Naturedoc’s Lucinda Miller answers my questions on what’s best for your CMPA baby in terms of nutrients and milks once they reach toddler age.
What exactly is in full fat dairy milk / dairy products that’s so important for our children?
Full fat whole milk contains a broad range of nutrients needed for a growing child. Calcium for bone growth and good sleep patterns, vitamin D for good mood, immunity and bone strength, omega 3 for brain and eye development and iodine for growth and metabolism. It also contains traces of important minerals such as zinc, potassium, selenium and B vitamins important for energy and immunity. Furthermore, it is a good source of protein which kids needs for making blood, bones and muscles. There are no other foods that provide this nutritional profile in one drink right now in nature or on the market.
What are the most important nutrients/vitamins children are lacking by not being able to consume dairy and what effect can this have on their health and development?
Kids who do not drink milk and milk products derived from animals such as cows, goats or sheep do often struggle to eat a diet containing the right nutrients to help them flourish. This is a long answer and I am going to start with calcium…
A toddler needs about 350-450mg of calcium daily and an older child needs between 550mg – 1000mg per day for optimal bone strength. Here is a table which gives more detail:
|Age||mg calcium per day|
|Baby under one year||525mg|
|Adolescents (aged 11-18)||800mg (girls)/1000mg (boys)|
Source: Association of British Dieticians
Cow’s milk contains about 120mg per 100ml (3.5oz) so 2 large cups of milk (480ml) per day will easily meet a child’s daily calcium needs. If your child is on infant formula (including hypoallergenic) however, they are only getting more like 50-70mg per 100ml in their milk for the under one’s and 60-95mg per 100ml in the follow-on toddler formulas, including the hypoallergenic ones.
The fortified milks you buy in the supermarkets do usually contain extra calcium that matches the levels contained in cow’s milk but this is not always the case, so you always need to read the label. It is often in the form of calcium carbonate (chalk) which is not that easy to digest and absorb, especially if the child is on stomach acid medication like omeprazole and ranitidine. Since most kids that need to be on a dairy-free diet have a compromised gut function or an over reactive gut immune system, I have always felt that the milks fortified with calcium carbonate milks may not be that beneficial for these kids. This is why I usually recommend a good quality oat milk instead which contains calcium in its natural form and then top up with other foods naturally rich in calcium.
Organic Oatly, Plenish and Rude Health all contain 11% oats which is the equivalent to about 60mg of calcium per 100ml so you basically need to double up the amount of milk they are drinking per day or you need to ensure your kids are getting other sources of calcium from their diet such as oats, chia seeds, poppy seeds, sesame seeds, almond butter, tahini, tinned salmon, tinned sardines, green leafy veg and oranges.
Milk also is a good source of vitamin D and 100ml contains about 40iu (young children need 400iu-1000iu per day for optimal mood, immunity and bone strength). Vitamin D is added to many fortified milk alternatives such as Oatly however it is usually in the plant-based vitamin D2 form which is less effective at increasing blood levels of vitamin D than vitamin D3 found in fatty animal-sourced foods such as whole milk, oily fish and egg yolk and synthesised from sunlight exposure.
This is why I encourage eating lots of eggs and oily fish such as salmon and sardines when a child is on a dairy free diet. One piece of baked salmon can contain 240iu of vitamin D so is an excellent source for dairy-free kids. It is also important to let your kids enjoy some sun cream-free sunshine time in the summer months and top up with a vitamin D supplement during the winter.
Depending on the quality of the animals’ feed, milk can contain 75mg of omega 3 per 100ml which is important for brain and eye development. Omega 3 is important for learning and concentration as well as supports mood and behaviour. Research has shown that a shortfall in omega 3 is often linked to neurodevelopmental and learning challenges like Autism, Attention Deficit Disorder, Dyslexia and Dyspraxia. Babies need around 500mg of omega 3 per day and toddlers aged 1-3 need more like 700mg per day. Older school aged kids from 4–8 are better off with 900mg omega 3 per day.
Milk-alternative manufacturers have not caught onto this important need, mainly because plant-based omega 3 (in walnuts, chia seeds, flax seeds and hemp seeds) is much harder to convert into the brain building DHA form (maximum 10%). Salmon comes to the rescue again as one 150g salmon steak gives 1,900mg of EPA and DHA omega 3 – so this is why it only needs to be given 2-3 times per week.
Iodine is essential for healthy thyroid function which controls your metabolism and growth. It is key for proper bone and brain development and without enough iodine, kids are at risk of having learning difficulties. Kids need about 90-130mcg per day depending on their age.
Milk is a good source of iodine and there is usually 23mcg in 100ml cow’s milk. Cod is a good source at 99mcg per serving and eggs and prawns provide a little. The champion alternative is seaweed which you can buy as little nori sheets in supermarkets, that kids love to munch on, or give them a treat of sushi from time to time or even buy an iodine rich condiment like Seagreens which you can sprinkle onto food instead of salt. Some milk alternatives like Oatly and Oatly Barista do contain iodised salt which can provide a little daily iodine.
