Can a Toddler Drink Too Much Cow's Milk?

A viral Facebook post about milk anemia has parents questioning the safety of cow's milk for toddlers, but here's what the experts say about the condition.

Anastacia Gencarelli’s nightmare started when her 2-year-old daughter began showing signs of an ear infection. She brought her to the family doctor who prescribed a round of antibiotics for a double ear and chest infection, and after a week of meds three times a day, her little one was back to her happy self for five days. But on day six, Gencarelli explained in a now-viral Facebook post, her daughter was lethargic and not eating, so mom returned to the doctor where they prescribed more antibiotics. After another week, her daughter still wasn't getting better.

As she sat cuddling her daughter later that day, she said her “mom instinct” just wouldn’t stop, so she jumped up, grabbed her husband, and sped off to the emergency room. “We were not even in that waiting room 5 minutes before an amazing nurse noticed Dad walking very impatiently with our limp baby. She comes flying out, saying, ‘I don’t care how long you have all been waiting, that baby comes with me.’ We didn’t do triage, we didn’t register, nurse kicked people out of a room for my daughter and as we rush in six nurses and two doctors follow.”

What transpired was a horrific ordeal, complete with multiple needle sticks for blood, difficulty obtaining venous access for an IV catheter, monitors, cuffs, and a room full of worried doctors and nurses. When the toddler’s bloodwork came back, they were shocked to see that her total blood volume was 25% of what it should’ve been, the mom wrote on Facebook. She had no external bleeding, no visible signs of blood loss at all, but the fact remained that she had lost a majority of her blood supply.

What caused such massive blood loss in a child with no visible bleeding? Doctors confirmed the little girl had developed milk anemia, a rare but serious form of iron-deficiency from drinking too much cows milk. Here's what parents need to know about the condition.

What is milk anemia?

Milk anemia, also referred to as iron-deficiency anemia (IDA), is a type of anemia where the body's blood cannot supply tissues and organs with adequate oxygen. Milk affects the body’s ability to absorb iron, which is necessary for the formation of hemoglobin, the part of the blood that carries oxygen.

Symptoms of IDA might include pale skin, poor appetite, fatigue, rapid breathing, frequent infections, slowed development, behavioral problems, and cravings for dirt, paint, or ice. Cow’s milk has also been known to cause intestinal bleeding in infants and older babies, which is what happened in the case of Gencarelli’s daughter and led to her severe blood loss.

How common is milk anemia?

According to Sahira Long, M.D., of Children’s National in Washington D.C., milk anemia is rare. Only 2 to 3% of toddlers have IDA, but 7 to 9% of toddlers have an iron deficiency that could be caused by milk or another part of their diet.

“Though the amount of iron in breast milk is low, it is known to be much more bioavailable and that influences how much is absorbed," explains Dr. Long. "Full-term babies who are breastfed typically have adequate iron stores to meet their needs until around 6 months of age at which time they need to have a complementary source of dietary iron introduced.”

According to Dr. Long, babies who drink cow’s milk are at increased risk of developing GI blood loss due to a reaction with certain milk proteins. She also explains that “Prior to 12 months of age, drinking cow's milk increases the risk of the baby developing iron-deficiency anemia.”

What milk is safe for toddlers?

According to the American Academy of Pediatricians, children under 12 months of age shouldn't receive cow’s milk at all. Children aged 12 to 24 months should not consume more than 12 ounces of milk per day and toddlers over the age of 2 should not consume more than 32 ounces of milk per day.

Portland, Oregon pediatrician and author Whitney Casares, M.D. explains that it’s not just cow’s milk that can cause problems. “Other mammalian milks like goat milk can also cause gut irritation and anemia," she explains. “Alternative milks, like soy milk and nut milks, also do not meet the nutritional needs of children under one year old. After one year old, parents should check alternative milk labels carefully as these beverages can have less protein and fewer calories compared to cow’s milk.”

The AAP also recommends that all babies have iron and hemoglobin levels checked at 12 months old. This test is usually performed at the 1-year well-check. If levels are determined to be low, iron-supplementation, as well as dietary changes, may be recommended.

The Bottom Line

After a blood transfusion and more medical tests, Gencarelli’s daughter is recovering and the mom wants other parents to share information about the dangers of milk anemia. The take-home is to follow AAP nutritional guidelines for infants and toddlers, stick to breast milk or

iron-fortified infant formula and avoid low-iron milk (cow, goat, and soy), even in cereal. Milk can be a great supplement when babies are old enough, but be careful not to overdo it.

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