Dairy Foods for Infant Brain Development & Cognition
A thousand-day window.
This period, from conception to a child’s second birthday, is critical for setting a foundation of brain development that could impact the quality and success of their life. And much depends on how well one eats during pregnancy, and even before it begins.
However, the powerful consequences of “eating for two” often aren’t fully realized.
Carol Cheatham, PhD, from the Nutrition Research Institute at the University of North Carolina at Chapel Hill, has studied how brain development supports cognition and how nutrition affects both. She stresses good dietary practices should also happen during the preconception days.
“Before you get pregnant is the most critical time to make sure that you have good nutrition and are healthy enough to make a human being,” she said. “We know nutrition is central to brain development across the lifespan.”
Dr. Robert Murray, an expert in pediatric nutrition, who spent his career at the Ohio State University School of Medicine, said the 1,000-day emphasis sprang from two factors. First, the extraordinary rate of human growth during the fetal, neonatal, and toddler stages, making nutrition a critical factor.
Second, we have come to understand nutrition and nurturing contribute to brain development during the first 1,000 days, due to novel technological innovations that allow us to visualize brain growth. Murray said a neonate’s brain will double in size at 12 months and triple in size by 36 months.
“That is astonishing because that represents 85% of an adult’s brain volume in a 3-year-old child,” Murray said. “So, you have this little kid with this big brain with extensive connections and processing speed, ready to learn. But if a child is deprived nutritionally or lives in an environment without nurturing adult relationships it can change how the brain develops. The brain becomes wired based on stress, rather than based on exploration and learning. The child will carry the events of the first 1000 days for life. So, for pediatricians, the thousand days suddenly took on this gravitas.”
Benefits of Dairy Foods for Infancy and Childhood
Pregnancy is a critical time to practice the “101s” of nutrition and follow basic dietary guidance, including getting the recommended three daily servings of dairy, like milk, cheese, yogurt or kefir. An American Academy of Pediatrics policy statement recognizes 14 nutrients important for early brain development, and dairy foods provide seven of them. Each 8-ounce serving of milk provides 13 essential nutrients, including calcium, protein and vitamin D.
In addition to brain health and cognition, Katie Brown, EdD, RDN and senior vice president of scientific and nutrition affairs for National Dairy Council, said that “dairy benefits many other areas of children’s health, including three new parents should know about.”
Growth and development: Early childhood is a critical period for growth and development, which require the right balance of nutrients, including high-quality protein, while keeping weight gain on the right track. Research shows that what children drink – from birth through age 5 – can significantly impact their health. Experts at the American Academy of Pediatrics, the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry and the American Heart Association recommend dairy milk and water as the go-to beverages for children 1 to 5 years of age.
Immune health: Immunity remains top of mind for many people, and a healthy diet featuring dairy can help. Immune cells require a constant supply of energy and nutrients as they are defending and protecting the body. Nutrients from a variety of foods, including dairy with its protein, selenium, zinc and vitamins A, B12 and D, can help build a strong immune system.
Bone health: The more bone mass created during childhood and adolescence, the greater the chance of preventing osteoporosis and related injuries later in life. The American Academy of Pediatrics, National Institutes of Health and 2020-2025 Dietary Guidelines for Americans recommend eating dairy foods daily to achieve peak bone mass. Beyond calcium and vitamin D, dairy contains protein, phosphorus, potassium and zinc, which play important roles in building healthy bones.
Yet, despite these many benefits, the gap between daily dairy recommendations and actual consumption is evident even at a very early age. The Dietary Guidelines for Americans recommends two servings of dairy for those 2 to 3 years of age and two and a half servings for ages 4 to 8. However, Black children as young as 2 and 3 years old, are less likely to meet these recommendations. By age 4, most children are not meeting them at all, placing them at significant risk of missing out on dairy’s important nutrients and at greater risk of not reaching their full growth and developmental potential.
“I have had the perspective over my entire career that if we could just meet the daily recommended servings for dairy, we could solve a lot of nutritional problems. Unfortunately, it’s not the way we eat in America,” Murray said. “Dairy has a tremendous nutrient package. There are very few things that have that breadth of nutrition, and if we can help children consume the recommended dairy servings, I know that it will make an enormous difference.”
