Just as there is much information — and disinformation — about what makes a healthy diet for adults, there are also lots of opinions about proper nutrition for children under 5. This can lead to confusion and concern for parents, as they attempt to differentiate fact from fiction.
One example is whether children under 5 should consume plant-based milks, such as soy, rice, almond, oat and coconut. National guidelines released in late 2019 advise that children ages 2 to 5 should drink only cow’s milk. However, pediatricians, nutritionists and lifestyle medicine doctors, such as Dr. Teresa Hardisty and Dr. Cherie Chu with Sharp Rees-Stealy Medical Group, recommend carefully reviewing and weighing the effects of dairy consumption and the value of some plant-based milks.
Drs. Chu and Hardisty recently shared their answers to some of parents’ top questions about the guidelines and why they feel they may be confusing — and even misleading.
Q: What are your concerns about the report’s recommendation that children ages 2 to 5 consume only cow’s milk and avoid plant-based milks?
A: In the report, cow’s milk was set as the standard in comparison to plant-based milks without significant justification. Although it is a rich source of macro- and micronutrients, there are many health concerns with dairy consumption.
The report failed to mention that researchers were comparing sweetened soy milk and sweetened plant-based milks against unsweetened cow’s milk, which is not an appropriate comparison. It also did not recognize that fortified soy milk has been given to toddlers with cow’s milk allergies for decades, and in many ways, is a superior source of macro- and micronutrients versus cow’s milk.
The labels confirm that fortified vanilla-flavored soy milk and fortified unsweetened soy milk contain more calcium, fiber, iron, magnesium, riboflavin, and vitamins D and A; an equivalent amount of protein, potassium and sodium; and less saturated fat, total fat, sugar, calories and cholesterol than cow’s milk. Any form of cow’s milk, even nonfat, contains 12 grams of sugar per serving, while unsweetened soy milk has only 1 gram of sugar, and flavored soy milks vary from 6 to 10 grams, depending on the brand.
Considering the health concerns of dairy and the health benefits of soy milk, soy milk should be a preferred milk beverage option to offer young children over age 1, rather than cow’s milk.
Do plant-based milks pose health risks to children?
Neither cow’s milk nor plant-based milk should be given to children under the age of 1, as their nutritional profiles are inappropriate for this age group. Only breastmilk or formula should be given to babies, as they are still dependent on this milk for a majority of their calories.
However, children over age 1 should be eating a wide variety of food and start to become less dependent on milk for calories. Where certain plant-based milks might potentially fall short in this age group is if a child is not eating much food and is only drinking milk. If a low-calorie, plant-based milk is being given, it may not have the appropriate amount of nutrients to support proper growth.
What concerns do you have about restricting a child’s milk intake solely to cow’s milk?
Drinking too much cow’s milk can cause constipation, as well as anemia. Cow’s milk can interfere with the body’s absorption of iron and can cause small losses of blood in the intestine. It is also important to keep in mind that cow’s milk is one of the biggest sources of saturated fat in the American diet. If it is overconsumed, it can lead to issues of obesity and heart disease later in life. We need to be judicious in how we incorporate it into our children's diets, as their food choices when they are young often shape their eating habits as adults.
In general, what do you recommend children under 5 drink?
It is recommended that kids consume 16 to 24 ounces of calcium-containing milk and yogurt per day, whether it is from a cow or plant-based. Families may choose a plant-based milk for their child for a variety of reasons, including a child’s milk allergy or intolerance, health benefits or personal belief. A plant-based milk, such as fortified soy milk, would be an appropriate choice in all of these cases for children over age 1.
For families who prefer plant-based milks besides soy, there are other options, but they should talk with their doctor about whether it would be appropriate for their child’s specific dietary situation. Other types of plant-based milk can provide similar nutrition, but it is important to look at the nutrition label — especially at the level of calcium — to see if your milk of choice is comparable. The plant-based milk market is quickly expanding and there are wide variations in nutritional content.
For hydration, water is still the best choice. It can be fun for kids to add sliced strawberries, oranges, mint or cucumbers in their water to give it some flavor as a healthier alternative to sugary beverages. Juice, sports drinks and soda are not recommended for children. In fact, sugary drinks and sugary snacks undermine hunger, which then interferes with healthy eating habits.
Talk to your child’s doctor about milk choices and what might be best for your family. The bottom line is that feeding your child a healthy diet with a wide variety of food will help them to thrive, regardless of their milk choice.