Cow's milk and milk alternatives for > 12 months: What you need to know

All milks are not created equal and with so many alternatives on the market it can get confusing, especially when choosing a milk or milk replacement for your child.

Firstly, breastfeeding is recommended for 2 years and beyond by the World Health Organisation (WHO), so if breastfeeding is working for you and your child then continue beyond 12 months, there is no need to stop, and there are ongoing significant health benefits to breastfeeding for both you and your child.

From 0-12 completed months of age breastfeeding and/or infant formula is recommended as the main fluid source of milk. Breast milk should not be replaced with other options other than infant formula, if required. Cow’s milk, mammalian milks and plant milk alternatives are not suitable for infants as their main drink.

After 12 completed months of age babies can transition to a standard milk as their main drink (remember you can continue to breastfeed if this is working for you and your child). Infant formula can be stopped and there is no need for toddler or follow-on formulas beyond 12 months in healthy children.

When you are transitioning to a milk or milk alternative, it is important to remember that after 12 months of age the consumption of cow’s milk should be limited to a maximum of 500 mL/day because of the risk of reducing diversity in the diet by affecting appetite and impacting iron absorption in higher amounts (NHMRC 2012). This 500ml limit should also be applied to milk alternatives for the risk of reducing diversity in the diet if consumed in larger volumes and due to low nutritional value of some milk alternatives, displacing more nutritional options.

Full cream cow’s milk:

Full cream cow’s milk is an excellent source of fat, protein and calcium for children. Cow’s milk protein contains all nine essential amino acids (making it a complete source of protein) and with 8g of protein per cup it can meet 60% of the recommended daily intake (RDI) in toddlers. The 4% fat in full cream milk also contributes to 50% of its total energy content (similar to breast milk) making it a great source of fat, fat is essential for growth in children. Low-fat and reduced-fat milks (including skim milk) have a fat content of 0.1–2.5% so fat levels are not nutritionally suitable for children (NHMRC 2012).

Lactose free milk:

Lactose free milk is used specifically for lactose intolerance, it is not a suitable alternative for CMPA (cows milk protein allergy/intolerance) as it still contains dairy proteins. Lactose free milk contains none of the sugar Lactose which has either been filtered and removed or broken down in the milk by the addition of the enzyme lactase which converts Lactose into 2 simple sugars that are easier to digest. Like Cow’s milk, a full cream lactose free milk should be chosen.

Goats Milk:

Also not recommended as an alternative milk for CMPA (cow’s milk protein allergy) In vitro studies have shown cross-reactivity between cow’s milk and goat’s milk protein, it is also not beneficial for use in lactose intolerance. Goat’s milk is actually low in B12, C, D and folic acid compared to cow’s milk. Total fat content and the proportion of fatty acids are relatively similar in goat and cow milk except for more medium chain fatty acids (caprylic and capric) and branched‐chain fatty acids, there are some reports that because of this it may be easier to digest.

Soy Milk:

A suitable plant-based alternative to cow’s milk and the most nutritionally complete plant-based alternative in children over 12 months of age. Similar in calories and protein to cow’s milk and also contains fat. Choose a soy milk that is calcium fortified and unsweetened.

Almond Milk:

The lowest nutritional value for calories, protein and fat, it is an inadequate nutrition source for children. However, if children are meeting their nutrition requirements from other foods than this may be an alternative (discuss with your health professional). Choose an almond milk that is calcium fortified and unsweetened

Rice Milk:

Similar in calories to cow’s milk but low in protein and fat which are important for children. Again, choosing a rice milk that is calcium enriched, no added sugars/sweeteners. Rice and rice-based products can be a source of inorganic arsenic, as such, FSANZ (Food Safety Australia and New Zealand) advises eating a mixed diet with a variety of foods to limit exposure. So, rotate the use of rice milk for your child, with other plant-based milk alternatives. Other sources of fat and protein would be required in the diet.

Oat milk:

Lower in calories, protein and fat compared to cow’s milk, it is an inadequate nutrition source for children. It is not suitable in Coeliac disease. If children are meeting their nutrition requirements from other foods than this may be an alternative (discuss with your health professional).Choose one that is calcium enriched and unsweetened.

Milk alternatives can be used after 12 completed months of age under health professional supervision, as long as they are calcium fortified (look for 120mg calcium per 100ml) alternative forms of fat, protein, and vitamin B12 are included in the diet (NHMRC 2012). For all plant-based milk alternatives for children it is also important to choose a milk substitute that is unsweetened, and I would also recommend finding one that has limited preservatives, binders and emulsifiers.

If your child does need to exclude cow’s milk from their diet due to allergies or as a lifestyle choice, it is best to seek assessment from a Dietitian to ensure their diet is adequate.

X Anna

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