Does my child need to drink milk? Is there one particular milk that reigns supreme? In this post, I will provide a Pediatric Dietitian's perspective on milk consumption and dairy/dairy alternatives for kids over one-year-old.
With an ever-growing list of milk alternatives out there, it is difficult to sort through so many choices and select the best for your child.
There are no perfect options. However, there are likely a couple of choices that will work well for your little ones.
I hope to help you understand the products that are available and discuss where they optimally fit into your child's diet.
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Does my Toddler Actually Need to Drink Milk?
The point of giving a toddler breast milk, dairy, or a dairy alternative is to keep them hydrated and ensure that they are meeting their needs for some very key nutrients in development - vitamin D and calcium.
While milk itself is not crucial, it is an excellent vehicle to guarantee your little one is getting what they need after they pass the 12-month mark.
Below are the general recommendations for vitamin D and calcium consumption for kids¹*:
Vitamin D Recommendations
7-12 months old: 400 IU (male); 400 IU(female); 1,500 IU(upper limit)
1-3 years old: 600 IU (male); 600 IU(female); 2,500 IU(upper limit)
4-8 years old: 600 IU (male); 600 IU(female); 3,000 IU(upper limit)
Calcium Recommendations
7-12 months old: 260 mg/day (male); 260 mg/day (female); 1,500 mg/day (upper limit)
1-3 years old: 700 mg/day(male); 700 mg/day(female); 2,500 mg/day (upper limit)
4-8 years old: 1,000 mg/day(male); 1,000 mg/day(female); 2,500 mg/day (upper limit)
*Recommendations increase further if your pediatrician finds that your child has low levels in their blood or has a certain condition that would affect how well their body absorbs vitamin D or calcium.
What Provides Vitamin D and Calcium Other Than Milk?
Vitamin D:
Many food sources contain vitamin D. If your child is not drinking milk it is possible to meet their needs with food alone. However, as you can see from the list below, that may be a daily challenge.
For example, if your 5-year-old needs at least 15 mcg or 600 IU to meet their needs they could consume one egg, one cup of fortified orange juice, one ounce of cheese, and one ounce of salmon. However, that would only meet about half of their daily goal.
Food Source¹:Amount of Vitamin D per serving¹
3 ounces Trout: 645 IU
3 ounces Sockeye Salmon: 570 IU
1 cup Orange Juice, fortified with Vitamin D:100 IU
1 serving Cereal, fortified with Vitamin D: 80 IU
2 Sardines: 46 IU
1 Large Egg: 46 IU
1 ounce Cheddar Cheese: 12 IU
1/2 cup Portabella Mushrooms: 4 IU
An additional source of vitamin D is from sun exposure. The UVB rays from the sun take the PreVitamin D that is already in your skin and convert it into a form that your body can use. Most individuals meet at least some of their vitamin D needs from this route. However, several factors can hinder this process such as season, time of day, sunscreen usage, and melanin content in the skin.
Calcium:
There are more food sources of calcium than there are of vitamin D. However, many children will not consume enough calcium-rich foods in a day to meet their goal.
Food Source¹: Amount of Calcium per serving¹
3 oz Sardines with bones:324 mg
1 1/2 ounces Cheddar Cheese:306 mg
8 ounces Yogurt, plain, low fat:300 mg
2 cups Cottage Cheese:276 mg
1 1/2 ounces Mozzarella, part skim:275 mg
1/2 cup Tofu, firm, set with calcium:204 mg
6 ounces Orange Juice, calcium fortified:200–260 mg
3 ounces Salmon, canned, solids with bone:181 mg
1/2 cup Instant chocolate Pudding:153 mg
1 cup Cereal, Calcium fortified:100–1000 mg
1/2 cup boiled Turnip Greens: 99 mg
1 cup raw Kale: 90 mg
1 cup cooked Kale: 94 mg
How Does Milk Compare to These Foods?
Milk or fortified milk alternatives are meant to fill in the gap that the food sources of vitamin D and calcium leave void.
