Infant Formula Versus Whole Milk in Six- to 12-Month-Olds

Related letter: "Management of Lactose Intolerance in Infants" Original Article: Infant Formula Issue Date: April 1, 2009 Available at: https://www.aafp.org/afp/2009/0401/p565.html to the editor: I have a billion-dollar question for the author of this article, assuming the following: 4 million babies born each year in the United States; one half with formula provided by the Women, Infants, and Children (WIC) Program, the other one half out of pocket; a difference of 11 cents between an ounce of whole milk and an ounce of formula; and the period between six and 12 months of age as the issue. Cow's milk has a much lower iron content than iron-fortified formula.1 It was originally hoped that iron-fortified cereals could compensate for this difference, but multiple nutritional surveys have demonstrated that infants do not consume sufficient quantities of cereal to meet their iron requirements.2 Furthermore, cow's milk (which is high in calcium and low in vitamin C) appears to decrease the bioavailability of iron from dietary sources.2 Infants who are fed cow's milk can lose additional iron through occult gastrointestinal blood loss.3,4 Most infants lose very little blood, but occasionally infants have significant occult blood loss. In 1983, the AAP issued a statement supporting the use of whole cow's milk instead of formula for infants older than six months who consumed at least one third of their calories from supplemental food.2 We now know that even mild iron deficiency (insufficient to cause anemia) can adversely impact cognitive development in children.5 In light of growing evidence linking cow's milk to iron deficiency, the AAP issued a new statement in 1992 reversing their earlier position; iron-fortified formula is recommended for all non-breastfed infants until one year of age.2 NINA R. O'CONNOR, MD Philadelphia, Pa.