The Best Milk Choices for Children
Around the time a child turns one, many parents become privy to the American Academy of Pediatrics recommendations for milk intake in infants. However in recent years, more and more parents are coming to me with questions about if cow’s milk is still the best milk option for their young children after transitioning off of breastmilk and/or infant formula.
This question usually comes up based on a variety of vantage points, making the “right” answer unique to a family’s personal food preferences and dietary priorities.
For children who cannot consume cow's milk due to an allergy or intolerance, cow's milk alternatives are medically indicated. For other families, dietary preferences guide their decision towards a milk alternative (i.e. veganism).
In this post, I will highlight some important considerations when choosing milk or a milk alternative for toddlers.
As always, be sure to consult your child’s primary health care provider if you have specific questions or concerns about which milk might be best for your toddler.
From a Public Health Perspective
The transition to milk or a milk alternative (from breastmilk or infant formula) in toddlerhood can have long term implications on a child’s dietary habits and overall health. We know, from scientific reports like this one, that the dietary choices families make during the impressionable window track into childhood and adolescence and ultimately can shape diet quality in adulthood.
As summarized in this report,
“Beverages play a critical role in young children’s health as they comprise a larger portion of the recommended overall diet during early life, serving as key contributors to both hydration and nutrition.”
So although we focus exclusively on milk and milk alternatives in this post, helping your child to develop healthy habits with the beverages they consume on a regular basis is something that starts the minute any alternative to breastmilk or infant formula is offered. For this reason, it is important to note in the following sections where certain nutritional pros and cons are mentioned and the public health impact that can occur when a child does not consume milk or a milk alternative.
If we narrowly look at our family’s choice in milk or a milk alternative as a short-term decision and solely on the immediacy of trying to get them to tolerate milk or a milk alternative early on, we may adopt unhealthy habits. In attempts to improve their interest in it, we may opt to introduce our young child to a sugar-sweetened milk or milk alternative (not from the lactose naturally occuring in cow’s milk but rather the use of added sweeteners to improve taste in milk and milk alternatives). Or, if we prematurely give up on finding a fluid milk our child enjoys, we may find it is harder for our child to meet their nutritional needs now and later in life when certain nutrients are in greater demand (such a calcium intake in adolescence). Either of these scenarios, as well as several others that can happen, point to the importance of finding a milk or milk alternative that is readily available, easily accessible, medically suitable, preferable, and nutritionally complete (or as close to as possible).
As parents, we need to seek out the best available research and consider the advice of expert committees when making our decisions. This may not always match popular opinion, the dietary preferences or food requests of a child, nor the products being marketed as seemingly “superior” milk options, but discerning what beverages play the most important role in a child’s diet is imperative and of great impact.
Your Child’s Nutritional Requirements
The transition from infancy to toddlerhood comes with changes to how your child meets their nutritional needs. As breastmilk and/or infant formula is decreased and more table foods are introduced, toddlers begin to rely more heavily on the nutrition they get from the foods they consume and less on liquid calories. This makes deciding on which milk or milk alternative to offer your child all the more important.
Parents need to consider what role milk plays in their child’s existing diet and if/how these nutritional gaps will be met (or not) through the different options for milk alternatives on the market. Many of the key nutrients that were critical in your child’s diet as an infant are still important in toddlerhood. These include:
Calories
On average, toddlers need around 1,000 calories per day. While I don’t recommend parents count their children’s calories, this can be a helpful number to keep in mind when parents consider how many calories per day their child gets from milk (or a milk alternative). Oftentimes, toddlers are meeting more of their calorie needs from milk than necessary. A good target for toddlers is to get 2-3 servings of dairy per day, as this helps children to meet their calorie, vitamin D, and calcium needs for growth and development without taking over with the role other foods have on helping them meet their overall nutritional needs. As interest and intake of dairy-based foods increase, intake of dairy in a fluid form needs to be adjusted as well so that calories are more evenly distributed across food groups. This will help ensure that a child’s source of calories comes from a variety of sources. Equally so, if a child consumes a lower-calorie milk alternative, calories need to be increased elsewhere in the diet to account for those that are lacking in their milk source.
Fat
More so than in any other age group, toddlers need fat in their diets. So much so that 30-40% of a toddler’s caloric intake should come in the form of fat. This is just under what they relied on getting from breast milk or infant formula. A variety of fats are necessary for key functions of a child’s health and development, including our children's ability to absorb important fat-soluble vitamins from food (like vitamin D). Fat also offers a mouth feel that can help reinforce pleasure and satiety (including with kids). Opting for a milk or milk alternative that offers flavor and a positive mouth-feel by way of fat instead of in the form of added sugars, flavors, or other additives is ideal.
