Does a Toddler or an Older Child Require Supplementation When Milk is Eliminated from the Diet?

The taste of supplementary products is peculiar, even unpleasant, and toddlers and older children are often not keen to drink them.

A population-based follow-up study (n = 3,289) monitored food-related symptoms with the aid of a questionnaire 1. When the children were 2 years of age, 83 % responded. Eighty-six children were investigated, 46 agreed to keep a food diary, and 28 were included in the final assessment (age 33 months).

In children on a milk-free diet the intake of the following was below the recommended limit: energy (7 of 10 less than the recommended 85 kcal/kg), protein (2 of 10 less than the recommended 1.5 g/kg), fat (3 of 10 less than the recommendation, i.e. < 20 % of energy intake), calcium (10 of 10 less than the minimum of 300 mg/day), iron and vitamin D. The findings were similar, but less marked, in those consuming milk products and supplements. The associated risks may include: retarded growth, lack of essential fatty acids due to the low intake of fat and problems with skeletal development. There is insufficient data on the long-term effects.

Similar results on the effects of milk-free diets have been obtained in studies carried out in specialist care patients in Finland 2, 3.

Comment: No input by a dietitian 1. How representative are the samples (all three studies)?

References

• Henriksen C, Eggesbø M, Halvorsen R, Botten G. Nutrient intake among two-year-old children on cows' milk-restricted diets. Acta Paediatr 2000 Mar;89(3):272-8. [PubMed]
• Paganus A, Juntunen-Backman K, Savilahti E. Follow-up of nutritional status and dietary survey in children with cow's milk allergy. Acta Paediatr 1992 Jun-Jul;81(6-7):518-21. [PubMed]
• Tiainen JM, Nuutinen OM, Kalavainen MP. Diet and nutritional status in children with cow's milk allergy. Eur J Clin Nutr 1995 Aug;49(8):605-12. [PubMed]