Early cow’s milk introduction is associated with failed personal–social milestones after 1 year of age
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- Bennett, W.E., Hendrix, K.S., Thompson-Fleming, R.T. et al. Eur J Pediatr (2014) 173: 887. doi:10.1007/s00431-014-2265-y
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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.