# Infant versus noninfant formulas and cow's milk: Transition based on age or weight?

## TL;DR

Transitioning children from infant to non-infant formulas or cow's milk at 1 year of age can cause health issues if they are underweight, suggesting weight should also be considered.

## Contribution

Highlights risks of transitioning underweight infants solely based on age and recommends using both age and weight criteria.

## Key findings

- Transitioning underweight infants to non-infant formulas or cow's milk can lead to excessive nutrient intake and electrolyte imbalances.
- Excess nutrients may overwhelm immature gastrointestinal or renal systems in underweight children.
- Clinicians should consider both age and weight when transitioning infants off infant formulas.

## Abstract

Infant formulas are meant to be used until 1 year of age, at which point children are transitioned to non‐infant formulas or cow's milk, depending on their remaining dietary intake. Noninfant formulas and cow's milk are appropriate for children who have an average weight at that 1‐year mark (9–9.5 kg); however, can contribute significant protein and/or electrolytes to children who are underweight for age, particularly if they still rely heavily on formula feeding for their caloric intake. In this short communication, we present several cases of patients who received excessive amounts of nutrients for age following the formula transition at the 1‐year mark. We also provide recommendations for clinicians to consider when faced with underweight infants who are meant to be transitioning off infant formulas.

Infant formulas are meant to be used within the first 12 months of life.At the 12‐month mark, it is recommended to transition off infant formulas, to either a noninfant formula or cow's milk.

Infant formulas are meant to be used within the first 12 months of life.

At the 12‐month mark, it is recommended to transition off infant formulas, to either a noninfant formula or cow's milk.

Transition off infant formulas based on age alone can lead to significant electrolyte and acid‐based derangements in children who are significantly underweight for age.This may be due to excess nutrient delivery in the context of an immature gastrointestinal and/or renal physiology.Clinicians should consider transitioning children off infant formulas when both age (≥12 months) and weight (≥9–9.5 kg) criteria are met, particularly in patients with underlying medical conditions.

Transition off infant formulas based on age alone can lead to significant electrolyte and acid‐based derangements in children who are significantly underweight for age.

This may be due to excess nutrient delivery in the context of an immature gastrointestinal and/or renal physiology.

Clinicians should consider transitioning children off infant formulas when both age (≥12 months) and weight (≥9–9.5 kg) criteria are met, particularly in patients with underlying medical conditions.