How Much Milk Is Too Much?

A Case Study of an Obese Toddler

Barbara Gray, PhD, RN, CPNP; Maria C. Reyes, MS, FNP-C, APRN; Lori L. Conners, RN, BSN; Jo Ann Serota, DNP, RN, CPNP; Beverly Giordano, MS, RN, ARNP, PMHS; Donna Hallas, PhD, PNP-BC, CPNP


J Pediatr Health Care. 2013;27(2):148-154. 

In This Article

Personal/Social/Developmental History

This child lives with both biological parents in a low-income apartment complex located near the pediatric clinic. The child's mother is the primary caregiver; he is not enrolled in daycare. Both parents were born in Mexico and traveled to the U.S. in their early twenties to look for work. The father works as a day laborer when he can get job offers. There is limited outdoor playtime for the child because the mother reports that she does not feel safe going for walks in the neighborhood. He speaks numerous words in Spanish, including some two-word phrases, and can follow directions given in Spanish. The child is not yet toilet-trained, and wears extra-large disposable diapers, which cause irritation at the elastic areas of the legs and waist. There is no smoking, alcohol, or drug use in the household.

The child was fed formula until he was about one year of age, when he transitioned to whole milk. He can drink from a cup, but continues to drink whole milk primarily in bottles throughout the day, with an intake of up to one gallon of milk in one day. Chocolate syrup is added to the milk at least twice a day. The parents are concerned because even though they are receiving coupons from the Women, Infant, and Children's program (WIC) for the milk, they frequently run out of coupons due to the large amount of milk the child consumes. In addition to milk, what the child typically consumes is outlined in the Box.