Recommendations on the transition from a whole milk to low-fat or fat-free alternative after two years of age will be addressed in greater detail in next week’s blog post.
Protein
Protein is a major component of every cell in the body and plays a part in helping keep young kids feeling full between meals.Young children, however, often need less protein in their diets than many parents assume, with the average 1-3 year old only requiring 0.5 grams of protein per pound of body weight per day (i.e. 13 grams of protein for a 26-pound child). While this may not be a lot of protein, milk or milk alternatives can play a key role in helping toddlers meet their protein needs as they transition to table foods, and adopt eating habits that include protein-rich foods. Parents should consider the amount, quality, and variety of protein their child is getting from milk- and food-based sources when evaluating which milk alternative offers adequate protein to help their child meet their daily needs.
Vitamin D
Vitamin D is increasingly being known not just for its role in the development of healthy bones and teeth but also in immune health and reducing inflammation. As toddlers, our children’s need for vitamin D increases from 400 to 600 IU daily. Although some foods have been fortified with vitamin D to help boost our toddler’s intake, many toddlers struggle to get enough vitamin D from naturally-occurring or fortified food sources alone. Since cow’s milk is often a key source of vitamin D for toddlers as they transition to table foods, parents ought to consider if and how much vitamin D their child gets from non-milk-based sources, in order to find a milk alternative that best fills the nutritional void for vitamin D.
Calcium
From ages 1-3, children need approximately 700 mg of calcium per day to support children’s growing bones, bodies, and teeth. While cow’s milk is an obvious and efficient way to help toddlers meet their calcium needs, traditional milk is not the only means for children to get enough calcium. Other foods are naturally good sources of calcium and many milk alternatives are fortified to help children on dairy-free diets to meet their calcium needs. Parents should compare the calcium content of milk alternatives when considering which one is best suited for helping their child meet and maintain their calcium needs throughout childhood.
With these nutritional considerations in mind, parents should be able to more keenly compare and contrast the following milk and milk alternatives to evaluate which is nutritionally the best option for their child’s diet.
Milk Choices for Children: Cow’s Milk and Milk Alternatives
Cow’s Milk
Nutritional Pros
Many families are already accustomed to buying and consuming cow’s milk. This makes this milk option an obvious choice for many (who aren’t avoiding dairy). It is an efficient way to help toddlers get in calcium and vitamin D, as well as to add protein and fat to their diet (assuming a full or reduced fat milk variety is used). Cow’s milk can be an economical and readily available option for families who prefer a milk choice that is convenient both in accessibility and nutritional bioavailability. The fatty acid profile of organic and grass-fed milks also offer higher amounts of omega-3 fatty acids over conventional cow’s milk and milk alternatives, when available.
Nutritional Cons
An obvious concern with cow’s milk is that it is not suitable for children with a cow’s milk allergy or dairy intolerance, or for families who have adopted a vegan lifestyle. Nutritionally speaking, if a child consumes more than the recommended daily amount of cow’s milk (or dairy), it may interfere with their intake of iron-rich foods and compromise their iron status since cow’s milk lacks iron and often replaces iron-rich foods in toddler’s diets. Ethically speaking, more families are becoming concerned about consuming animal-based milk in general, as well as with the quality of conventional cow’s milk compared to more premium options for organic and/or grass-fed on the market. Premium milk options may be less available and/or cost-prohibitive for many families.
Bottom Line
Cow’s milk is an appropriate pick for parents who want an affordable, readily-available milk option that helps promote the nutrients their toddler needs, as the child’s diet continues to expand to include more nutrient-rich foods. High-quality milk products from humanely raised cows that are grass-fed, allowed to graze, and with year-round access to the outdoors are the gold standard. When it fits a family’s food budget to do so, choose organic varieties fortified with omega-3 fatty acids or milk from grass-fed cows (which have higher amounts of conjugated linoleic acid and omega-3 fatty acids than conventional milk).
Goat Milk
Nutritional Pros
Goat milk is an often overlooked alternative to cow’s milk. With more calories, fat, calcium, and vitamin A than cow’s milk, goat milk offers a nutrient-dense option to help growing children get in the nutrition they need. For children who are sensitive to milk, goat milk may be a gentler alternative before eliminating dairy-based milk options altogether. Goat milk also contains prebiotics, which can help support digestive health by feeding probiotics in the gut.
Nutritional Cons
Goat milk is not suitable for children with a confirmed Cow Milk Protein Allergy, as the majority of children with a Cow Milk Protein Allergy also do not tolerate goat’s milk. While standard goat milk is an appropriate option for older children and families, it lacks some important vitamins and minerals for toddlers and infants, such as folic acid, iron, vitamin D, and B12. Additionally, goat milk can be more difficult to find than cow’s milk and come at an increased price point.
