Do not confuse lactose intolerance with cow’s milk allergy

I have written about this topic before, but constantly get reminded through social media posts, how much misconception about still exists and how people who are not specialist in this field allow themselves an opinion that can be so dangerous. I saw a Instagram post by a vegan advocate, talking about lactose intolerance being a primary motivation to why breastfeeding should be motivated and cow’s milk formula not be used but rather a plant-based alternative. In addition, this post makes the statement that many babies are born with a lactose intolerance. Whilst we should motivate ongoing breastfeeding for many many reasons, this is not one of them and again highlights the confusion of distinguishing between lactose intolerance and cow’s milk allergy.

Congenital lactase deficiency (i.e. being born with a lactose intolerance) is an extremely rare genetic condition and in my career as paediatric dietitian working in allergy/intolerances for 23 years, I have only ever seen 1 baby with this. The primary source of energy in breastmilk is lactose (also in standard formula), so if a baby has a congenital lactase deficiency they can not tolerate breastmilk or standard formula due to the lactose content. Conversely primary lactose intolerance is common, but only develops in children from around 3 years of age and affects certain populations more (i.e. Africans, Asians). So the latter develops usually when a baby is off breastmilk or formula. Typically children with primary lactose intolerance can tolerate cheese and some may also tolerate yoghurt, but can not tolerate milk as a drink. Secondary lactose intolerance is more common in babies as a result of chronic diarrhoea (this can occur as a result of a bug or a chronic disease affecting the gastrointestinal tract) where the mucosa is damaged, which leads to an intolerance to lactose that is totally reversible on treatment.

A lactose intolerance is non-immune mediated, whereas a cow’s milk allergy is an immune mediated disorder and is related to an allergic reaction to the protein (not lactose, which is a carbohydrate) in cow’s milk. Cow’s milk protein consumed by the mother can transfer through breastmilk and can ins some cases lead to a reaction through breast milk. This has nothing to do with the lactose content of breastmilk (which can not be changed in mothers milk, even with a vegan diet). For these babies, under the supervision of a dietitian and an allergist/gastroenterologist a maternal elimination diet should be considered and if breastmilk is not available a hypoallergenic formula should be provided. There was a suggestion that there are plenty of suitable plant alternatives available for babies, but that is not necessarily the case and proper advice should be sought as this may differ between countries. For example, no over the counter plant milk (note not formula) is currently suitable (in any country) as a primary drink for any baby < 1 year of age and care should be taken if used > 1 year of age as they are low in protein and lacking many of the essential micronutrients. Soya formula is available, but in the UK about 50% of babies with a delayed cow’s milk allergy will also be allergic to soya. Rice formulas are available in some European countries (but not in the UK), so this is not always an alternative.

Whilst it is really important to think about sustainable choices when feeding the future generation and moving towards an increase in plant-based sources, it is so important that parents get the right advice around infant formulas (allergic or non-allergic) if breast milk is not available. Not all advice provided is correct and can have a negative nutritional impact.

Is a sustainable diet suitable for young children?

The discussion about healthy eating, whilst considering the environment is a topic that comes up much more frequent in my consultations. This can be a real challenge when you want to achieve iron requirements, but not eat too much meat, when you want to achieve essential fatty acid intake, but do not want to contribute towards over-fishing and when you are aware that too much fibre (which is common in a plant-based diet) can impact on the availability of many vitamins and minerals.


Already in 2017, the British Dietetic Association launched a toolkit for dietitians to help them advise a more sustainable diet and recently, the LANCET, one of the most well-known medical journals, gathered healthcare professionals working in public health to work on a diet that is both healthy (i.e. meeting all requirements) and is good for the environment. According to this publication “Global consumption of fruits, vegetables, nuts and legumes will have to double, and consumption of foods such as red meat and sugar will have to be reduced by more than 50%”. A diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits.”  ) I have copied below the suggested diet, based on the research by the LANCET, but the problem with these nutritional aims is that to date, they have not been adjusted for children and in particular for babies and toddlers.

Whilst, I can certainly not replace a whole research team, which really is required to answer this question on exact amount, I will try with this blog to provide some general guidance for parents who want to raise their children taking food sustainability into account but not harming their health.

