Do you have a fussy eating 1 year old? This is the first thing to look at!

Firstly, don't panic if your little one has gone off their food or appears to be eating less. Pockets of "fussiness" are actually normal for babies and toddlers.

We have a resource here covering really common reason why babies go off solids, and most of them will just pass with time. This is why we look at what kids eat over the week and not just in a single day. You'll be happy to know that when we look at the diet of most "fussy" eaters they do actually get all the nutrition they need over the week!

"BUT there is ONE thing that we as paediatric dietitians always look at when we have fussy eaters over the age of 1... their milk intake!"

Specifically, we are looking at the amount of cow's milk or formula they are drinking. Drinking large amounts of cow's milk and formula can:

• Fill them up and reduce their appetite for solids
• Reduce intake of iron rich foods
• Cow's milk can interfere with bodies ability to absorb iron
• Reduce intake of fibre rich food
• In some cases, with very large amounts of milk intake, it can impact their growth too.

 Did you know that roughly 10% of 1-3 year old children are iron deficient? One of the most common causes of iron deficiency in toddlers is drinking too much cow's milk!

Why is this an issue?

Well iron is important for brain development, immune function and overall growth and development. Babies have high iron needs and their natural stores are depleted around 6 months- which is why we focus on iron rich foods so much when we start solids.

So what might iron deficiency look like?

Symptoms include:

• Fatigue and tiredness over the day
• Struggles with sleep at night including trouble falling sleep
• Recurrent illness (although this is also just a big part of toddler life)
• Behavioural challenges (also a part of toddler life!)
• We may also see reduced appetite and fussy eating
• A craving for eating unusual things (this is called PICA and is associated with iron deficiency anaemia)
• Slow growth 

So what about breastmilk?

Now, it is REALLY important to make the distinction between offering a large amount of cow's milk or formula over the day and continuing to breastfeed after 1. We want to make it SO clear that we are not encouraging anyone to limit breastfeeding after 1- there is no evidence that this is needed. In fact, it is encouraged to continue to breastfeed (as long as it is working for you and your family) up until the age of 2 years and beyond.

If you're child is over the age of 1 and struggling with intake of solids then it is worth a 1:1 consult to ensure everything is going well and give you support to progress your solids journey while continuing to support your goals around breastfeeding.

There is no need to limit or restrict breastfeeding after 1 unless advised by an experienced healthcare professional. 

Cow's Milk- How Much After 1?

After the age of 1 you can introduce cow's milk as a drink to your little one if you want to. But, there is actually no need to introduce it! It is a bit of a myth that children need to drink milk. Although milk is an excellent source of nutrition (protein and calcium in particular) kids can get all the calcium they need from other dairy and calcium rich foods. So don't feel pressured to introduce it or stressed if your little one just isn't interested.

Cow's milk intake should be limited to 500ml max in a 24 hour period. 

If you are breastfeeding after 1, be mindful of adding in cow's milk as a drink as well. Doing this is adding to their overall milk intake and between breastfeeds and cow's milk may also displace solids....you might also be displacing breastmilk!

If you are breastfeeding after 1, we would suggest that you offer water for hydration instead of cow's milk. A small amount of cow's milk is okay, but there is no need to offer much to them.

How to get calcium in without milk?

Glad you asked! While milk is a great source of calcium, so are many other dairy and non-dairy foods. Including foods from the list below will help your little one to easily meet their calcium needs.

• Cheese
• Yoghurt
• Almond butter
• Tahini (unhulled is best for calcium)
• Fish with soft bones like salmon and sardines
• Fortified products -like some cereals and breads
• Green veggies and some fruits offer a small amount
• Chia seeds

Daily Dairy- How much do toddlers need?

Did you know that children aged 1-2 years are recommended to have 1-1.5 serves of dairy a day?

What does this look like?

Let's look at milk first. 1 cup (250ml of milk) is 1 serve. So 2 cups of milk (500ml- the max we recommend in 24 hours) is actually more than the recommended total serves of dairy for 1-2 years olds. This is without adding any cheese or yoghurt in the mix! 

If you offered 250ml of milk + 1 slice of cheese this is 1.5 serves of dairy = 85% of the recommended daily intake (RDI) for calcium and 115% of the estimated average requirements (EAR) for this age group.

Okay, how would you do this without milk? You could offer 1 slice of cheese + 200g of yoghurt and get 1.5 serves of dairy which = 92% RDI and 150% of the EAR.

Considering the number of parents we talk to that have yoghurt and cheese fiends at home- you're probably able to get their calcium needs met pretty easily without a lot of milk. We don't expect anyone to sit there and calculate out that amount of calcium their kids are getting! We just offered the above examples to show you how easy it is to get enough calcium with or without a lot of milk.

But what about formula?

Formula is not needed after 12 months of age for most babies (some allergy babies or children with growth/medical concerns may need it beyond this but will be advised by their health care team).  After 1, water should be the main drink on offer.  

Thoughts on bottles?

As parents ourselves we also know that on the day a child turns 1, they don't magically decide to stop drinking from a bottle either. Bottles can have a really strong comfort associations for many children. We advise that you gradually wean the bottle after 1 as quickly as you can and try to transition to a cup instead of a bottle.

We know that the advice is to wean bottles by 12 months- but we also understand the reality that every child is different. They are not robots. You do not need to feel guilty if your child still has a bottle after 1, but you should have a plan to reduce and wean bottles. If it is feeling hard, or you have tried and not succeeded, this is the perfect time to book in for a 1:1 consult with us.

If you are still giving a bottle after 1 you can switch from formula to cow's milk if you like but again- work towards weaning bottles and you still need to limit milk/formula to 500ml over a 24 hours period.

Of course, there can be MANY reasons why a toddler is going through a "fussy" phase, and we often don't need to do anything to "fix it" but looking at their overall milk intake can be a good place to start.

REFERENCES

https://www.rch.org.au/immigranthealth/clinical/Iron_deficiency_and_anaemia/

https://www.aihw.gov.au/getmedia/fc40ef46-be90-45c9-b287-851571647e7e/potnsocaa-c01.pdf.aspx

https://pubmed.ncbi.nlm.nih.gov/26448697/

https://journals.sagepub.com/doi/pdf/10.1177/1941406409335481

https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/iron-deficiency-and-associated-factors-in-australian-children-aged-46-years/3BA7853FF00196359E6F07EF4C50E282

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547444/

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-children-under-5-years-(-)

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