Brown says a focus on healthy eating competes with challenges and stresses of everyday life for busy parents and parents-to-be and we must acknowledge and support with solutions. “Time is at the top of the list – time to even think about how to serve and prepare healthy meals, time to grocery shop, and all the other priorities for their time,” Brown said. “Add to that, the financial pressures of feeding kids, paying rent or a mortgage, healthcare costs, it all adds barriers, especially when we think about low-income families or those who are food insecure.”
Additionally, nutrition and feeding questions are the top questions parents seek information about, yet more than 50% of moms report receiving mixed messages about what to feed their kids, and some of those mixed messages and confusion is about dairy.
“Despite these pressures and challenges, we believe there is a significant opportunity to confidently nourish children and empower parents to do so for the current and future generation,” she said. “We know dairy foods, like milk, cheese and yogurt, are vitally important to diets before, during and after pregnancy and easily fit into health-promoting eating patterns and check a lot of boxes—nutrient rich, delicious, culturally relevant, accessible and affordable. For example, an 8-ounce serving of milk costs about 20 cents.”
What types of dairy and when?
Infancy and early childhood is a key time to learn to like healthy foods and establish habits to nourish a lifetime of wellness. At around six months of age, as nutrient-dense complementary foods are introduced, cheese and yogurt are easy ways to familiarize babies to new tastes and textures. After baby’s first birthday, as they transition from breast milk or iron-fortified formula, whole milk and other dairy foods emerge as sources of calories, high-quality protein and other nutrients. Dairy foods are also versatile in flavor and texture and pair well with fruits, vegetables and whole grains. But how much milk, or other dairy products like cheese or yogurt, can they have, and starting at what age? Here are recommendations based on dairy type and serving for infants and toddlers:
- Babies 0-6 months: Breast milk or infant formula only.
- Babies 6-12 months: Breast milk or infant formula only with baby’s first bites. Introduce foods like whole milk yogurt (plain, unsweetened) and cheese (including cottage cheese), eggs, iron-fortified cereal, ground beef and pureed fruits and vegetables to help baby learn to like a variety of healthy foods.
- 12 months: After baby’s first birthday, it is time to add whole dairy milk to help fuel brain and growth spurts. Breastfeeding can continue after 1 year if desired. Aim for 1 2/3 to 2 cups a day of milk, cheese and/or yogurt.
- 2-5 years: Switch from whole milk to low-fat or fat-free dairy milk. Tip: Think milk at meals and water in between. Aim for 2 to 2 1/2 cups a day of milk, cheese and/or yogurt.
Iodine and prenatal support
Adding to the nutrition basics is emerging research and support for nutrients that are of significance to the first 1,000 days. The benefit of iodine, for example, is recognized by the medical and nutrition communities for its role in brain health.
Dr. Elizabeth Pearce is a renowned clinical investigator, endocrinologist and epidemiologist at the Boston University School of Medicine who leads research on iodine, nutrition and thyroid disease in pregnancy. She said severe iodine deficiency is linked to higher risks for miscarriage and perinatal and infant mortality. In parts of the world where expecting mothers have extremely low iodine intakes, babies can be born with a syndrome known as cretinism, meaning they experience profoundly impaired intellectual development and growth.
Pearce’s internationally cited publications have changed U.S. recommendations for iodine supplementation and iodine use in pregnancy, and she hopes to continue shining a light on the association between iodine nutrition and brain development in early life, as even mild iodine deficiency is seen in many women in the U.S. who limit animal foods.
“We know that if there is inadequate iodine nutrition in those first thousand days, it can lead to lower IQ, particularly verbal IQ and measures of language,” Pearce said. “There also are suggestions in the literature that maternal iodine deficiency in pregnancy may linked to attention deficit hyperactivity disorder and possibly to autism spectrum disorder in children.”
Pearce explains how iodine made its way into table salt to help solve the goiter, or thyroid enlargement, crisis she said was prevalent in the Midwest among school-aged children before the 1920s. Adding iodine to salt — with one brand boasting “American Mothers Are Bearing Better Babies Since The Introduction Of This Salt” — soon had a profound impact on reversing this trend.
But nutrition advice over time began pushing people away from salt use, and Pearce has seen a rise in iodine deficiency in U.S. pregnant women in the last decade. This deficiency can be addressed through diet, and Pearce said dairy foods, such as milk, cheese and yogurt, as well as iodized salt, eggs, fish and seafood, are important sources of iodine.