  1. Breast milk and/or formula play an essential part of the diet until your baby is 1 year of age and should not be limited due to environmental concerns.
  2. After 1 year of age full cream milk or plant-based alternative can be considered. According to the planetary diet, cow’s milk/cow’s milk products need to be limited to 250 ml per day, which would not achieve calcium requirements for young children. Whilst calcium enriched plant-based milks provide a similar calcium content, they are generally low in energy, protein (outside of soya-based milk alternatives) and iodine (essential for brain development). Of course, you have other plant-based sources of calcium like broccoli, tahini ect, but the availability for absorption of the body is often quite low due to the fibre content. So it is really difficult to establish exactly how much a baby is in fact absorbing when this nutrient is combined with a lot of fibre. I therefore usually suggest from 1 year of age to aim for 250 ml milk + 1 portion of 30 cheese/100 ml yoghurt to achieve requirements. If you use a plant-based milk, then you need to aim for 300 ml/day or 250 ml + calcium enriched yoghurt (the plant based cheeses are usually enriched with calcium). As a lot of plant-based milks are low in energy and protein (outside of soya) its important to consider how these are replace. In addition, iodine is usually low in plant-based milks and is essential for brain development. It is worth looking at alternatives, including seaweed and in some countries bread is supplemented with iodine (not in the UK).
  3. If I convert the suggested planetary diet meal plan for protein you get the following weekly plan:
    1. Red meat – 1x per week
    2. White meat (poultry) – 2x per week
    3. Fish – 2x per week, of which one portion should be an oily fish
    4. Egg – 1 per week
    5. Legumes (including nuts) – daily
  4. The above schedule of protein would achieve protein and iron (and zinc) requirements in babies/toddlers, but it is worth to consider combining your legumes with a vitamin C rich source (i.e. fruit as dessert or tomato as finger food) to increase the iron absorption. The reason I am not suggesting here cooked vegetables as vitamin C source, is that a lot of the vitamin C is lost during the cooking process.
  5. The planetary diet also suggests reducing saturated fats (i.e. animal fats) and increasing polyunsaturated fats. Its very important to mention here, that babies and toddlers (when growing normally) should not be on a low-fat diet, as they need plenty of fat to sustain energy intake and this nutrient contributes also towards brain development. I therefore suggest to use a combination of olive oil, rapeseed oil and sunflower oil (all contribute different fats) and not to avoid nut butters if not allergic. Palm oil is a saturated fat, but it is essential to assess how this has been sourced. In regards to coconut oil, this is also a saturated fat and can be used, but its also important to establish where this has been sourced and think about the fact that both these fats are not manufactured locally in European countries (i.e. needs to be imported).
  6. The rest of the diet is supposed to be composed of fruit, vegetables and grains. Whole grains I would avoid until 1 year of age and after this age be careful in the amount of wholegrain products, because this can affect the availability of vitamins and minerals by affecting the absorption. For fruit, I would keep to 3 portions of fruit per day (what the child can hold in hand/size of hand) and totally avoid fruit juice.
  7. Avoid sugar, honey and salt definitely until 1 year of age and limit this to a minimum after 1 year of age.


I will post guidance on vegan/vegetarian diets in my next blog, as I know this is also a hot topic.

Lastly, it is important to note that this advice is not suitable for children that are on a restricted diet due to allergies or other conditions and they require individualised advice. If in doubt, speak to your dietitian.

Sugar in Commercial Baby Food

Many of you would have read in the last week the BBC article on hidden sugars in commercial baby foods in the form of fruit juice or fruit puree. Of course this does not mean, that a baby should not have fruit, but what is acceptable and what not?

This is a pretty simple answer in fact and I will share some simple tips with you today. Baby food should not contain fruit juice, as this is refined sugar and should be avoided. In addition, if a savoury meal contains fruit puree (check the ingredients list for this) and you would not expect this normally in that meal, then that is also a commercial baby food mix you ideally want to avoid. Why ? – well babies are hard wired to prefer sweet food, so if you lace savoury vegetables with fruit, then they will prefer to have all of their bitter tasting vegetables mixed with fruit  and not learn to eat greens. This also goes for recipes that contain fruit. I have noticed grated apple or sweet vegetables in recipes that would not usually have this as an ingredient. Adjust these recipes by replacing the sweet fruit/vegetables with savoury/bitter tasting vegetables.

