Milk for infants under one year of age

Assessment of the risks related to consumption of beverages other than breast milk or breast milk substitutes in infants.

Further to several serious cases reported in infants below one year of age who were fed partially or exclusively with plant-based beverages presented as "plant milks" (soy, rice, almond, chestnut, quinoa, etc.) or milks of animal origin (goat, donkey, mare, etc.), ANSES launched a formal internal request. Analysis of the nutritional composition of these products shows that they are not suitable for the needs of infants. The Agency reiterates that breast milk is the most suitable food for infants. In the absence of breast-feeding or as a supplement for breast-feeding, only infant formulas or follow-on formulas approved in health regulations cover the nutritional needs of infants.

Growth is considerable during the first months of life: on average, birth weight is multiplied by three, length increases by close to 50 %, and the weight of the brain increases from 300-400 g to more than 1 kg in just one year. As a result, infants are particularly dependent on sufficient food intake to cover nutritional needs and to ensure optimal development. These needs have been used to establish standards for the composition of infant formulas and follow-on formulas. 

Further to several reports of serious malnutrition in very young children who were fed partially or entirely with beverages other than breast milk or infant formula (first infant formula and follow-on formula ), ANSES launched a formal internal request to assess the risks related to these products in infant nutrition.

The products examined in this assessment are common beverages such as  plant-based drinks, sometimes presented as "plant milks", containing for example soy, rice, almond milk, etc., as well as milks of animal origin, for example goat’s, donkey’s, sheep’s and mare’s milk.

These products have recently become more popular and are consumed as a supplement or even as a replacement for conventional formula, to cover the needs of infants. Parents sometimes partially or completely replace infant formula with these products due to allergies, intolerance to conventional formula, or simply by conviction.

The ANSES assessment

The collective expert appraisal carried out by the Expert Committee (CES) on Human nutrition focused on a comparison of the nutritional data for most of these products versus regulatory limit values for infant formula. 

This analysis of composition shows overall that these formulations do not cover the nutritional needs of infants.

In infancy, insufficient intake of energy, protein, fat, minerals, or vitamins can have consequences on the increase in body weight and height, and on cerebral development. Insufficient intakes at an early age and prolonged insufficiency increase the severity of effects on the infant.

These feeding practices may result in a state of malnutrition or severe metabolic disorders that may induce infectious complications, potentially leading to infant death.

ANSES recommendations

On the basis of this analysis:

  • parents should be informed of the fact that common beverages, whether of plant or animal origin, are not suitable for infants under one year of age: they cannot replace breast milk and/or infant formula or follow-on formula, since this may result in serious health effects;
  • the Agency emphasises that breast milk is the most suitable food to cover the needs of infants. It also highlights the importance of maternal nutrition during pregnancy and breast-feeding. Special caution should be exercised in women following a vegan-type diet with no products of animal origin, who require vitamin B12 supplementation during these critical phases;
  • in the absence of breast-feeding or as a supplement to breast-feeding, it should be noted that there is a specific formula for each age: first infant formula from 0 to 4-6 months, follow-on formula from 4-6 months to 1 year; after 1 year of age, growing-up milk should be used rather than cow’s milk, which is suitable for the nutritional needs of children only from 3 years of age;
  • in the event of infant intolerance to proteins in cow’s milk, infant formulas made from plant proteins can be prescribed by physicians, but these products are always specially formulated to cover the needs of infants.