Avoiding dairy products, both in childhood or adulthood, is often the only solution for those suffering from milk intolerance or allergy. But what are the nutritional consequences?
Calcium is the main concern. Milk and dairy products make a significant contribution to calcium intake in our diets. Milk alternatives such as soya, rice, oat or coconut milks are naturally poor sources of calcium, but fortified versions contain similar or higher levels. This is why it’s important to choose calcium-added milk alternatives (usually these are not organic unfortunately). The bioavailability of the calcium in fortified products is similar to that of milk.
For children, other nutritional concerns are the energy, protein, fat and fat-soluble vitamins that a dairy-free diet may be deficient in. Again, cow’s milk contains a whole host of benefits aside from just calcium, so avoiding milk means either finding a substitute that can mimic some of milk’s properties, or by ensuring the rest of the diet can make up for what is lost in avoiding milk. For this reason, it is really important to have your child’s diet assessed (and periodically re-assessed) by a paediatric dietitian who will ensure your child is getting everything they need. Children under the age of 2 will typically need a prescription milk. Older children can have soy (if tolerated) but other milk alternatives such as rice, oat or coconut milk are not usually recommended for toddlers. Rice milk is not recommended for children under the age of 4 due to arsenic levels.
Soy, rice and oat milks contain between 38-47kcal/100ml (about the same as semi-skimmed milk). Coconut milk has less than 30kcal/100ml (ie. lower in calories than skimmed milk) and therefore is not always suitable for growing, active children. The protein content of milk alternatives tends to be lower (some significantly lower). Quite often the sugars in milk alternatives are high, and the effect on teeth should be considered. I always suggest open cup drinking for children on milk substitutes (see my previous blog on open cups). Calcium content of any milk substitute should be at least 120mg/100ml.