What about fruit purees? Its useful here to think what would be a normal mealtime balance to give you an idea of allocation for fruit and also some guidance on portions. Ideally you would aim for every meal to have a protein, carbohydrate and fruit/vegetables. This would roughly work out as breakfast cereal with fruit, lunch/dinner with vegetables and either 2 fruit snacks or a small amount of fruit after lunch/dinner.  So about 3 portions per day. The amount of fresh fruit for a baby < 1 year would roughly be the equivalent to 1/3-1/2 (max) of a fresh fruit, outside of really small fruit (like cherries, where you would allow more). So, imagine cooking and pureeing this amount and how much you get. You will find that a pouch of 90-120g would usually be more than that, so it is worth adjusting the amount.

Finally…..mentioned in many previous blog posts! Avoid letting your baby suck the food directly from the pouch. Outside of this not promoting oral motor skills, this feeds into an aversion to self feeding with mess (which is essential for self feeding) and usually this way they consume much more than when they get this either fresh or with fed via spoon.

High Protein Intake in Early Childhood – Should I worry or not?

For adult nutrition, following a high protein diet has become very fashionable with the increasing popularity of the paleo diet. There has been a lot of scientific debate on the efficacy of that diet in adults, I am however more worried about this trend blowing over into nutrition in early childhood.

Over the last year, more and more parents have been asking me about the value of increasing protein intake in their babies complementary food and I have seen also some of the baby food company advertising their food as “high in protein”, as if this is a good thing. Firstly, I want to say, that today’s blog entry is for healthy babies, without any underlying medical diagnoses, where there may be a need to alter protein intake. The latter need to get individualised help from a paediatric dietitian. 

I am just going to come out with it – high protein intake during early childhood is NOT good! In breastmilk  about 6% (give or take) of the energy comes from protein. Breastmilk is the ideal source of nutrition in babies and recommended alongside solids until 2 years of age. So breastmilk is in fact low in protein, high in fat and carbohydrates and this is the ideal source of nutrition for babies. More than 10 years ago, studies started to emerge that babies who were on infant formulas, which then had a higher protein content, had a higher BMI in later life, than breastfed children. As a result ALL standard infant formulas dropped their protein content since then. It was initially thought that the link between higher protein intake and obesity in later life was related to milk protein specifically, but over the last 5 years, it has transpired from research, that it is high protein intake per se (so that means any protein from meat, fish ect) that is linked to obesity in later life. How does excessive protein intake lead to obesity in later life? The “early protein hypothesis” has been generated to try to explain this phenomenon. It is thought that high early protein intakes increases plasma concentrations of insulin-releasing amino acids, which in turn stimulate the secretion of insulin and insulin-like growth factor I, which enhance weight gain and body fat deposition, as well as the later risk of obesity, adiposity, and associated diseases.

I am sure that you are now wondering, what is high protein intake?  Research points towards a protein intake within the first 2 years that exceeds 15%  being linked to obesity. So what does 15% of protein mean? If you had a meal of 100 kcal, it should ideally not contain more than 3.75 g of protein (1 g = 4 kcal and 3.75 g = 15 kcal). I have looked through many of the commercial foods and quite a number of these, exceed this threshold. Is this against the law? No, not at this stage, as companies in the EU can go up to 5.5g of protein per 100 kcal (that would be 22% of energy from protein). This legislation is from 2006 and was put in place before all of this research emerged of the impact of high protein intake. I understand, the EU is due to update this in 2020.

So what would I practically suggest – first of all monitor the protein content in baby foods (see above guidance), AND do not fall for any marketing saying “high protein is good in babies”. If you have a pouch that is higher in protein, you can bring down the ratio by adding vegetables/carbohydrates to the pouch. When you cook your own food, try not to exceed the following ratios 1:5 protein and 2:5 starchy foods and 2:5 veg/fruit. There is also no need in a young babies on solids to limit fat intake, remember breastmilk is very high in fat.

I hope that this provides parents with some clarity on the topic.

Home-made versus ready-made meals for babies and toddlers

I have touched on this topic with previous posts, but it remains an extremely common question that I get from parents whether home-cooked foods are better than ready-made meals.

Of course as a dietitian, I will always prefer home-cooked foods to ready-made meals, as this does not only allow for a lot of flexibility with meal variety, but also ensures that babies and toddlers are exposed to an environment where cooking occurs and where they eat the same as the rest of the family (minus salt and sugar). Role-modelling around food, meaning that a baby/toddler observes that the foods that he or she is eating is also being consumed by other family members is so important.

