies included in the WHO review were limited (9 studies), making it difficult to recommend any changes to the New Zealand infant feeding guidelines without further research.
• It's important to recognise that the WHO recommendations consider a global perspective, encompassing regions where access to safe drinking water, used to reconstitute formula, may be limited.
• The WHO recommendation is for using cow’s milk only. Other animal and plant-based milks have different nutrition profiles. These milks are not included in the recommendation and are not suitable for infants from 6 – 12 months.
• Our current New Zealand infant feeding guidelines recommend introducing cow’s milk added to solids (such as pureed or mashed vegetables), or yoghurt and cheese from 6 months of age.
• The differences in the protein and nutrient composition of cow’s milk compared to breastmilk or formula can make babies’ kidneys work harder.

How to reduce the risk of iron deficiency anaemia

Dietitians New Zealand say many babies are born with low iron stores and are at risk of developing anaemia in their first year of life.

"This risk is increased if their māmā experienced iron deficiency in pregnancy or if infant was born prematurely. Commercial infant formulas are iron fortified, whereas cow’s milk is not," says a Dietitians New Zealand spokesperson.

"By six months of age babies have used up most of their stored iron. This is why The Ministry of Health encourages families to start introducing their infant to iron-rich foods such as pureed red meat, or chicken, iron fortified rice or cereal, and egg.

"Legumes and vegetables have some iron but are less available for absorption than animal foods rich in iron. These kinds of foods are encouraged daily, as babies become more established on solids."

Cow’s milk and kidneys

"Babies’ kidneys are immature when they are born and mature over the first year of life," says a Dietitians New Zealand spokesperson.

"Cow’s milk contains high levels of protein and minerals which can increase stress on the kidneys during this time.

"Evidence is currently lacking to determine, when in the first year of life, the kidneys are mature enough to manage cow’s milk."

Babies are individuals

Dietitians New Zealand are encouraging parents and caregivers to talk with their Well Child Provider or GP before making any changes to cow’s milk from infant formula from six months of age.

"Each infant is unique, and they need individual care to keep them healthy and growing well."

For individualised nutrition advice, specific to the needs of the infant, Dietitians New Zealand recommends consulting with a Registered Dietitian.

For those seeking further information about dietitians or wishing to know where to find a local dietitian, please go to the Dietitians New Zealand website at www.dietitians.org.nz.

References:

• WHO Guideline for complementary feeding of infants and young children 6-23 months of age - October 16 2023
• Healthy Eating Guidelines for New Zealand Babies and Toddlers (0-2 years old) | Ministry of Health NZ