“There is a huge knowledge deficit,” Pearce said. “I don’t think pregnant women and the general public really understand what iodine does as a nutrient. In 2022 iodine deficiency remains the leading preventable cause of intellectual disability around the globe.”
Choline and cognition
Another essential nutrient known for its cognition benefits is choline. Though the liver produces small amounts of choline, the rest must be obtained through the diet and milk contributes about 8% of the daily value for choline per 8-ounce serving.
Taylor Wallace, PhD, a professor in the department of nutrition and food studies at George Mason University, has studied choline and said a published review of 16 human and 38 rodent studies found most offspring would benefit from increased choline supply during the first 1,000 days of life, particularly in relation to helping facilitate normal brain development.
“Choline levels in younger children tend to be higher because in my mind the National School Lunch Program and the dairy it provides is a source of choline for children, but this drops off among teenagers as they start to choose sweetened beverages and other options,” Wallace said.
Helping expectant mothers
But messages such as this aren’t always reaching new moms, who sometimes have other concerns on their mind, said Dr. Yolanda Lawson, a Dallas-based OBGYN and president-elect of the National Medical Association, the largest and oldest national organization representing African American physicians and their patients in the U.S.
She notes that the majority of her new patients come to her already pregnant, missing the opportunity for a preconception discussion about pregnancy expectations and setting sound nutrition guidance. Many of them instead express a very different, prevailing concern.
“It isn’t about the baby’s brain development and eating to make their baby smart,” she said. “It’s, ‘How will I get the weight off?’ after they give birth.”
This context, though, offers Lawson the opportunity to talk about nutrition, a topic she feels most people can be confused by given the many conflicting messages they hear.
“There is a huge gap in education, so a lot of it is getting back to the nutrition basics and reinforcing factual information,” Lawson said. “I tell them all the time, ‘These are things you learned in school.’ I try to navigate fact from fiction, but the messaging they hear is just coming from so many places.”
Dr. Elizabeth Zmuda, a pediatrician at Ohio Health Doctors Hospital in Columbus, Ohio, visits with many new parents and works to make sense of the confusing advice on how to effectively feed their newborn. She sees herself as their “coach” and works to relate to them as a fellow mother.
“I have a medical background, but I’m a mom and I have experienced the same challenges and barriers when I am trying to feed my kids,” Zmuda said. “There is a lot of anxiety, and I need to cut through the anxiety with actionable steps. I think it’s important to give them an approach rather than a prescription. I try to meet them where they are first and remind them this can be really simple.”
Zmuda works hard to put new and expecting mothers at ease amid the many challenges and cluttered messages they hear. Her goal is to offer counsel without a serving of guilt.
“Really, what moms want to know is they are doing a good job and there is going to be a good outcome,” Zmuda said. “It’s blending that together to make them understand the process is the most important thing and the outcome will come. I think you can do that by meeting them where they are.”
Murray agrees and references a British pediatrician’s concept of the “good enough mom.”
“You don’t have to be perfect,” Murray said. “Do the best you can. I consider it my job to help moms do just that. It’s not about guilt.”
Murray stresses there are “thousands and thousands of ways to approach building a good diet” and people will factor in their own experiences, food preferences, culture and economic situation into forming a diet that works for them.
“So, establishing a strong dietary pattern is a long marathon, not an abrupt sprint. You make incremental changes over time,” he said. “I think it’s important for nutritionists to remember that you’re not selling one product to all people. You’re trying to give each person a process to improve their diet.” There are resources from the American Academy of Pediatrics and the Dietary Guidelines of Americans and MyPlate to help parents and caregivers navigate the basics of healthy eating patterns for their kids.
Lawson says she also encourages her patients to just do the best they can, adding, “It’s about little wins and I take each one I can get.”
No matter the person or their age, she says dairy will find its way into her counsel.
“My youngest patient is 3 and my oldest is 99,” Lawson said. “Dairy for me is important whether I am talking with children in their adolescence, women when they are at child-bearing age or menopausal women.
“Dairy will always be a huge part of what we talk about.”
National Dairy Council, funded by America’s dairy farmers and importers, is committed to increasing access to nutrient-rich milk and dairy foods for those facing food and nutrition insecurity, and supporting nutrition research, education and partner engagement during the critical prenatal and childhood years and across the lifespan.