Pediatrics

got non-dairy milk?

When thinking of infant and child nutrition, it is important to first make the observation. Is your child reacting to what you are giving? Does either parent express a food sensitivity or allergy? The most common question in practice is, what is the best nutritional advice? And this is a complex answer because it depends on many factors involved in the child’s life: finances, health history, lifestyle habits, family history, etc. Overall, it is best to receive individual consultations based on your personal situation. My best advice is: the more you can observe your child’s behavior, the better you can tailor their diet to their needs. I often say to parents that they themselves will be doctors for rearing their child!

A big concern is cow’s milk – when and is it a good idea to introduce, and what are the safe alternatives?

When to introduce: overall, breast-fed babies appear to have stronger immune system’s then non breast-fed babies. As for the length of time to breast-feed, evidence in the literature is not conclusive, however it is generally said to be between 6 months to 1.5 years, and it appears the longer the better. The major concern with introducing cow’s milk to early appears to be related to the association with auto-immune disease (such as Type 1 diabetes) (Horm Metab 2002) or atopic dermatitis (eczema). It seems as though the latter may have stronger evidence to prove that early intervention of cow’s milk may contribute to atopy (Curr Allergy Asthma Rep 2011), although it is seems to be a trigger in those with a family history. Food triggers other than cow’s milk include egg, soy, wheat, fish, peanuts, and tree nuts.

The link with type 1 diabetes appears to be stronger if fed cow’s milk before 6 months of age (N Engl J Med 2010) as compared to casein hydrolyzed formula in the event when breast-feeding is not possible.

In one study, cow’s milk may induce celiac disease-like symptoms because of the possibility of gluten peptides present in cow’s milk (Nutrition 2008). In another study, cow’s milk and other complex proteins found in foods may contribute to cross reactive antibodies which may increase symptoms of joint pain in people suffering from Rheumatoid Arthritis (Gut 2006). This occurs as a results of multiple modest hypersensitivity reactions mediated by immune complexes promoting auto-immune reactions in joints. Another negative association with cow’s milk comes from the link with certain cancers such as breast and prostate, as it increases insulin-like-growth factor (IGF-1) (Proc Nutr Soc 2011).

IGF-1, however, is necessary for growth and development, especially in children. Furthermore, calcium content is most indicative of long-term bone mineral density based on the calcium ingested during adolescence. And so, eliminating cow’s milk may surely decrease the amount of calcium that is being consumed at a crucial point in life. This is in tandem with vitamin D. And with children, eating dark-leafy greens may pose some difficulties with some children!

If there are no sensitivity reactions or allergic reactions to cow’s milk, then you are off to a good start! However, more and more children are having difficulty digesting cow’s milk due to the complexe proteins, toxins and additives in milk. First and foremost, is to buy organic milk from cow’s free of growth hormones. This will reduce the amount of IGFs. If there is an allergy to cow’s milk, there is most likely an allergy to soy milk. Soy milk is generally not advised before puberty because of the potential phyto-estrogenic compounds. As alternatives, I recommend almond, rice, goat, or sheep’s milk – any of which to be unsweetened. Most non-dairy milk products are now fortified with the appropriate levels of vitamins and minerals.

Supplementing with a liquid calcium may be considered if you suspect that nutrition is not adequate – or during big growth spurts.

You want to be cautious of oral tolerance. It is not recommended to avoid allergenic foods (Arch Pediatr Adolesc Med 2011) in the event of sensitivity, however responding with appropriate dosing of foods, using variety and maintaining a rotation diet to avoid over or under expression of the immune system are the most protective measures to take.

Keep in mind that the immune system is like a see-saw. You have your humoral system (responsible for allergies and atopy) on one end, and the cell-mediated (responsible for auto-immune conditions) on the other. As one goes down, the other goes up and vice-versa. And so, with complex proteins found in cow’s milk, if you are to use it, be sure to use in moderation. And, in genetically susceptible children with a family history, ensure that bowel health is at the optimal because many protein-complexes make it to the intestines where they create immune reactions and certain non-specific symptoms which may indicate the beginnings of a chronic illness.

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