“My kid is 12+ months and I keep getting mixed information about how much milk (cow's milk, if you choose that, which is another question) he should have. The AAP says 16-24 oz, my doctor says not to go above 16-20, and my sleep consultant and online info say not to worry too much because they get calcium from other dairy products. But realistically my kid eats very little dairy, roughly 2-3 oz during the day (milk and solids combined). I'm still giving him a 4 oz bottle of cow's milk at night, so about 6 oz total. I'd like to move him to a sippy cup only, but I'm worried he isn't getting enough calcium. Please help!!!!”
All that mixed advice is enough to make anyone's head spin, but the numbers are closer than they sound. Even one trusted source gives two ranges. One KidsHealth page says to limit milk to about 16 ounces a day for toddlers 12 to 24 months, and another puts the limit at 16 to 24 ounces. Most of these numbers are ceilings, meant to keep kids from drinking too much. Toddlers who drink a lot of cow's milk can end up less hungry for iron-rich foods, which raises their risk of iron deficiency.
There's actually no minimum amount of milk a toddler has to drink. As I explain in my blog post on transitioning to cow's milk, food matters most; yogurt and cheese can fill in through meals and snacks, and the main goal is to stay under 24 ounces so he doesn't fill up on milk. Your sleep consultant is right that calcium can come from other foods. That only helps if he's eating those foods, though, and right now he isn't eating much of them. So your instinct to pay attention is a good one.
Kids ages 1 to 3 need about 700 mg of calcium a day, and one serving of dairy has roughly 300 mg. At about 6 ounces of dairy a day, he's likely getting around a third of what he needs. That isn't an emergency, but it is a gap worth closing slowly as you work on the cup.
Take the milk to the table and provide a few ounces in a cup when serving meals. He will probably drink less at first because drinking from a bottle is easier, and it's common for children to drink less milk after they start using a cup; however, this reduced intake usually evened out as he got used to it. When you're looking for a cup, choose one with a straw or an open cup rather than a sippy cup, as both bottles and sippy cups allow liquid to pool around the teeth and involve a more immature tongue technique. The post I wrote on which cups to use looks at the different options, and the one about straw cups includes some tips for teaching him how to use one.
Count all types of dairy, not just milk. Yogurt and cheese can quickly add up in quantity. Since one and a half ounces of natural cheese is equivalent to a cup of milk, a cheese stick at a snack time has a big impact.
Don't just consider dairy; there are some foods which contain more calcium than parents anticipate. Calcium-fortified cereal, calcium-set tofu, and fortified orange juice are all suitable choices, and salmon as well as dark leafy greens also contain some. When you do decide to switch to a plant-based milk, soy and pea milk are the ones that most closely resemble cow's milk in terms of protein, and you should check the labels for any added sugar.
Move the bedtime milk earlier by giving him milk in a cup along with a bedtime snack and then brushing his teeth. Since milk in bottles at bedtime is known to cause early tooth decay, this arrangement benefits both his teeth and his ability to use a cup. If he is attached to the bottle, you can gradually dilute it a bit each night over a period of a week or two before stopping it altogether.
If his dairy intake stays low even after these changes, ask his pediatrician to look at his whole diet with you. They can tell you whether a supplement makes sense for him. Please don't start one on your own, since dosing matters at this age.
If you'd like to know more about the milk switch, such as how to read milk labels and compare the various plant-based alternatives, you can watch this YouTube video from PedsDocTalk. And in the case where low dairy intake is part of a more widespread picky eating behavior, the Picky Eating Playbook looks at the concepts of exposure and pressure and tells you what to serve when your child has very strong opinions about what's on the plate.
“My 18 month old is very affectionate and loves giving hugs. She also loves petting our dog, who is 70 lbs and doesn't seem bothered when it's more of a hit than a pet. But I'm worried she is starting to think hitting is the same thing as a hug, because she'll mix a hard hit in with a gentle back tap when giving hugs. How can we teach her the difference between appropriate affection and hitting?”
She is still working out the balance between hard and too hard at 18 months. At this age toddlers have very little ability to control the amount of force they use, and their excitement makes it even more difficult. A sweet hug ending in a smack is generally because her excitement had got ahead of her hands. She is most likely not confused about what a hug is.
She gains an understanding of a gentle touch mainly through her body rather than from what you say. With children of this age, you can hold the hand that she used to hit and demonstrate for her what a gentle touch is like. That is essentially all that needs to be done at the moment even if it's carried out about a thousand times.
Lead her hand. Whenever she hugs you, hold her hand and gently rub your arms together. "Soft. Soft hands." Always use those short words each time, so that 'soft' ends up meaning something in her body.
Do this when no one is excited. Together, give a stuffed animal a pat, then run your hand over your own arm and then hers. Make it a game by saying, "Can you touch the bear gently? Now my cheek?" She learns more effectively when she is calm than when she is in the middle of a hug and excited.
Keep your reaction small when a hard one sneaks in. A big dramatic "OUCH!" can turn into the best show in town. Catch her hand and say, "That was hard. Show me soft," then let her try again. When she does it gently, say so: "That was so soft. I liked that."
Give the big feelings somewhere to go. Some of those hard taps are pure joy with nowhere to land. Clapping, a high five, or a big squeeze of a stuffed animal gives her excitement an outlet that doesn't land on someone's back.
Your dog sounds like a 70-pound saint, and that's lucky. It's also a reason to stay close. Most dog bites to young children happen during everyday moments with familiar dogs, like the family pet. A dog that puts up with something for weeks can still reach his limit. Because kids under 5 can't reliably tell when a dog is about to bite, that part is your job for now.
I talked about this with certified dog trainer Michelle from Pooch Parenting on the PedsDocTalk Podcast, and her approach fits this age really well:
Place her hand over yours. When you're petting the dog, you put your hand on it and she places her hand on top of yours. Give it one or two strokes and that's all. If she grabs, then she grabs you rather than the dog. Try to pat him on the back and sides since most dogs don't like having their heads patted.
Demonstrate to her the kind of thing you'd like her to copy. Since she's observing the way you look after the dog, reserve the strong squeezes and the nose kisses for when you're not having her around; otherwise, she'll next try a big hug.
Let him come to her; when he is sleeping or eating leave him alone and instead invite him over rather than having her go to him. In that way, he will be able to make his choice.
Learn to recognize the warning signs. If he is stressed it may be shown by him licking his lips or looking away. More serious warning signs include his body becoming stiff, his mouth closing, the whites of his eyes becoming visible, or a change in his tail. When you notice these signs, stop the petting. If you notice them frequently, then baby gates and barriers can be used to give him more room.
If you'd like to know more about why toddlers resort to physical behavior, I spoke to child development specialist Dr. Siggie Cohen on the PedsDocTalk Podcast episode which discusses when to intervene if a child is hitting and also how to provide an alternative way of expressing the same urge. And if hitting begins to occur when she is frustrated rather than excited, the PedsDocTalk YouTube video looks at why children behave physically when they are overwhelmed and how one should respond.
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Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!