Bottom Line
Goat’s milk is an appropriate pick for parents who have a child with digestive symptoms associated with cow milk (i.e. constipation, diarrhea, spit up), but not a true Cow Milk Protein Allergy. Goat milk is also a good option for families who need an alternative to cow’s milk, with more nutritional value than many plant based milk options.
Soy Milk
Nutritional Pros
Soy milk is often one of the first milk alternatives parents think of when a dairy allergy or intolerance presents or among families pursuing a more plant-based lifestyle. Until the introduction of pea milk, soy milk was the vegan milk alternative with the highest amount of protein. Soy milk has some fat content as well, comparable to that of a reduced-fat cow’s milk.
Nutritional Cons
As moms with dairy intolerant infants can attest, research has shown that children may also react poorly to soy milk if a milk protein allergy or intolerance is also present. For this reason, soy may not always be a suitable alternative to cow’s milk for some toddlers. Since soy milk is lower in important vitamins and minerals than cow’s milk, most soy milk is fortified with calcium, vitamin D, phosphorus, riboflavin, and vitamin B12 to more closely compare to the nutrition of cow’s milk. Although the American Institute for Cancer Research shows that soy is safe for children in moderate amounts, children should limit their intake of soy milk to two servings per day. Soy milk may also be sweetened to improve the taste, so parents should opt for varieties with low- to no-added sugar.
Bottom Line
Soy milk is an appropriate pick for parents who want a vegan, nutrient-dense alternative to cow’s milk with more protein than many other plant-based milk alternatives.
Pea Milk
Nutritional Pros
Pea milk offers a safe, vegan alternative for toddlers allergic to top allergens like dairy, soy, nuts, and gluten. It is also the first plant-based milk alternative since soy to have a comparable protein content to cow’s milk (due to the yellow pea content). With fat content comparable to 2% reduced fat cow’s milk plus added omega-3s, pea milk also offers more fat than other nut-based milks. Pea milk has been fortified to have more calcium and vitamin D than cow’s milk.
Nutritional Cons
Although there are unsweetened varieties of pea milk, many flavors contain added sugars. Pea milk also may be harder for families to both find and afford. The price point of pea milk tends to be more expensive than conventionally-raised cow’s milk and more similar in cost ounce for ounce to a high-quality milk product.
Bottom Line
Pea milk is an appropriate pick for parents who need a milk free from common allergens like dairy, soy, nuts, and gluten, or who prefer a plant-based milk option with more fat and protein than other alternatives on the market. As with other flavored milk alternatives, parents should select pea milk that is unsweetened. Of milk alternatives, pea milk is a top contender as it offers more dietary bang for a family’s buck than other options in terms of calories, protein, fat, and vitamin and mineral fortification.
Coconut Milk
Nutritional Pros
Coconut milk offers a safe, vegan alternative for toddlers allergic to top allergens like dairy, soy, nuts, and gluten. While naturally high in fat (and calories), most commercial coconut milk alternatives have been made into a drinking milk option available in the carton (instead of the varieties available for cooking in the can). With this, both the fat and calorie content is less than in regular coconut milk and more closely resembles the fact content of a reduced-fat 2% cow’s milk.
Nutritional Cons
Coconut milk has less calcium, vitamin D, protein, and calories compared to cow’s milk. For this reason, parents ought to opt for the drinking beverage options that have been fortified with added vitamins and minerals (although these still have low protein content).
Bottom Line
Coconut milk is an appropriate pick for parents who need a milk free from common allergens like dairy, soy, or nuts. If a toddler consumes enough protein from other food sources, coconut milk may be an acceptable milk alternative. Otherwise, using coconut milk to cook with is a good way to include this milk alternative on occasion (instead of exclusively).
Nut Milks
Nutritional Pros
Almond, cashew, and other nut-based milk options offer a safe, vegan alternative for toddlers allergic to dairy, soy, and gluten. Most nut milk options (available at the grocery store) have been fortified with calcium and vitamin D to better help children meet their recommended daily needs.
Nutritional Cons
Nut milk is not suitable for toddlers with a nut allergy. Nut milks also remain the lowest in calories of all milk alternatives, so parents should be sure their toddler is consuming enough calories to sustain proper growth and development elsewhere in the diet if switching to a nut milk alternative. Although almonds and other nuts like cashews provide heart healthy fats and protein, nut milk alternatives are low in both fat and protein and other important vitamins and minerals. Although nut milks are rather simple to make at home, critical vitamins and minerals will be lacking as none have been fortified to your homemade alternative. Some store-bought nut milks have added fillers and sweeteners, however, to improve their taste and texture and are best avoided.
