Cow's Milk, Honey and the Food Rules That Change at 12 Months

When can a baby have cow's milk and honey?

At 12 months, for both. The NHS says not to give honey until a child is over 1 year old, and that cow's milk can be introduced as a main drink from 12 months. Several other feeding rules change on the same birthday, and a few carry on for years.

At 12 months	What the guidance says
Honey	Allowed over 1 year (NHS), though still counted as sugar to avoid up to age 4
Cow's milk as a drink	Whole or semi-skimmed from 1 year (NHS); whole milk from 12 to 24 months (AAP)
How much milk	About 16 oz (2 cups) a day from 12 to 24 months (AAP); no more than 750 ml (25 oz) (CPS)
Water	8 to 32 oz (1 to 4 cups) a day from 12 to 24 months (AAP)
Formula and toddler milks	Not needed after 12 months (NHS); toddler milks are unnecessary (AAP)
Plant-based drinks	Unsweetened, calcium-fortified soya, oat or almond from 1 (NHS); the AAP accepts only soy in place of milk
Rice drinks	Not under 5, because of arsenic (NHS)
Whole nuts	Still not under 5 (NHS)
Vitamin D	10 micrograms a day for every child aged 1 to 4 (NHS)

Why does honey have to wait until 12 months?

Because of infant botulism. The NHS says honey occasionally contains bacteria that can produce toxins in a baby's intestines, leading to infant botulism, a very serious illness, and not to give honey until a child is over 1 year old. The rule is set by age, so it ends there.

Honey is still sugar, though. The NHS advises avoiding food and drink with sugar or sweeteners for children aged 4 or younger, and names the natural sugar in honey, syrup, fruit juice and smoothies among them; fruit itself is fine. Avoiding them helps prevent tooth decay. So after the first birthday honey becomes safe, not an everyday food.

When can a baby drink cow's milk instead of formula?

At 12 months. The NHS says cow's milk can be used in cooking or mixed with food from around 6 months, but should not be the main drink until 12 months, because it does not contain the right balance of nutrients to meet a baby's needs. Once your child is 1, the NHS says formula milks are not needed, and that includes first infant formula, follow-on formula, growing-up milks and toddler milks. The AAP agrees on the last of those: it calls toddler milks, marketed by formula companies as "next stage" or "transitional", unnecessary.

Canadian guidance allows an earlier start. The CPS says whole (3.25%) cow's milk can be introduced between 9 and 12 months if breast milk is no longer available.

Do you have to switch from formula to cow's milk all at once?

No. The NHS and the AAP set an age for the switch, not a speed, so you can offer cow's milk alongside what your baby already drinks and let the balance shift over days or weeks. Offer it in a cup: the NHS says that once your baby is 1, feeding from a bottle should be discouraged.

Breastfeeding does not have to stop at 1. WHO and UNICEF recommend continuing breastfeeding up to 2 years of age or beyond, alongside solid foods, and the NHS says breastfeeding will continue to benefit you and your baby for as long as you carry on.

How much milk should a 1-year-old drink?

About 2 cups (16 oz, roughly 470 ml) a day, in the AAP's figure for 12 to 24 months. The CPS sets a ceiling: after 12 months, no more than 25 ounces (750 ml) a day, because a child who drinks more fills up and does not want solid food, and too much milk can also lead to iron deficiency anemia. For water, the AAP's figure at the same age is 8 to 32 oz (1 to 4 cups) a day.

Which milk should a 1-year-old drink?

Whole milk, in the AAP's advice for 12 to 24 months, with a move to nonfat (skim) or low-fat (1%) milk from age 2. The NHS allows pasteurised whole or semi-skimmed milk as a main drink from 1, and says skimmed and 1% milk should not be the main drink for children under 5, because they do not contain enough calories. Lower-fat milks can be used in cooking from 1.

Plain is the point. The AAP says flavored milks contain added sugars, that added sugars should be avoided under 2, and that children aged 2 to 5 should also avoid flavored milk. The NHS adds that young children should not have unpasteurised milk, because of the higher risk of food poisoning. Goats' and sheep's milk can be a main drink from 1, as long as they are pasteurised.

What if your child can't drink cow's milk?

The NHS says unsweetened, calcium-fortified milk alternatives, such as soya, oat or almond drinks, can be given from age 1 as part of a healthy, balanced diet. The AAP is narrower: other than soy milk, it does not recommend plant-based milks in place of dairy milk, and it calls soy milk nutritionally equivalent to cow's milk and an acceptable alternative.

Two limits either way. The NHS says children under 5 should not have rice drinks as a substitute for breast milk, formula or cow's milk, as they may contain too much arsenic. And goats' milk formula is not suitable for babies with cow's milk protein allergy, the NHS says, because its proteins are very similar to those in cow's milk formula. If your child has an allergy or intolerance to milk, the NHS advice is to talk to your health visitor or GP about suitable alternatives.

Which food rules still apply after the first birthday?

Whole nuts until 5, the highest-risk choking foods until at least 4, added sugar until 2 or 4 depending on whose guidance you follow, and no added salt.

• Whole nuts. The NHS says not to give whole nuts to children under 5, because they can choke on them. Crushed or ground nuts have been fine since weaning began, and so has nut butter spread on a food such as toast. The AAP adds that nut butter should be spread thinly, never served in thick chunks.
• Choking foods. The AAP says to keep high-risk foods from children until 4 years of age or older, depending on each child's development: hot dogs, hard, gooey or sticky candy, chewing gum, nuts and seeds, whole grapes, raw vegetables such as carrot sticks, raw fruit chunks such as apple pieces, popcorn, marshmallows, meat sticks or sausages, and chunks of meat or cheese. Round, firm foods such as hot dogs or grapes can be served if completely chopped into tiny pieces, and the AAP asks that food for young children be cut into pieces no larger than half an inch. Children should eat sitting down.
• Salt. The NHS's advice for babies and young children is not to add salt to food or cooking water, not to use stock cubes or gravy, and to avoid salty foods such as bacon, sausages, crisps, ready meals and takeaways.
• Sugar. The AAP says to avoid added sugars under 2; the NHS says to avoid food and drink with sugar or sweeteners up to age 4.

Now that most of the family's food is on the table, checking a food list by age shows what has become suitable at 12 months and how each food is usually served.

Do vitamin drops change at 12 months?

In the UK, yes. The NHS says a breastfed baby should have a daily supplement of 8.5 to 10 micrograms of vitamin D from birth, while a formula-fed baby having more than 500 ml of formula a day should not, because formula is already fortified. From 1 to 4 years, the NHS recommends a daily supplement of 10 micrograms of vitamin D for every child, and the UK government recommends supplements containing vitamins A, C and D for all children aged 6 months to 5 years. So as formula winds down, the formula exemption ends with it. Other countries set different amounts, so follow the advice where you live.

When should you talk to a doctor before switching milk?

• Your child has, or you suspect, a cow's milk allergy or intolerance. The NHS says to talk to your health visitor or GP about suitable alternatives.
• They are on a specialist or prescribed formula. The NHS says soya formula in particular should only be given if a health professional advises it.
• You plan to make a plant-based drink their main drink rather than an occasional one.
• You are not sure whether vitamin drops are still needed now that formula is winding down.
• Milk seems to be crowding out meals, or your child refuses milk entirely. The CPS links more than 750 ml a day with eating less solid food and with iron deficiency anemia.

For the months before, see what a 9-month-old can eat and three meals a day.