However, there are  other reasons why I prefer home-cooked foods, which relate to the variation in texture and also the fact that home-cooked food is not sterile and therefore seems to have a positive impact on the gut microbiota (the bugs in the small and large bowel). Most of the baby foods come in 3 stages for texture, they come in pouches and the recipe of the meals remain exactly the same. Whereas home meals, even with the similar ingredients, often have slight variations in taste and texture. I frequently see children in my clinic, that will not eat home-cooked foods because its not as finely pureed as ready-made meals or they do not cope with the texture of stage 2 or 3 meals.

Lastly, there has been a worrying trend in ready-made foods for babies and toddler, with the addition of fruit into savoury meals. These are also often not spoon fed, but given to babies to suck on, because this is faster and cleaner. This is now starting be addressed internationally and the first position statement has been published in Germany against using excessive fruit in ready meals and I am hoping this will lead to also a position statement in the UK. Sweet is a primary taste that is well developed in babies because breastmilk and formula milk contains lactose which is sweet and signals energy. Babies and toddlers will  prefer sweet flavours and by having savoury meals with sweet fruit in them, they do not learn to eat the more bitter tasting vegetables and savoury tasting legumes and meats. Also, babies need to learn to feed themselves and this is a messy process and should not occur through sucking a pouch, which is clean and they know how to suck, but need to learn to chew and take a spoon.

Of course, we all live in the real world and I know it is impossible for all parents to cook for their baby or toddler all the time and when you go on holiday, parents also need a break from cooking. So for me its finding the happy midway of doing some cooking at home (there are usually foods you cook for yourself that can be used for babies – minus sugar and salt) and complementing this with ready-meals as it suits your lifestyle. Have a look at the ingredients of the ready-made meals and avoid savoury meals with sweet fruit added to them and go for combinations of foods that your baby/toddler is likely to be exposed to at home as well. Vary the texture by adding vegetables or meats/legumes to the ready-made meals and also offer age appropriate finger foods. Most importantly, feed the ready-made meals with a spoon and avoid for your baby/ toddler suck their food from a pouch.

Keeping your Baby and Toddler Hydrated in this Hot Weather

We have been having exceptionally hot weather in Europe and unlike other years where this may last just for a day or two, this seems to be going on and on.

Babies/Toddlers (as well as elderly) are at higher risk of becoming dehydrated, because of their smaller bodies they have less body fluid reserve and their surface area to volume ratio is higher. Its important therefore to recognise the symptoms of dehydration early, which include:

  • seem drowsy
  • breathe fast
  • have few or no tears when they cry
  • have a soft spot on their head that sinks inwards (sunken fontanelle)
  • have a dry mouth
  • have dark-yellow pee (less wet nappies)
  • have cold and blotchy-looking hands and feet

Firstly it is important to keep them out of the sun and clothe appropriately with light, breathable clothing. Ensure also that your baby is not wrapped up too hot when sleeping.

For breastfed babies < 6 months of age, the ideal is to increase the breastfeeding frequency, which often occurs naturally, as babies signal when they need more fluid. For formula fed babies, they will need more formula as well during hot weather and again, most babies will signal this automatically.

For babies over 6 months of age, cooled boiled water should be offered frequently in hot weather. I often get asked how much they should have, which very much depends on the weight and age of the baby. Most babies > 6 months of age weigh > 5 kg, so that means you are looking at 100 ml/kg of total liquid (that is milk and water) to maintain hydration, during very hot weather this can increase to a total 120-130 ml/kg of water. This is just a rough guide as some children want more than that and some are fine just with 100 ml/kg. It is therefore important to monitor their hydration status.

For toddlers, milk of course is not such a prominent liquid in their diet as for babies. It is therefore really important to ensure that they consume sufficient additional liquid, ideally in the form of water. Fluid requirements are calculated as follows:

  • first 10 kg = 100 ml/kg and for the following 1 kg its 50 ml/kg. So a toddler of 13 kg would require 1150 ml liquid per day.
  • Remember though that food also contains water and contributes to the total fluid intake

I do have children that refuse to drink water and although I am not a fan of fruit juice, in this hot weather its more important to keep them hydrated, so I usually suggest (in cases that refuse to drink plain water) to flavour water with a little bit of fruit juice (1:5 dilution) and/or you can also try fruit ice lollies (blending fruit with water). In addition, offer plenty of juicy fruit (i.e. water melon) and vegetables that contain water (i.e cucumber).