Bottom Line
Nut milk is an appropriate pick for parents who want to include a dairy- and soy-free milk alternative into their child’s diet. If a toddler consumes enough fat and protein from other food sources, nut milks may be an acceptable alternative to consume as a beverage option. Nut milks can be a great substitute for other liquids in cooking and baking, especially in place of water, to help boost the food’s overall nutrition. When buying, parents should look for unsweetened varieties that limit added fillers or sugars.
Hemp Milks
Nutritional Pros
Hemp milk offers a safe, vegan alternative for toddlers allergic to dairy, soy, and gluten. Hemp milk has more fat and protein than other nut milk alternatives on the market. Of its fat content, hemp milk contains naturally-occurring omega-3 fats which are important for a toddler’s growth and development and may otherwise not be eaten enough through other foods sources in their diets.
Nutritional Cons
Even with more protein than other nut milk alternatives, hemp milk still provides much less protein than cow, goat, soy, or pea milk (2 grams protein per cup compared to 8-9 grams per cup). Hemp milk has less calcium and vitamin D than cow’s milk, so parents should look for a fortified option. In order to improve the taste, a lot of hemp milk varieties are flavored with added sugars. Hemp milk is still harder for most families to access and is a more expensive milk alternative for families looking to transition their whole family to it as a milk beverage substitute.
Bottom Line
Hemp milk is an appropriate pick for parents who need a dairy-, soy-, and gluten-free milk alternative that helps their toddler to get more omega fatty acids into their diet (although adding actual hemp hearts can also do this). In order to promote healthy long term habits however, it is important that toddlers learn to like unsweetened hemp milk options instead of the more sweetened, flavored varieties. Parents ought to also make sure their toddler is getting adequate protein from elsewhere in their diet prior to opting for hemp milk alternatives.
Rice Milk
Nutritional Pros
Rice milk offers a safe, vegan alternative for toddlers allergic to top allergens like dairy, soy, nuts, and gluten. It is higher in calories than most other plant-based milk alternatives, except oat milk.
Nutritional Cons
The higher calories in rice milk come in the form of refined carbohydrates and not the protein and fat needed for toddler’s growth and development. Rice milk offers a safe, vegan alternative for toddlers allergic to dairy, soy, and gluten. Rice milk also may be sweetened, so parents need to find unflavored options (which may not be palatable to toddlers). Since most toddlers do not have an issue meeting their need for carbohydrates from food sources, even fortified options of this carbohydrate-rich milk alternative offer little nutritional value to toddlers.
Bottom Line
Rice milk was on the market before many other milk alternatives existed. With many other options offering more nutritional benefits in the form of fat, protein, calories, and naturally-occurring or fortified vitamins and minerals, parents ought to evaluate other milk alternatives as more nutrient-rich options instead of rice milk.
Oat Milk
Nutritional Pros
Oat milk offers a safe, vegan alternative for toddlers allergic to top allergens like dairy, soy, and nuts. Oat milk has the most calories of any plant-based milk alternative, and although it is the highest in carbohydrates it also has more protein than nut milk alternatives (but still less than half the protein of cow’s milk). Oat milk is also the only milk alternative that has any fiber (with approximately 2 grams per cup).
Nutritional Cons
Oat milk may not be a safe alternative for toddlers with gluten intolerance or celiac disease. It can also be hard for families to find and is more expensive than conventionally-raised cow’s milk. Parents should be sure to select an oat milk that has been fortified with added calcium and vitamin D to make it more comparable to that in cow’s milk.
Bottom Line
Oat milk is an appropriate pick for parents who need a dairy, soy, and nut free option that has more fat and protein than other milk alternatives. Parents should continue to select unsweetened varieties to reduce any added sugar and opt for the full-fat options, whenever available. Oat milk, in addition to pea milk, would be the other top contender for more nutritionally-beneficial milk alternatives on the market.
Making a Choice about Milk or Milk Alternatives for Toddlers
In closing, it is important to note that every toddler’s dietary intake and taste preferences differ, making there no one-size-fits-all approach to selecting milk for families. Instead, each parent should consider their child’s nutritional needs, lifestyle, and what fits a family’s dietary values and food budget. The emphasis should be on selecting a milk or milk alternative that helps a family to optimize this stage of development to promote nutrition and establish healthy habits with the beverages being consumed.
“Early childhood (ages 0 to 5 years) is a critical period for establishing healthy dietary patterns and taste preferences, which are important in supporting optimal growth and development and in preventing diet-related chronic disease. Dietary habits established early in life track into childhood and adolescence, and influence diet quality during adulthood.”
Hopefully this review has helped provide you with a more comprehensive understanding of the pros, cons, and other considerations for choosing a milk or milk alternative for your child!