Meet Dina DiMaggio, MD, and Anthony F. Porto MD, MPH, official spokespeople for the American Academy of Pediatrics and the co-authors of The Pediatrician’s Guide to Feeding Babies and Toddlers. Each month, they'll write about the latest AAP guidelines, studies and seasonal issues affecting babies and toddlers. Follow them on Instagram @pediatriciansguide.
Since there are so many new ‘milks’ on the market, it is often confusing to know which is the best one to give a child. We are often asked by parents weaning baby off breast milk or formula which is the best milk to use after age one. Here we will discuss how much dairy is recommended for a toddler, the nutritional composition of milk alternatives and our picks for parents.
Dairy Recommendations For Your Toddler
Dairy provides fat, protein, vitamins and minerals for infants and young children. In infancy, the majority of calories come from breast milk or formula. At age one, dairy is still an important source of dietary fat, which continues to be important for brain development. From 1 to 2 years of age, the American Academy of Pediatrics (AAP) recommends that toddlers consume two servings of dairy per day, which is the equivalent of 16 ounces of milk. Most children will continue on whole cow’s milk until age 2, but in some cases, the AAP recommends starting reduced-fat milk between 12 months and 2 years of age in children who are at risk of being overweight, or whose families have a history of obesity, heart disease or high cholesterol. From 2 to 3 years of age, approximately 2.5 servings of dairy is recommended daily and your child can switch to low-fat or nonfat milk.
Some children, however, may not drink any milk and this is still okay, especially if they consume good sources of calcium and vitamin D from other sources, including cheese and yogurt. In fact, many pediatricians do not want children to drink more than 16 to 20 ounces of milk a day, because milk can fill children up, preventing them from eating more nutritious foods. Additionally, too much milk consumption could also lead to iron deficiency (calcium blocks iron absorption) and subsequent anemia.
Dairy Serving Sizes
Milk: 8 ounces = 1 serving of dairy
Yogurt: 8 ounces = 1 serving of dairy
Cheese: 3 ounces = 1 serving of dairy
Shredded Cheese: ⅓ cup = 1 serving of dairy
*2 servings of dairy are recommended daily for children between age 1 and 2, while 2½ servings are recommended for children between ages 2 and 3.
The Rise In Milk Alternatives
Milk alternatives have become more popular over the past decade as some families choose to be dairy-free. Additionally, some children are allergic to milk protein. In both cases, milk alternatives are important to make sure you child is getting enough protein and calcium. Understanding the difference between your options can help you choose the best one for your child.
Examples Of Milk Alternatives
Common milk alternatives include soy, coconut, rice and nut (cashew, almond) milk. Hemp milk, oat milk and milk made from pea protein are also available alternatives. Some will be found in the refrigerator next to cow’s milk while others are found in boxes in the beverage section of your supermarket.
Milk Alternatives Vs. Cow's Milk
In general, milk alternatives contain fewer calories and protein than cow’s milk. However, the majority of milk alternatives are fortified with calcium and vitamin D, similar to the amounts found in cow’s milk. Some milk alternatives may also be fortified with protein, so it's always important to read labels. Of note, milk alternatives such as almond milk made at home will not be fortified and will likely be deficient in these nutrients.
The Latest Research On Milk Alternatives
Results from a recent study show that children who drink milk alternatives may be shorter than children who consume cow’s milk. The study, published in The American Journal of Clinical Nutrition, collected data from over 5,000 healthy Canadian children from 2 to 6 years old. The authors stated that each cup of milk alternative that a child drank each day was associated with an average decrease of 0.4 centimeters in height. A potential reason why their growth was lower? Many of these alternative milks do not contain enough protein and fat. More studies are needed to confirm this relationship, but the results do help raise awareness of the nutritional differences of milk and milk alternatives.
A Note About Soy Milk
There is a lot of conflicting evidence on the consumption of soy products, such as tofu, edamame and soy milk, and there is limited research on their effects in children. The debate stems from soy containing isoflavones or phytoestrogens, which are chemically similar to estrogen. On a positive note, soy has been linked to lowering the risk of osteoporosis, heart disease and breast cancer, but because it resembles estrogen, it has also been thought to be associated with infertility. The AAP states that there is no conclusive evidence in animal or human studies that soy will have a negative effect on development, immune, thyroid or reproductive functions. We agree that more studies in children are needed before a definite recommendation can be made, but as many cultures have been safely eating soy products for years, soy is likely safe to consume in moderation as part of a well-balanced, diverse diet.
Dairy provides an important source of protein for toddlers. If you are choosing a milk alternative, we recommend choosing one that contains protein and is most similar in caloric content to cow’s milk. Almond, coconut and rice milk contain a minimal amount of protein while hemp and oat milk both contain some protein. Newer to the market is Ripple Milk, a pea-based protein milk, which contains calories and protein more comparable to cow’s milk.
In general, using a toddler formula is unnecessary. Whichever milk or milk alternative you use, it is important to speak to your pediatrician and possibly a dietitian to ensure that your child’s diet is not protein or vitamin and mineral deficient.
About the authors:
Dina works as a board certified pediatrician at Pediatric Associates of NYC and at NYU Langone Medical Center. She has received numerous research awards, along with Patient’s Choice award, compassionate doctor recognition and was featured in the New York Times Magazine as a Super Doctors and New York Rising Star. She is dedicated to educating parents on baby and toddler nutrition and gives talks to parent groups throughout New York.
Anthony is a board certified pediatrician and board certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University. He has won numerous awards including the Norman J. Siegel Award at Yale University for leadership and providing outstanding clinical care as well as Physician of the Year during his time at Morgan Stanley Children’s Hospital. He has been named Castle Connolly Top Doctors since 2012. Anthony is interested in nutrition, especially in the care of children with difficulty gaining weight, feeding issues, and celiac disease. He loves teaching and educating parents and gives lectures to parents throughout New York and Connecticut.
Published August 2017