The take home point from all of this is that you can’t rely on fortified milks to give your child the nutrition they need if they are dairy free. There is no plant-based “milk” that will give you the like for like nutrition that milk provides. So, this is why you will need to look for nutritional boosts from the other foods they are eating. If you are struggling to meet their nutritional needs, then seek support from a nutritional therapist or naturopath specialising in child nutrition to help you provide a nourishing diet for your child.
Why are some children weaned off prescription milk and others offered a follow-on i.e. Neocate?
It is up the paediatrician’s or dietician’s preference. Their decision probably boils down to whether the child has other allergies or gastric issues; if the child is a good eater and eats a broad range of foods to include eggs, oily fish, oats and green veg or whether they need more nutrient support via the milk formula. Remember Neocate is very expensive, so a doctor will more likely recommend moving onto plant-based milks.
Which type of milk do you recommend for CMPA kids post Neocate or other prescription milks and why?
Oat milk is my recommendation and as you can read from the information above, I prefer the oat milks made from simple ingredients like oat, spring water and salt rather than the fortified milks and top up with good nourishing food. It usually also contains many more calories than the nut and coconut “milks”.
However, if you have an incredibly selective eater and they do not eat meat, vegetables, fish, eggs, seeds and/or nuts then you may need to talk to a nutritional therapist who will be able to guide you through supplementation. A new plant-based milk that has just been launched is Koko Dairy Free Super Drink which is fortified with everything from extra protein to calcium, to iodine to vitamin D, so this may be another solution for the very fussy eater.
Why is oat milk recommended over almond, coconut – or any other substitute on the market?
Oat milk is the only plant-based milk that naturally contains good amount of calcium, protein and calories. Home-made almond milk generally contains more calcium than shop bought almond milk. The others need to be fortified to contain any calcium at all!
Do you recommend a specific oat milk, and why? If Oatly – can you explain which type and why, and why that brand in particular, as neither Oatly product contains added iodine, whereas the Asda and M&S oat milks do?
I love Plenish, Rude Health and Organic Oatly as these contain natural organic ingredients. You then should top up the nutrients with a broad and healthy diet as per the information above. Oatly and Oatly Barista do contain iodised salt which is a source of iodine.
How should we supplement the iodine that’s lacking in most oat milks? I know diet is key, but why should dairy free kids miss out on the extra iodine in dairy that normal children get in their daily yoghurts, milk etc.?
It seems there are very few multivitamins that contain iodine, and this is why our NatureDoc.Shop stocks lots of good quality multis such as BioCare Children’s Complete Complex Multinutrient which has been specifically made for children with food allergies and picky eaters who are struggling to get the nutrition they need out of their diet and contains good amounts of iodine.
Do you recommend a probiotic for non-dairy free kids, and is it the same for CMPA kids? Do they have different needs when it comes to a probiotic?
When a child has an allergy or non-IgE sensitivity to a dairy, it is not the milk’s fault! It is the child’s gut immune system which is reacting to the milk products – it has simply tagged milk as an “alien” and overreacts whenever this “extra-terrestrial” enters the body.
Research has found that in some cases when you build up a healthy gut microbiome (the bacteria in the gut) through eating a very broad range of fruits, vegetables, salads, pulses, nuts and seeds and supporting with probiotic rich foods such as coconut-kefir and probiotics that in time the child may become more tolerant of milk products. This may not work for all children, but it is worth a trial for a year to see if it makes any difference. There is no one probiotic that fits all so it is best to look on our online shop to find one for your child’s age and that does not contain any traces of milk.
The most important thing to remember when you have a dairy-fee kid to cater for is that you really can feed your child a very healthy diet. There are plenty of nutrient dense natural foods containing the things your child needs to thrive – it’s just there is no one food or drink which ticks all the boxes – so you need to feed them much more healthily across the board. My bestselling healthy family cookbook, The Good Stuff has over 100 delicious recipes with dairy-free swaps that will take the stress out of feeding your dairy-free little one.
Article by Lucinda Miller, Naturedoc.co.uk
Iodine Fact Sheet for Health Professionals https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
An Evaluation of the Vitamin D3 Content in Fish: Is the Vitamin D Content Adequate to Satisfy the Dietary Requirement for Vitamin D? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698592/
Re: “Iodine Content in Milk Alternatives” by Ma et al. (Thyroid 2016;26:1308–1310) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706538/
How well do plant-based alternatives fare nutritionally compared to cow’s milk? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756203/
Lactobacillus rhamnosus GG-supplemented formula expands butyrate-producing bacterial strains in food allergic infants. Nagler et al, (2015), The ISME Journal; https://www.ncbi.nlm.nih.gov/pubmed/26394008
Gut Microbiota as Potential Therapeutic Target for the Treatment of Cow’s Milk Allergy, Nutrients. Mar; 5(3): 651–662. https://www.ncbi.nlm.nih.gov/pubmed/23455693