How to Start Making Yogurt

Yogurt can be introduced as a complementary food from around 5-6 months of age. Unlike cow's milk, during the fermentation process, lactic acid bacteria break down lactose and partially break down proteins, making it easier to digest and reducing its allergenicity.

🔸Yogurt containing live lactic acid bacteria has been shown to alleviate symptoms of lactose intolerance; because it releases the enzyme that breaks down lactose (β-galactosidase) in the intestines, it is less likely to cause abdominal symptoms than cow’s milk.Studies involving children have also reported that abdominal symptoms are significantly less common with yogurt consumption than with cow’s milk.

🔸 Additionally, some studies have shown that about half of children with milk allergies could tolerate yogurt, suggesting that protein denaturation through fermentation reduces allergenicity. However, unpasteurized yogurt is not suitable for infants, and pasteurized products must always be used.

🔸Start with about 1 teaspoon and gradually increase the amount while monitoring your baby's reaction. The basic option is the plain variety without added sugar.

How to start with cheese

🔸Cheese can be introduced as a solid food starting around 5 to 6 months of age, but you need to proceed more cautiously than with yogurt. Because moisture is removed during the manufacturing process and milk proteins (especially casein) are concentrated, cheese contains a higher amount of allergens per unit volume than yogurt.

🔸Protein concentrations can be approximately 3 to 5 times higher than those in yogurt, making infants with high sensitivity to milk proteins more likely to experience a reaction. On the other hand, it has been reported that in long-aged cheeses (e.g., Parmigiano-Reggiano aged for 36 months), proteins are broken down during the aging process, reducing their allergenicity.

🔸When introducing these foods, start with small amounts of processed cheese or pre-cooked cheese, and be careful not to give too much, as they are high in salt. If your child has a history of allergies, it is best to proceed in consultation with a doctor.

🍶The Role of Follow-Up Milk

🔸Follow-up formula is not essential for healthy infants. The AAP (American Academy of Pediatrics) and ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology, and Nutrition) clearly state that follow-up formula “has no specific role and offers no nutritional advantage over a balanced diet.”

🔸However, their use as a supplement is acceptable in cases where there is a risk of deficiency in iron, vitamin D, or n-3 fatty acids. They can be particularly helpful as a dietary supplement during periods of highly selective eating or when there is concern about iron deficiency.

Even when used, it is recommended to limit intake to within 500mL per day, as excessive consumption, similar to milk, inhibits iron absorption. It is important to remember that follow-up milk is purely supplementary, and the main focus should be on complementary foods.

🤱 The Differences Between Breast Milk, Formula, and Cow's Milk

🔸Although breast milk, infant formula, and cow’s milk look similar, their nutritional composition and physiological effects differ significantly.Particularly during infancy, while breast milk and infant formula have compositions suitable for an infant’s development, cow’s milk places a heavy burden on an infant’s kidneys and intestines and is therefore not recommended for children under 1 year of age.

🔸The main nutritional differences are summarized below.

Nutritional Comparison Chart

Ingredients: Breast milk, Formula, Cow's milk; Lactoferrin: High concentration (approx. 1.4 mg/mL), Low concentration (may be added), Trace amounts

Ingredients	Breast milk	Formula	Milk
Lactoferrin	High concentration, approximately 1.4 mg/mL	May be added in low concentrations	Trace amounts
Iron Content and Absorption Rate	Although the concentration is low, the absorption rate is approximately 50%.	The absorption rate of iron-fortified products is approximately 4 to 101 TP3T.	The iron content is low, and the absorption rate is approximately 10%.
Calcium Content	Approximately 78-260 mg/L	Approximately 530-560 mg/L	Approximately 1,160 mg/L
Calcium absorption rate	Approx. 761 TP3T	Approx. 56–591 TP3T	Limited data
Total Protein	Approximately 9–10 g/L	Approximately 13 g/L	Approximately 30–35 g/L
Whey-to-Casein Ratio	60:40–70:30	60:40	20:80
β-lactoglobulin	Does not include	Includes	Includes

Breast milk is rich in immune components (lactoferrin, IgA), has high bioavailability, and is optimized for infant development. Formula is adjusted to closely resemble breast milk and is fortified with iron and calcium. Cow's milk is high in protein and minerals, which places a burden on an infant's kidneys, and therefore should not be given to infants under one year of age.

🍼 Baby Bottle Weaving & Cup Practice

The AAP recommends introducing a cup around 6 months of age and weaning off the bottle by 12 to 15 months. Multiple studies have shown that bottles can easily lead to overfeeding and increase the risk of iron deficiency anemia.

In particular, the use of a baby bottle at bedtime is strongly associated with severe iron deficiency anemia, with a reported odds ratio of 6.5. This is because drinking from a bottle leads to the unconscious consumption of large amounts of cow's milk and a reduction in solid food intake.

As steps for weaning, it is recommended to first discontinue daytime bottle use, and then stop bottle use before bedtime. Since sippy cups can lead to overdrinking, the use of open cups is preferred.

As a developmental milestone, it is said that at 6 months infants can drink from an open cup if held by a caregiver, at 12 months they can use an open cup, and at 18 months they can drink by themselves, even if they spill.

💡Getting used to new flavors

Getting used to new foods takes time, and it is said that 8 to 15 repeated exposures are necessary. It is natural for babies to be wary of new tastes, and they learn to accept them through repeated experiences.

Key points to encourage eating include showing family members happily eating (the modeling effect), serving new foods alongside familiar ones, and avoiding forcing. Coercion increases mealtime stress and has the opposite effect.

Even if you are concerned about picky eating, it is common during early childhood and is not necessarily a long-term problem. However, because children are prone to iron and zinc deficiencies, it is important to continue offering small amounts of meat, beans, and vegetables. In addition, caution is needed as drinking too much liquid such as milk or juice can cause a decrease in appetite.

Literature

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Consumption of Cow's Milk as a Cause of Iron Deficiency in Infants and Toddlers. Nutrition Reviews. 2011.

Is Cow's Milk Harmful to a Child's Health?. Journal of Pediatric Gastroenterology and Nutrition. 2011.

Complementary Feeding: A Position Paper by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition. 2017.

Older Infant-Young Child "Formulas". Pediatrics. 2023.

Young Child Formula: A Position Paper by the ESPGHAN Committee on Nutrition. JPGN. 2018.

Lactose Digestion From Yogurt: Mechanism and Relevance. AJCN. 2014.

Yogurt—an Autodigesting Source of Lactose. NEJM. 1984.

Most Children Who Are Allergic to Cow's Milk Tolerate Yogurt. JIMR. 2018.

Tolerability of a Fully Maturated Cheese in Cow's Milk Allergic Children. PLoS One. 2012.

BSACI Guideline for the Diagnosis and Management of Cow's Milk Allergy. Clinical and Experimental Allergy. 2013.

Iron Requirements of Infants and Toddlers. JPGN. 2014.

The Relationship Between Cow's Milk and Stores of Vitamin D and Iron in Early Childhood. Pediatrics. 2013.

Office-Based Intervention to Reduce Bottle Use Among Toddlers. Pediatrics. 2010.

Repeated Exposure to Food and Food Acceptability in Infants and Toddlers. AJCN. 2019.

Caregiver Influences on Eating Behaviors in Young Children. JAHA. 2020.