Got Milk: Providing the Best Nutrition for Your Toddler

BY WENDY BAZILIAN, DrPH, RD.

When it comes to feeding a toddler, moms are faced with many questions, decisions and transitions. There are challenges, stand-offs, and even some victories, too. With all of these variables, only one thing is for sure: toddlers have tiny tummies, so it’s important to make their nutrition count. One of the very first decisions to make when a toddler is weaned from the breast or bottle is: Will he or she be a milk drinker?

Why Milk?

Breast milk and fortified formulas are essential for children from 1 to 3 years of age, but cow’s milk is a natural transition for many moms when introducing solid foods and new beverages to toddlers.

Cow’s milk has been the go-to beverage for toddlers 1 year and older for centuries.  Its nutritional profile most closely resembles breast milk, and it provides a wide array of essential nutrients.  Keith Ayoob, registered dietitian and associate professor at New York’s Albert Einstein College of Medicine, calls milk one of the “truly perfect packages” for toddlers.

In a recent paper published in the Journal of the American Dietetic Association, researchers concluded that milk is the leading contributor of minerals (calcium, phosphorus, zinc and magnesium), as well as the best source of vitamins (A, B6, B12 and D), thiamin, riboflavin and potassium in a toddler’s diet. In fact, milk is one of the very few foods that provide vitamin D, a critical nutrient that has an increasing and alarming prevalence of insufficiency in children.

As well as being packed with key nutrients, “it’s very economical at only 25 cents per 8 ounce glass” Elizabeth Ward, registered dietitian and author of The Complete Idiot’s Guide to Feeding Your Baby and Toddler, notes (she’s even using an expensive $4 gallon as an example).

NOTE: Ayoob, Ward, and pediatricians and dietitians nationwide recommend that toddlers drink whole milk until the age of 2. Fat and cholesterol play an important role in a toddler’s brain growth and development.

Soy Milk

Moms looking for alternatives to cow’s milk (due to intolerance, allergies or personal preference) might look to soy milk as a nutritious substitute. Soy milk can be a healthy alternative if you’re aware of the nutrients needed to match milk, cautions Ward. Soy provides a complete plant protein, but doesn’t contain calcium or vitamin D naturally, so choose regular, full-fat soy milks fortified with calcium and vitamin D.

Other Milk Substitutes?

Ayoob and Ward agree that rice and almond milks — fortified or not — aren’t appropriate substitutes for cow’s milk.  Rice and almonds are nutritious as foods, but neither provide the protein that toddlers’ bodies rely on from milk or soy milk.

Goat’s milk is a viable substitute, as it has many of the same essential nutrients as cow’s milk (calcium, protein and fat), but make sure that it’s fortified with vitamin D. Goat’s milk tends to be more expensive, less available, and has a different flavor that some children may find less appealing.

The Issue of Allergies and Intolerance

Some infants develop a milk allergy, but Ward notes that most kids outgrow their allergy with time, and that moms should work with a pediatrician to monitor this (or any food allergy).  Intolerance can create many symptoms, including digestive discomfort, gas, bloating or diarrhea, which can range from very mild to very severe. A true milk allergy is serious and should be treated through elimination and with medical advice.  However, lactose-intolerance is usually a matter of degree, and isn’t typically something absolute.

Soy is another common food sensitivity, with symptoms ranging from mild discomfort to downright pain. If a toddler demonstrates symptoms that appear to be associated with soy, talk to a pediatrician or a registered dietitian about making eating experiences both nutritious and pleasant for your child.

Some Things to Keep in Mind

When choosing milk,

Do:

• Pay attention to any signs of allergy or intolerance; consult your pediatrician or registered dietitian if necessary.
• Provide whole milk until age 2. After age 2, assess total fat intake and adjust accordingly (30 to 35 percent of total calories should be fat).
• Incorporate other foods and nutrients in addition to milk. Fruits, veggies, beans, nuts and other lean proteins are important, too.
• Limit milk servings to 16 to 20 ounces daily.
• Honor your personal religious and philosophical dietary preferences confidently. You can create a nutritious diet that includes animal-based foods or not.