If ant any stage you are worried about your baby or toddlers’ hydration status, please seek professional medical help.

Moving on in weaning – a confusing process

Through recent correspondance with parents, it has become apparent to me again, how difficult the progression through weaning can be, as you are bombarded with advice from friends, family members and books. In reality, your baby is an individual and it does not matter what people say or write, a one-fits-all approach just does not work for every baby. That is something that I can reassure every parents, that their child is unique and therefore will require a unique approach.

I like providing parents with a structured way of introducing foods as this way they can keep track of what foods were trialled, how the baby liked the foods and also in my allergic children if there were any reactions. Therefore, I usually suggest starting with  one food, which is then followed by other new food(s). Introduction of weaning food is cumulative, so for example if you have started with carrots and your baby tolerates carrots you then try potato, but you can mix your carrots with the potato. So you are constantly trying  a new food but can mix this with existing foods.

I have provided below an example of a couple of days-weeks:

Start: Carrots

Then: Carrots and potato

Then: Carrots and potato and a pear  (new food)

Then: Carrots, potato and courgette (new food) and pear as a dessert

Now start with 2 meals per day

Then: Potato and courgette (one meal) and another meal of pear and porridge (new food)

Then: Potato, courgette and butternut (new food) and another meal porridge with apple (new food)

As you can see it is an easy process of constantly expanding the foods your child is given and of course repeating foods already trialled to ensure that tastes are accepted. Research has found that some foods (tastes) will need at least 15 introductions before a baby likes the new food, so please do not give up if your baby is not a big fan of a new food and repeat the food many times.

So when do you move from 1-2 -3 meals? I usually suggest going to 2 meals very quickly (when you have introduced 3 or more foods) and when protein are introduced (i.e. meat, chicken, fish, lentils) to move to 3 meals. There is no “rule” that says you have to do this, but I have found this works really well.

Of course what follows on from going up in solid volume is the cutting down of breastfeed/formula. I have in a previous blog entry provided some guidance on routines and milk feeds, but I want to reiterate what I have said before, that responsive feeding is the best feeding method, which means we respond to a child’s appetite and satiety cues. If a child refuses to drink or eat then we stop, if they signal more, then we offer more (please see previous blog entry on portion sizes). This means, that as you go up in volumes of solids, your child would signal which feeds or bottles they are not that keen on and these are the ones you cut out/reduce and adjust your feeding regime around this. It does of course occur that sometimes they love the breast or the bottle too much and would rather take the breast or bottle rather than take solids. If this occurs then it is worth having a chat with your health visitor (in the UK) or dietitian to help you decide which feed should be cut out/reduced to give you maximum benefit with creating appetite for food.

The most important message to come out of this blog entry is that your child is unique and will not always fit into a regime set out by a book/another person. As long as you respond to feeding cues, increase the variety of foods (as explained above), move up in texture and adjust volume of feed/breastfeeding frequency as your child signals, the vast majority of cases babies thrive and do well.


From dirt to probiotics

The most common question I get in my clinic is about which probiotics should be used in children. The answer I give unfortunately can be quite disappointing for some parents because my answer is usually quite vague, unless I know specific research exists related to a specific strain of probiotic and a specific diagnosis.

The gut has millions of bacteria and these are made up of different strains and to make it even more complex, although there is some overlap in bacterial flora in children, the gut microbiota of the individual is quite unique to every child related to whether they were born via C-section/vaginal birth, breast fed or bottle fed, weaning diet and also the environment. So suggesting one strain or even multiple strains for an individual child can be difficult as the microbiota is so specific to an individual. What I can certainly reassure parents is that outside of specific conditions (i.e when a child is immunocompromised for example with cancer) probiotics are fine to use and not harmful, so you will not do any harm if you were to try. We know that a breastfed child will have a flora that is more dominant in bifidobacteria and that this changes with the introduction of solids to more lactobacillus. This of course is a very simplistic explanation as you have lots of other strains that develop.

