Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
Both the American Academy of Pediatrics (AAP) and the Institute of Medicine (IOM) recommend delaying the introduction of cow's milk until after 1 year of age due to its low absorbable iron content. We used a novel computerized decision support system to gather data from multiple general pediatrics offices. We asked families whether their child received cow's milk before 1 year of age, had a low-iron diet, or used low-iron formula. Then, at subsequent visits, we performed a modified developmental assessment using the Denver II. We assessed the effect of early cow's milk or a low-iron diet on the later failure of achieving developmental milestones. We controlled for covariates using logistic regression. Early cow's milk introduction (odds ratio (OR) 1.30, p = 0.012), as well as a low-iron diet or low-iron formula (OR 1.42, p < 0.001), was associated with increased rates of milestone failure. Only personal-social milestones (OR 1.44, p = 0.002) showed a significantly higher rate of milestone failure. Both personal-social (OR 1.42, p < 0.001) and language (OR 1.22, p = 0.009) showed higher rates of failure in children with a low-iron diet.


CONCLUSIONS
There is an association between the introduction of cow's milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age. This adds strength to the recommendations from the AAP and IOM to delay cow's milk introduction until after 1 year of age.
Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA, webjr@iu.edu.
William E
WE
Bennett
Kristin S
KS
Hendrix
Rachel T
RT
Thompson-Fleming
Stephen M
SM
Downs
Aaron E
AE
Carroll
D000818:Animals; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003661:Decision Support Techniques; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D019266:Iron, Dietary / Q000097:blood; D016015:Logistic Models; D008297:Male; D008892:Milk / Q000009:adverse effects*; D014481:United States
D019266:Iron, Dietary