Toddler Milk Substitutes
By Jennifer J. Francis, MPH, RD/LD
Q. My daughter 13 1/2 months and has been VERY sensitive to dairy through my breastmilk which we didn't figure out until she was about 4 months (she had a really bad rash, diarhea, cried cried cried, dark circles around her eyes, rash around her mouth after nursing, changed her diaper like 40 times a day). I have not yet tried to give her ANY dairy, as we went through quite a bit in the early days with her. From about the time she was 4 months, I switched my entire diet and have been drinking calcium enriched rice milk, and eating a non-dairy diet, including rice cheese, rice dream ice cream (on occasion) and soy yogurt.
I am trying to wean her now and am wondering what your thoughts are on keeping her off of dairy for the time being. She is a picky eater and at the moment gets about 75% nutrition through breastfeeding. What can I do to provide her with the needed nutrients she won't be getting through cow's milk?
A. Children occasionally grow out of a milk allergy, so you might try introducing a small amount of hard cheeses, such as cheddar, from time to time, watching carefully to note any reactions. If no reaction is noted, the amount can be gradually increased and other sources of dairy attempted.
Dairy is a good source of not only calcium, but also riboflavin, Vitamin D, potassium and vitamin A. The reason dairy gets to be it's own food group is that it is a concentrated source of some of these key nutrients. These nutrients can be found in other foods, but in lesser amounts, so more food needs to be consumed to get the same amount of vitamins and minerals you would get from one serving of dairy. However, an adequate diet with a variety of nutrient dense foods can be achieved with careful planning.
Here are some of the best sources of foods containing some of the nutrients found in dairy:
Some non-dairy sources of calcium include: corn tortillas, Chinese cabbage, broccoli, kale, calcium set tofu. There are many calcium fortified products on the market today, including some breakfast cereals and orange juice. Manufacturers are getting better at using more absorbable types of calcium in these products. Orange juice is another possibility.
Riboflavin: Lean meats, eggs, nuts, green leafy vegetables, legumes and fortified breads and cereals are good sources. Our bodies can manufacture Vitamin D when our skin is exposed to the sun. Just 10 to 15 minutes a day on the face and arms 2-3 times a week seems to be sufficient. Some fortified cereals also have a little bit.
Potassium: Dried apricots, raisins, prunes, dried figs, trout, clams, chestnuts, water chestnuts, halibut, spinach, beet greens, fennel, bananas, okra, turkey, oranges, tomatoes and bell peppers
Vitamin A: Dark yellow/orange and dark green veggies such as carrots, sweet potatoes, dandelion greens, turnip greens, kale, butternut squash, beet greens, spinach, arugula, watercress, hubbard squash, and red bell peppers. There are other sources, such as liver, fish oil, and eggs, but they can be high in fat and calories.
Of course, not all of these foods are on the top ten list of a 13 month old's favorite foods, especially if she is a picky eater. However, you may be able to find one or two foods from each list that she likes. It's best to keep your pediatrician appraised of the situation. Although the foods listed are good sources of some of the nutrients in dairy, there is no food that is a good concentrated source of all the nutrients in dairy. It would be a shame to unnecessarily eliminate this group from her diet. Her doctor can probably refer you for some diagnostic tests if her problems with dairy persist.