Dairy: contains 285- 300 mg Calcium and 120 IU vitamin D
Fortified Soy, Almond, Oat Milk: calcium content varies but typically contains 100-144 IU vitamin D
Therefore, from 1-3 years about 16-20 ounces (2-2.5 cups) per day of dairy or well-fortified alternatives will cover their vitamin D and calcium needs. Any intake from foods would be an additional source.
Why is Dairy the Standard? What Makes it Better for Kids?
1. Consistency
Dairy milk is consistent. Whether it is fat-free, low-fat, whole, lactose-free, or even flavored, milk meets the Food and Drug Administration (FDA) standard of identity. It is guaranteed to be safe and has 9 uniform essential nutrients in each glass - Protein, vitamin A, riboflavin, niacin, pantothenic acid, vitamin B12, vitamin D, calcium, and phosphorus. Additionally, the protein in cow's milk is extremely "bioavailable" or readily absorbed by our bodies.
2. Lowers risk of disease²
Decades of research have shown that including milk as a part of a varied diet is associated with strong bones, lower risk of heart disease, reduced risk of Type 2 Diabetes, and improvement in weight management.
3. Simple ingredients
Unlike alternatives, unflavored milk contains three ingredients: milk, vitamin A and vitamin D. Unless the milk is lactose-free. In which case you will also see lactase added on the label. Additionally, the sugars in plain cow's milk are always naturally occurring. In milk alternatives, sugars and stabilizers are often added.
4. Affordable
When examined next to its non-dairy counterparts' milk will always be cheaper per glass.
Soy, Nuts, and Grains. Which Milk Alternative is Best?
Dairy alternative options abound. So much so, that they have been quite disruptive to the dairy industry in the past few years. Unfortunately, in the milk alternative market, one oftentimes compromises on taste, price, or protein. No dairy alternative meets the nutritional standard of cow's milk. However, I will highlight my two favorite milk alternatives for kids that come very close: Soy "Milk" and Pea Protein "Milk"
1. Soy "Milk" is made from straining ground soybeans and water. Soy milk is an affordable alternative to dairy and most fortified brands contain similar amounts of calcium, vitamin D, vitamin A, potassium, and protein. As opposed to some of its plant protein counterparts, soy protein contains all nine essential amino acids. This means that the protein is digested and used by the body similarly to dairy. Soy milk also has naturally occurring nutrients called "isoflavones" that are being studied extensively for their health benefits.
This option is great for those with milk allergies or sensitivities to the proteins found in milk. If you opt for soy milk be sure to check labels for added calcium and vitamin D.
2. Pea "Milk" comes from purified pea protein stripped from the color and flavor molecules of yellow split peas. Ripple is a brand that is consistently fortified with calcium/vitamin D and they are leading the way for pea protein beverages. Pea milk is a great option for those that are allergic to dairy, soy, or gluten or those looking for a more sustainable alternative, as the carbon footprint and water footprint of producing pea milk are very low. Ripple has a "kids" version of their milk that is well suited for toddlers.
Summary
Milk is very beneficial for kids and this generation of toddlers is blessed! Whether it is allergies, intolerances, religious restrictions, or preference we have so many milk and milk alternatives to choose from.
While cow's milk is a research-driven, affordable, and simple standard, many do not tolerate it or are allergic. In this case, the recommendation is to turn to soy beverages or pea beverages due to their comparable protein, calcium, and vitamin D content.
Other milk alternatives such as rice milk, almond milk, banana milk, coconut milk, goat's milk, flaxseed milk, or oat milk are only recommended as a primary source (over 2 cups per day) for specific situations in toddlers. However, these are great options for blending into smoothies or baking as they provide variety in your child's diet.
If you need help navigating the vast milk market, reach out to a Pediatric Registered Dietitian like Molly Williams RD for more information!
References:
1. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, et al., editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK56070/.
2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020. 9th Edition, Washington, DC: U.S. Government Printing Office, December 2020