The message that I wanted to get out with this blog post is that you can do a lot of positive with your baby’s gut microbiota with breast feeding (best option) and some formula now also contain prebiotics (food for the good bacteria) and also when solids are introduced to expand the variety to lots of fruit, vegetables and grains, which provide food for bacteria and promote a healthy balance of gut microbiota. In addition to this, is the importance of home-cooked foods, which have also been shown to help with the microbiota, as home-cooked food is not sterile and contains some bacteria, that also helps the microbiota.

I think many of you have heard of the the excessive hygienic conditions we live in, being blamed for the development of allergies. So allowing your child to crawl on a floor, pick things up and put in their mouth (within reason of course) and explore is an important step to helping the gut microbiota develop and improve the immune system. So before you look at a probiotic, think about all the things that you can do at home already that promote not only 1 or 5 bacterial strains in the gut, but millions of strains. If you still then want to try a probiotic for a specific situation, do discuss this with your healthcare professional as there are some strains that have shown to be beneficial for specific symptoms/diagnoses.

….and more on Cow’s Milk Protein Allergy

In spite of a lot of advances in food allergy, the misconceptions amongst parents as well as healthcare professionals continue.  One of the biggest area of confusion is that of non-IgE mediated cow’s milk protein allergy, affecting the gastrointestinal tract. As there are no simple tests (and I mean really NO tests, no matter what the internet says) that can confirm this allergy, it remains an allergy that is based on identifying the symptoms followed by a trial elimination diet and then reintroduction to confirm/disprove the allergy.

I have been involved with an international team to publish the new iMAP guidelines, which provides simple guidelines for healthcare professionals (and parents) for this delayed form of cow’s milk allergy. Allergy UK has been supporting the distribution of these guidelines in the UK and has some useful tools (supported by the UK authors), which can be downloaded from their site.

In addition, Dr. Adam Fox, one of the authors also did a very useful BBC radio interview that many parents may find useful. The section on cow’s milk allergy starts about 7 minutes into the link.

Feeding Routines in the Weaning Infant

I always struggle to answer parent’s questions about feeding routines in babies that are going through the weaning process (when solids are introduced). It would be lovely if there was clear scientific evidence for what exactly to do when solids are introduced but the truth is that there is no clear evidence of what to advise parents, as babies are different sizes, have different growth velocities and different hunger and satiety patterns. I also think that it is really important to take into account other siblings and meal patterns at home, when thinking about a baby’s routine.

The best way to address this question (I think) is to start by thinking what we know in regards to baby’s routines:

  1. In the early stages of weaning the majority of nutrients will come from breast milk or formula and this will remain an important part of the diet until around 1 year of age (give or take)
  2. After 6 months of age babies will need some of the key nutrients to come from food and this includes iron rich foods
  3. The responsive feeding style has been shown to be the most effective in early childhood (see blog on feeding difficulties). To be responsive as a parent around mealtimes, means you listen to their hunger and satiety cues – if they want to stop you stop if they want more you give more (it’s not driven by specific portion sizes)
  4. It is important to broaden the variety of tastes and textures early on, because > 10 months of age it becomes much harder introduce new foods and increase textures

So, when you start weaning, I usually suggest keeping the milk (breast or bottle) routine exactly the same and introduce a midmorning solid. Initially this may just be a couple of teaspoons and you may find that these initial vegetables/fruit do not displace any feeds. It is important to know, that fruit and vegetables do not replace the energy, fat and protein rich breast milk or infant formula. You will soon see whether your child wants to progress faster (i.e. they want bigger portions, they exited about the meal and do really well with new tastes/textures). If your baby is progressing well, you can introduce 2 meals per day quite soon (even if this is within the first week of weaning) and at this stage you may find that they start signalling that they may not want to drink all of their milk. You an follow their lead at that stage and reduce the breast/bottle feed that they are not that interested in.

Introduce iron rich protein foods soon after 6 months, which then allows you to go onto 3 meals per day. At this stage, your baby should naturally signal that they want to cut down some of their feeds, so you may end up with a routine as below:

Early morning breast feed/bottle




Breastfeed/bottle – depending on the age of the baby you could cut out either midmorning or mid-afternoon feed and replace with a snack (i.e. yoghurt and fruit)



I do sometimes have parents that report that their baby eats big volumes and do not want to cut down any breast/bottle feed. If this happens, it is worth to check growth and see whether your baby is moving up excessively in weight gain. If this is the case, I would recommend you talk to a dietitian to see what can be done to prevent early onset overweight/obesity.