Make Mine Milk

With a vast number of milk choices crowding the supermarket shelves and chiller cabinets, it is no wonder many parents are confused as to what milk type is the right choice for their children. 

It seems like there are hundreds of options when it comes to milk. Not only are we offered cow’s milk but many others including goat’s milk, sheep’s milk, soy milk and rice milk. Each then comes in many permutations; full fat, low fat, no fat, skimmed, calcium fortified and vitamin enriched just to name a few.

Parents today are bombarded with various marketing messages, myths and fallacies, but the fact is milk and dairy foods play an essential role in a child’s growth and development.  

The importance of milk

Calcium cannot be made by the body so dairy foods like milk, cheese and yoghurt need to be eaten every day. Milk and milk-related products are a rich source of calcium and many other vitamins and nutrients including; protein, fat, vitamin A, a range of B group vitamins.

These promote growth, provide energy, assist with the normal development of bones and teeth and help with the proper functioning of the neuromuscular and cardiac functions. 

Daily Calcium Requirements 

To ensure your child’s daily calcium requirements are met, encourage them to eat 2-3 serves of dairy food per day.

One serve is equivalent to either 250mls of milk, 35g of cheese, 200g of yoghurt or 200g of icecream.

Age/Recommended Daily Intake

1-3 years 500mg
4-8 years 700mg
9-13 years 1000-1300mg
14-18 years 1300mg

Source: National Health and Medical Research Council 2005 – Nutrient Reference Values for Australia and New Zealand.

Milk types

Cow’s milk has been the milk choice for generations and it remains the best option for a child once breastfeeding or formula feeding has ceased.

‘Cow’s milk is the predominant milk in our society, and can be given undiluted to children over 12 months of age’ says Mrs Barbara Dennison, Dietician at The Children’s Hospital Westmead. 

For children aged between one and two years, full fat milk should be given. For children over two years reduced fat milk is recommended for good heart health. It is assumed that children over two years of age are eating a range of nutritionally sound foods and getting fat from other sources.

Regular cow’s milk in Australia is a mix of A1 and A2 protein milks. In recent times, A2-only milk is being heavily promoted as being superior. At this point of time, A1 and A2 milk are both considered safe and nutritious for both children and adults. 

Milk needn’t be avoided when a child has a cold. Research shows that drinking milk does not increase mucus production. It is the creamy mouth-feel that leaves a smooth coating in the mouth and throat; a unique characteristic of all animal milk.

Sheep’s and goat’s milk are other animal milk sources that are also high in calcium. However, both have less of some vitamins than cow’s milk, specifically the B vitamin, folate.  As with all animal-sourced milks, serve only fully pasteurised varieties.  Sheep or goat’s milk are often selected for their unique taste. 

If for some reason cow’s milk cannot be tolerated, soy milk can be given as a nutritionally equivalent alternative.  ‘Be sure that you select a calcium-enriched variant as all soy milks are not the same’ says Barbara. The calcium-enriched type will provide the essential calcium requirements for growing children.

It is worth taking the time to check the nutritional panels to see which one provides the best range of vitamins and minerals. To take the place of cow’s milk, there should be at least 100mg of calcium per 100mls of soy milk.

Some parents are concerned that phytoestrogens found in soy milk could interfere with the hormone levels in children. The Cancer Council believes that a moderate consumption of soy foods (eg 1-2 serves of soy foods/day), along with an overall healthy eating plan is unlikely to have any adverse health effects.

Rice milk, oat milk and almond milk have also all been rising in popularity. Paediatric dieticians do not consider these appropriate as a complete milk for children under five years of age. The manufacturers state this clearly on their packs. ‘They are not nutritionally adequate and have less protein, calcium and B group vitamins than cow’s milk’ warns Barbara.

Should your child be unable to tolerate cow’s milk or soy milk, consult a paediatric dietician for what is best for your child and what you can do to make sure they receive the appropriate daily intake of calcium.

Common milk-related allergies

According to The Australian Society of Clinical Immunology and Allergy (ASCIA), food allergy occurs in around 1 in 20 children. The majority of food allergies in children are not severe and will generally disappear in time. The most common triggers are eggs, cow’s milk, peanuts and tree nuts.

Children with a milk allergy or soy allergy are allergic to the proteins found in either the cow’s milk or soy milk. Symptoms include hives around the mouth or other parts of the body and/or swelling of the lips or eyes.  More severe reactions can include vomiting, abdominal pain, diarrhoea, coughing and wheezing.

