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When you have a preemie, age becomes relative. When gauging the proper age for nearly every milestone your baby achieves, you have to ask yourself: should I look at his corrected age, which takes his prematurity into account, or his chronological (actual) age? This includes when to wean your preemie from infant formula or breast milk to cow's milk. Your baby's corrected age is more important than his chronological age in this and many other cases.
You can try your child on whole milk when he reaches a corrected age of 12 months. When that happens depends on how premature he was. If he was born one month early, wait until he's at least 13 months old. If he was born three months early, his gut might not be able to handle whole milk even if you wait until he's 15 months to try it. Preemies are prone to intestinal difficulties, such as gastrointestinal reflux, that might make it prudent to wait a little longer before starting whole milk. Up to 80 percent of preemies suffer from reflux, which causes pain and frequent spitting up or vomiting. Your doctor might recommend waiting to start cow's milk if your baby still has trouble with reflux.
The American Academy of Pediatrics recommends waiting until a child reaches the age of 12 months before starting whole milk. Before this age, a baby can't ingest and break down cow's milk well. Infant formulas contain nutrients closer to those found in breast milk, although breast milk remains the best feeding option for any child, premature of not, under 12 months. Use whole milk for your baby unless your pediatrician recommends against it; your baby needs the additional calories and fats in whole milk compared with skim milk.
Weaning from Preemie Formulas
Your doctor may recommend waiting until your baby is 12 months chronological, or actual, age before switching from preemie formula to regular formula. Preemie formulas provide more calcium, protein, calories and other vitamins and minerals than regular formula. Regular formula, breast milk and cow's milk all supply 20 calories per ounce, while preemie formulas provide 22 to 24 calories per ounce. If your baby is gaining weight adequately, you might be able to switch to regular formula around 6 months corrected age, but talk to your pediatrician first.
Cow's milk contains more sodium, protein and potassium than formula and not enough fatty acids, vitamin E and iron compared with breast milk and formula. The proteins in cow's milk can cause microscopic bleeding in your baby's stomach if he's not physically ready to adjust to it. Bleeding can lead to iron deficiency; the low iron level in cow's milk can exacerbate iron-deficiency anemia. More immediate symptoms, such as vomiting, diarrhea, rash, hives or breathing problems after drinking cow's milk, could indicate a milk allergy.
Weaning From Breast or Bottle
When you wean your breast-fed premature baby altogether is completely up to you. The American Academy of Pediatrics, or AAP, advises breastfeeding for the first year of life, but there is no reason you can't continue to nurse after that point. The World Health Organization recommends breastfeeding until age 2. On the other hand, the AAP recommends weaning from the bottle altogether by 18 months to prevent tooth decay from prolonged contact with milk in the mouth. Your baby's corrected age is an appropriate gauge in this case. If you can't wean him off the bottle altogether, never give him a bottle in bed, unless it contains plain water. Use a sippy cup only until he's ready to drink from an open cup, usually around age 2.
Suzanne Robin is a registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology. She also has extensive experience working in home health with developmentally delayed or medically fragile children. Robin received her RN degree from Western Oklahoma State College. She has coauthored and edited numerous books for the Wiley "Dummies" series.