Milk for Toddlers – Traditional Cow’s Milk or Fortified?

By: Hilary Jones, MD

July 21, 2017

As parents transition their toddlers to milk, an important question arises – which milk to use?

As a general practitioner, I typically come across parental concerns about ‘Cow’s Milk Allergy’ or CMA.  When putting this into real context, research shows that the true prevalence of CMA when diagnosed using ‘gold standard’ procedures is less than 1 percent of children up to the age of 2 years [1].  So, from this stance the risk of CMA is actually relatively low.

From a nutrition perspective traditional cow’s milk has benefits, but also some drawbacks. Traditional cow’s milk delivers B vitamins, including B2 (riboflavin) and B12 along with the minerals iodine, potassium and phosphorous [2].  It also contains choline – a nutrient that supports brain development [3] and the ‘milk fat’ delivers a mix of around 400 different fatty acids [4].  The energy density and fat content of whole milk is largely why  ‘whole milk’ rather than skim milk varieties are recommended for children under 2 years of age. [5].  Unfortunately, traditional cow’s milk is naturally low in iron and vitamin D [2].  These are two very important nutrients for young children.

Iron and Vitamin D Deficiency

As a medical doctor, iron and vitamin D deficiency are two of the most common nutritional deficiencies that we see in youngsters today. Recently, in 2016 Western European data from Germany, the Netherlands and the UK showed that 1 in 10 (11.8%) and 1 in 5 (22.8%) of 1 to 3 years olds had iron and vitamin D deficiency, respectively [6]. There are many different reasons behind this including poor iron and vitamin D status in pregnancy coupled with low dietary intakes in infants and toddlers and poor compliance with supplements. Interestingly though, the use of cow’s milk as the main type of milk during the toddler years has been linked to suboptimal iron and vitamin D status in these children [6].

In terms of broader health consequences, iron deficiency can lead to anemia (where a lack of iron leads to a reduction in the number of red blood cells).  In turn, iron shortfalls in infants and toddlers have been linked to reduced brain function of children, and in the long run, leads to increased risk of lead toxicity [7].  While the link between iron deficiency and iron toxicity is yet to be fully decoded, one school of thought is that iron acts as a transporter of lead [8]. So, improved iron levels in young children could lower the risk of lead poisoning.

For vitamin D, the role of this nutrient goes beyond bone health. There is now growing evidence that this fat-soluble vitamin plays a central role in the immune system [9].  More recently, it has also been linked to respiratory health, including a reduced susceptibility to childhood allergies and asthma [10].

New Research

A new 2017 study [11] shows that a cow’s milk formula specially developed for young children and fortified with key micronutrients helps to improve the iron and vitamin D status of youngsters.

The well-designed double-blind trial took place over five months.  A sample of 318 predominantly white European children aged 1 to 3 years were randomly allocated to drink either: 1) non-fortified cow’s milk or 2) a fortified young child formula providing 1.2 mg iron and 1.7 µg vitamin D per 100ml.

These results clearly showed that the risk of iron and vitamin D deficiency was lower among young children drinking the fortified iron and vitamin-D enriched young child formula milk compared to those drinking traditional cow’s milk.  While further trials are needed to reconfirm these findings, fortified milk appears to have benefits in terms of preserving and indeed supporting young children’s iron and vitamin D levels.

The health of our next generation is profoundly important.  Iron and vitamin D deficiency are two of the most common deficiencies in children today.  Drinking fortified milk may be one way to help counter-balance this, especially as compliance with supplements is typically so low.


  1. Schoemaker, A.A., et al. (2015). “Incidence and natural history of challenge-proven cow’s milk allergy in European children–EuroPrevall birth cohort.” Allergy 70(8): 963-72.
  2. Public Health England (2015) Data from: Composition of foods integrated dataset (CoFID). Available at:
  3. Artegoitia, V.M., et al. (2014). “Choline and choline metabolite patterns and associations in blood and milk during lactation in dairy cows.” PLoS One 9(8):e103412.
  4. Cichosz, G. and Czeczot, H. (2015). “Milk fat – the only existing for any reason.” Pol Merkur Lekarski 38(225):174-9.
  5. NHS Choices (2015). “Milk and dairy in your diet.”  Available at:
  6. Akkermans, M.D., et al. (2016). “Iron and Vitamin D Deficiency in Healthy Young Children in Western Europe Despite Current Nutritional Recommendations.” J Pediatr Gastroenterol Nutr 62(4):635-42.
  7. Eden, A.N. and Sandoval, C. (2012). “Iron deficiency in infants and toddlers in the United States.” Pediatr Hematol Oncol 29(8):704-9.
  8. Kwong WT., et al. (2004). “Interactions between iron deficiency and lead poisoning: epidemiology and pathogenesis.” Sci Total Environ 330(1-3):21-37.
  9. Dankers, W., et al. (2017). “Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential.” Front Immunol 7:697.
  10. Hollams, E., et al. (2017). “Vitamin D over the first decade and susceptibility to childhood allergy and asthma.” J Allergy Clin Immunol 139(2): 472-481.
  11. Akkermans, M.D., et al. (2017). “A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: a randomized, double-blind controlled trial.” Am J Clin Nutr 105(2):391-399.

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