Parents have long been advised to wean their babies to whole milk at age 12 months, until the child is 2 years old. That advice has now changed for children who are overweight or at risk of being overweight, or whose families have a history of obesity, heart disease, or high cholesterol.

The American Academy of Pediatrics (AAP) now advises that those at-risk children should get reduced-fat 2% milk from their first birthday until their second birthday. After that, the AAP recommends, all children should be switched to fat free milk.

What prompted the changes? In the July, 2008 issue of Pediatrics, a clinical report replacing an AAP 1998 policy statement on cholesterol in childhood acknowledges a increased urgency in light of the "current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults." AAP’s Committee on Nutrition, which issued the report, found that "there is no harm associated with prudent diet changes, even when they are instituted in children soon after weaning. This includes use of reduced-fat milk in children after 12 months of age."

What does this mean for nutrition educators? While health-care professionals may advise that their individual patients with high risk move to reduced fat milk at age 12 months, the policy’s recommendations are not for all children at this time. WIC (the Special Supplemental Nutrition Program for Women, Infants and Children) is implementing new food regulations by October 1, 2009. By those new regulations, children age 1 to age 2 may receive only whole milk. For children age 2 and above, and all women participants, only reduced fat (2%, 1% or fat free) milk will be allowed.

"WIC will not be able to provide the lower fat milks to the very youngest children by regulation," said Patricia Dunavan, Nutrition Services Coordinator for the Kansas WIC Program. "It would take a change in the Federal regulations before we could follow the AAP guidelines."

So for now, it is important to know that the recommendations have changed when the child is at risk of overweight, or member of a family with a history of obesity or high cholesterol. Additionally, data from research trials "in children as young as 7 months of age have demonstrated that these dietary recommendations are safe and do not interfere with normal growth, development, and sexual maturation," the AAP Committee on Nutrition said.

For the complete online version of the reference article "Lipid screening and cardiovascular health in childhood" by SR Daniels, FR Greer and the Committee on Nutrition, see http://www.pediatrics.org/cgi/content/full/122/1/198. Accessed 7/17/08.