Don’t:

• Give children raw milk. “There have been some real safety concerns over raw milk and there is no evidence that raw milk is better. Pasteurized milk is safe, healthy and nutritious for your toddler,” according to Ayoob.

When choosing soy milk,

Do:

• Pay attention to any signs of allergy or intolerance; consult your pediatrician or registered dietitian if necessary.
• Choose varieties fortified with calcium (30 percent DV) and vitamin D (20 to 25 percent DV) comparable to milk.
• Make sure that soy is the first ingredient in the ingredient list, and that added ingredients are limited (especially sugar).
• Incorporate other foods and nutrients in addition to soy milk. Fruits, veggies, beans, nuts and other lean proteins are important, too.
• Limit soy milk servings to about 16 to 20 ounces daily.
• Add a source of vitamin B12 if feeding a vegan diet to your toddler, and speak with a pediatrician or dietitian about other necessary nutrients.

Don’t:

• Mistake rice, almond and unfortified soy milks as substitutes.

How do They Stack up Nutritionally?

Following is a chart that compares the nutritional breakdown for milk and a nutritious, fortified soy milk, along with the daily recommendations for toddlers ages 1 through 3 years.

* The American Academy of Pediatrics recently recommended infants, toddlers and children receive 400 IU daily. The AAP suggests supplementation of vitamin D if a toddler is not getting the recommended amount through diet, which would be almost exclusively through milk or fortified soy.

** After age 2, moms should determine whether to stick with whole milk or shift to lower fat milk for toddlers. Low fat milk provides the very same nutrients, but has less fat and fewer calories.

Organic or Conventional?

Making mindful choices about buying organic versus conventional milk or soy milk for a toddler and the whole family is an important — and personal — decision. However, scientists and dietitians are confident that this is more a matter of personal preference than one of safety. Here’s a bit of information to guide your decision:

• rBST-free: rBST is a growth hormone given to some dairy cattle that helps increase milk production. Cows administered rBST are often administered antibiotics, as well. There is no solid evidence that this has any effect on human health, but a label on milk that reads ‘rBST-free’ indicates that this hormone was not used.
• Organic: To receive the organic label, dairy cows cannot be treated with rBST or antibiotics. Farmers also cannot use synthetic fertilizers or pesticides on their farmland. Soy milk is also available in organic and conventional varieties. To earn the organic label, all ingredients must be organic unless specified otherwise, such as “made with organic soybeans,” which may indicate other ingredients are conventionally grown or processed.
• Local: According to Ayoob, “Most people live within a two to three hour drive of a dairy farm, so it can actually be a relatively green drink.” Milk and soy milk can also travel great distances to get to grocery stores, both organic and conventional varieties alike. Therefore, a local option could at times be more important than organic when making a personal choice.
• UHT: Ultra-high temperature pasteurization is a high temperature, fast pasteurization method that sterilizes the milk from bacteria and also extends shelf life. You’ll see this in organic and conventional varieties. It’s safe and does not alter the nutritional quality of the milk.
• GMO (genetically modified organism): This pertains to soy milk only. The U.S. doesn’t require a label for this, as science hasn’t conclusively determined an associated risk. However, soybeans and corn are the top two genetically modified organisms in the U.S., so chances are the product is probably genetically modified if not listed as GMO-free.

The Bottom Line

Toddlers and their tiny tummies need food and beverages that are packed with the nutrients necessary for proper development and health, including milk or nutritionally-fortified soy milk. Focus on whole foods and natural nutrient sources when possible, and adapt personal philosophies around these when making the choice on milk and milk substitutes for your little one.

Wendy Bazilian is a doctor of public health, registered dietitian and freelance writer in San Diego. She is also the nutrition specialist at the renowned Golden Door and co-owner of Bazilian’s Health Clinic with her husband, Dr. Jason Bazilian. Dr. Wendy is author of “The SuperFoodsRx Diet.” www.wendybazilian.com