Raw milk is often promoted as a more natural, less processed alternative to pasteurized milk. But an updated policy statement from the American Academy of Pediatrics says the evidence does not support claims that raw milk is healthier, while its risks are well established.
The guidance is based on a review of existing research and outbreak data, not a new clinical trial. The AAP says unpasteurized milk can carry harmful bacteria including Listeria, Salmonella and certain strains of E. coli. Children, pregnant people and people with weakened immune systems face the greatest risk of serious complications.
Pasteurization works by briefly heating milk to kill disease-causing germs before it is cooled and sold. The process has been widely used for more than a century.
Before pasteurization became common in the United States, milk was a major source of foodborne illness. Those risks have not disappeared. From 2013 through 2018, raw milk was linked to 75 outbreaks involving 675 illnesses, 98 hospitalizations and two deaths, according to data reviewed by the AAP. Nearly half of those illnesses occurred in people younger than 20.
“Nearly half of illnesses caused by raw dairy consumption occur in people under age 20 – and a significant share of those cases are in children under 5,” said Dr. Adam J. Ratner, lead author of the statement.
For pregnant people, the concern is especially serious because some foodborne infections can also affect a developing baby. Listeriosis, for example, is much more common during pregnancy and can lead to miscarriage, stillbirth, premature delivery or severe illness in newborns.
One of the arguments often made in favor of raw milk is that pasteurization destroys important nutrients. The AAP review found little evidence to support that concern.
Studies cited in the statement found no meaningful differences in several important fats or minerals between raw and pasteurized milk. Pasteurization can alter some proteins and reduce certain compounds, but the AAP found no evidence that those changes make pasteurized milk nutritionally inferior in a meaningful way.
Overall, the group concluded that pasteurization does not significantly reduce the nutritional value of milk.
That distinction matters because "less processed" can sound synonymous with "healthier." In this case, though, processing serves a clear purpose: reducing the chance that harmful bacteria and other pathogens survive in the milk.
The updated guidance also raises a newer concern about H5N1 avian influenza.
Since the virus began spreading among U.S. dairy cattle in 2024, researchers have found that infected cows can shed large amounts of the virus into their milk. Studies have also shown that infectious H5N1 can remain in refrigerated raw milk for weeks, while pasteurization effectively inactivates it.
So far, no human cases of H5N1 have been confirmed from drinking raw milk. That means the evidence does not show that people are currently getting bird flu this way. But health experts consider contaminated raw milk a possible route of exposure, adding another concern to the already established risk of bacterial infection.
Raw milk remains legal to sell in some form in many states, although federal law prohibits the interstate sale of unpasteurized milk intended for direct consumption. Some cheeses made from raw milk can still be sold if they meet aging requirements.
The AAP recommends that children, pregnant people and breastfeeding parents choose pasteurized milk and dairy products.
“Parents may choose raw milk because they have heard it is healthier or more natural, but the scientific evidence tells a different story,” said Dr. Mark R. Corkins, a co-author of the statement.
For consumers, the bigger lesson may be that the amount of processing a food undergoes does not automatically tell you whether it is healthier. In the case of milk, pasteurization changes very little nutritionally while dramatically reducing the risk of foodborne illness.
The American Academy of Pediatrics reported no external funding for the policy statement. The authors disclosed professional and financial relationships under AAP conflict-of-interest policies, and the organization reported no commercial involvement in developing the guidance.