A lactose-intolerant child has an inability to digest the sugar (known as lactose) found in cow’s milk. Abdominal pain, gas and diarrhoea are the most common symptoms.

If you suspect your child may have any one of these allergies, seek immediate medical advice.  A skin-prick test or blood tests (commonly referred to as RAST tests) will help to confirm or exclude potential triggers.

A caution to parents

There is much discussion about food allergies and intolerances today. Whilst there are many real cases of childhood allergies, it is extremely important that any suspected allergies be properly diagnosed by an expert.

Eliminating foods from your child’s diet with no medical basis can be denying your child important nutrients to aid their growth and development.

Some children have been found to be suffering from protein malnutrition, because dairy foods and cow’s milk have been eliminated from their diet without supplementing them with an appropriate alternative.

Your GP will be able to provide you with more information and a referral to a Paediatric Allergist or Dietician specialising in this area.

Cow’s milk remains the best milk choice for most Australian children and soy milk is a very good alternative. Fortunately Australian families have easy access to many fresh and high quality cow and soy milk products. Two to three serves a day is all it takes.
 

Real life choices

As a breastfed baby, Flynn would often vomit and break out in a facial rash each time his mother Sue had consumed dairy products.  Sue avoided dairy until Flynn weaned at 14 months. She then slowly introduced yoghurt and cheese into his diet.  With no visible reactions, small amounts of cow’s milk were slowly given.  Flynn has had no further reactions and now enjoys a wide range of dairy products.

Charlotte suffered severe eczema and abdominal pain as a breastfed infant. Her mother Samantha initially consulted a naturopath and then onto an allergist in an attempt to source the problem. A milk protein allergy was medically diagnosed and a calcium-fortified soy milk was recommended as a cow’s milk alternative. Charlotte now consumes soy milk and soy yoghurt on a daily basis. She is growing and developing well and her eczema is also under control.

Lactose intolerance and children

Lactose is produced by milk and other dairy products. The body breaks it down in the digestive process with an enzyme called lactase.

Without enough lactase, a person can have digestive problems like abdominal pain and diarrhoea. This is known as lactose intolerance or lactase deficiency. An intolerance (as opposed to an allergy) means that many people can consume some lactose (their tolerance level) before symptoms appear.

Lactase enzymes are found in the mucus of the small intestine. If there is not enough lactase, milk sugars (lactose) will be partially broken down by bacteria in the intestines, causing excessive wind, bloating and associated pain, and sometimes diarrhoea.

Diagnostic tests can include a breath hydrogen test and a lactose tolerance blood test.

Many Australian babies are unnecessarily weaned because their irritability is wrongly assumed to be lactose intolerance. The severe form of this condition – known as primary lactose intolerance (where the infant does not produce lactase from birth) – is rare.

Secondary lactose intolerance often occurs for a short time after gastroenteritis in infants and toddlers. In children with bowel symptoms, it is unusual for cow’s milk intolerance to exist as an isolated problem. Milk intolerance is rarely permanent and regular cow’s milk can generally be reintroduced by 2–3 years of age.

It is also rare for Caucasians to develop lactose intolerance (only up to five percent); however up to 75 per cent of non-Caucasians living in Australia are lactose intolerant.

Dietary tips

There is no need to follow a cow's milk free diet. Milk is an important source of calcium and other nutrients important for good health.

• Most people with lactose intolerance can consume 8-10 grams of lactose per day (about 200ml or a small glass of milk)

• Chose full cream milk as the fat slows the passage of lactose through the digestive system.

• Most cheeses have very little lactose, particularly mature cheeses.

• Small serves of butter and cream have very little lactose.

• Yoghurt loses lactose while in the fridge so keep for a few days before consumption.

• Use lactose free cow's milk (available in supermarkets) as a substitute.

• Goats' milk contains lactose, and is not suitable for children with lactose intolerance.

• Soy milk does not contain lactose, but a child with lactose intolerance does not need to be on soy milk.

Sources:

The Gut Foundation 
Pamphlet - Understanding lactose intolerance
Booklet - Milk allergy and intolerance in infants and children

By Suzanne Sage

Resources

The Children’s Hospital at Westmead 

ASCIA

The National Health and Medical Research Council

Food Standards Australia and New Zealand

The Cancer Council