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. 2014 Jul;173(7):887-92.
doi: 10.1007/s00431-014-2265-y. Epub 2014 Jan 24.

Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age

William E Bennett Jr  1 , Kristin S Hendrix, Rachel T Thompson-Fleming, Stephen M Downs, Aaron E Carroll
Affiliations

Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age

William E Bennett Jr et al. Eur J Pediatr. 2014 Jul.

Abstract

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.

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Figures

Figure 1
Figure 1. Examples of Pre-Screener Form (PSF) questions from the CHICA system used to gather study data
The whole form is shown on the left of the figure, while a detail view of each question is shown at right. Figure 1A: Example of the PSF question on milk introduction given to the family. Figure 1B: Example of the PSF question on low iron diet. Figure 1C: Example of the PSF developmental assessment. This example is for a 7 month old; developmental questions are age-specific.
Figure 2
Figure 2. Rate of milestone failure after 1 year of age for early milk drinkers
There was a significant difference found for the rate of failure of any milestone (p = 0.012) and for personal-social milestones (p = 0.002), but the remaining developmental categories were non-significant. EM = Early Milk. NS = Non-significant.
Figure 3
Figure 3. Rate of milestone failure after 1 year of age for children with a low iron diet
There was a significant difference found for the rate of failure of any milestone (p < 0.001), language milestones (p = 0.009) and for personal-social milestones (p < 0.001), but the remaining developmental categories were non-significant. LID = Low Iron Diet or Low Iron Formula. NS = Non-significant.
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