Small Child with a Milk Allergy? Now what?
|original glass of milk courtesy of Hobbies Sudoneighm|
via Flickr Creative Commons
Learning your child has a dairy allergy, or a dairy intolerance can be far from straightforward. Small mammals are supposed to have a diet predominantly consisting of milk for the first year of life and although during an infant's first year you will probably have prescription formula as a main feed, there is little advice out there for weaning, let alone what to do for the older dairy allergic child.
Current advice is that a prescription non dairy and usually non soya feed is prescribed as a main food source for infants under a year. In some circumstances this is extended to the first two years. (always consult your health professional, since a) I am not one, b) I don't know your child and c) advice changes fairly frequently) After this time you are pretty much on your own, with the responsibility of giving your child a varied, tasty and nutritious diet with sufficient calcium since milk is often the main source of this mineral for young children.
There are several alternatives available though, many of them fortified with additional vitamins and minerals.
Soya Formula used to be the fall back when dairy intolerance was suspected. (My eldest was on Wysoy for most of his first year.) But due to the fact that it is high in phytoestrogens, and because it is also highly allergenic this is no longer recommended, and you cannot buy it off the shelf in the UK any longer. The other issue with soya formula was the glucose content, which is more harmful to infant teeth than lactose.
Soya milk is however highest in protein of all the non-dairy options. It’s the only one that’s comparable to cow’s milk, providing between 8 and 11 grams of protein per glass - one reason why older children are often encouraged to have soya milk and yoghurts if they cannot tolerate dairy. But even if you are not intolerant or allergic to Soya it is very easy to develop an intolerance to it if you overdo it. After breastfeeding my twins for 16 months on an exclusion diet I became intolerant to dairy. Whilst gradually trying to wean myself back on to regular milk I substituted wholesale with soya.... and quickly developed an intolerance to it. Moderation is key!
Soya milk is not heat stable and needs careful heating, or it will curdle. It's definitely not a good alternative for cooking and is rubbish in sauces.
Rice milk has been in the press recently due its naturally "high" levels of arsenic. Concern originally stemmed from a study of arsenic levels in Baby Rice. You can read the NHS report here. Rice and rice products are known to have higher levels of inorganic arsenic compared with other foodstuffs, but the real concern for many was twofold. First a small child drinking rice milk daily is going to ingest more arsenic per unit body mass than an adult as they are smaller. Second, anyone on an exclusion or "freefrom" diet is going to eat a LOT of rice, because it's in EVERYTHING. So drinking it as well is perhaps not ideal.
It's heat stable though - which is great for cooking and making sauces, and has a pleasant taste. It's the one you are least likely to be allergic to but tends to be higher in sugar and therefore calories and is likely to give your child a "sugar rush". So chocolate rice milk is really NOT a good idea!
UK advice is that Rice milk should not be given as a main drink to children under the age of 5.
I LOVE oat milk. Heat stable, thick and "creamy" with a lovely nutty taste, it makes excellent sauces, is lovely stirred in porridge, and Oatly Cream works wonders in baking. BUT... and it's a big but, it's not gluten free, due to possible cross contamination. It is very low in gluten - some might tolerate it, but do ensure you ask your health professional first since according to a top paediatric dietician, oat milk is not suitable for coeliacs and others sensitive to gluten might not tolerate it either. Rude Health do however say their oat drink is gluten free.
Oat milk has around 4g of protein per glass, is a little higher in sugar and fat but has additional fibre which is good.
You can make your own oat milk - which will not need to have oil added unlike bought oat milk.
As with oat Milk - you can make your own Almond Milk quite easily, although it is expensive in large volumes!
Almond milk has a lovely nutty taste and is pretty heat stable, it won't curdle when you warm it in sauces or hot drinks. Bizarrely it is quite low in protein, but also lower in fat and sugar than other milk-alternatives. It is high in minerals but these are less bioavailable due to something called physic acid present in Almond Milk.
Obviously a big no for nut allergy sufferers!!
When I first tried this 8 years ago, friends thought I was mad! It is an acquired taste, and I would never use it in a sweet recipe, but I like it. Likewise Hemp oil is great for cooking too - especially stir fries. It has Omega 3 Oils - 6 x as much as cows milk and 4 x as much as soya milk. It also has a variety of vitamins and minerals such as vitamins A, E, and B12, potassium, phosphorus, magnesium, iron, and zinc. It also contains all 10 essential amino acids! It's not very high in protein though.
Coconut milk is high in minerals like magnesium, iron and potassium, and vitamins B, C and E. It is high in medium chain fatty acids which are easily burned as fuel by the body, so good fats readily broken down. It is also uniquely high in lauric acid which is found in breastmilk, and has antiviral and anti fungal properties.
There are also now plenty of single carton coconut milk alternative drinks around. KoKo coconut milk comes in several flavours, it's very palatable and kids usually enjoy it.
There has been concern that since cows milk contains Vitamin D, using milk alternatives reduces a child's Vitamin D consumption. This is very relevant as low Vitamin D has been linked with gut (non IgE) food allergies in recent research, and the UK has seen a return of the condition Rickets since there are now increasing numbers of children deficient in Vitamin D in the UK.
However, there is actually very little Vitamin D in cows milk, and it is not fortified in the UK. it is however sensible to ensure your child gets sufficient dietary Vitamin D and sufficient time in sunlight to make their own Vitamin D.
- Babies need a prescription formula if they are Cows Milk Allergic or Intolerant.
- Infants under the age of two ideally should also have a prescription formula as a main drink.
- Weaning - It is however absolutely fine to use any of the above that a tolerated in cooking when weaning, and as the occasional drink (although not rice before age 5). Always take extra care when weaning a child with suspected food allergies and/or intolerances though and ALWAYS consult your health visitor or doctor before making changes to your child's diet.
- Older Children - From experience I would suggest variety is best, if they tolerate food keep it in their diet but don't switch to just one milk alternative unless you have to. Children with food allergies are always at risk of developing more, and it's best not to give too much of any new alternative for this reason.
So here I make sauces with rice milk, bake with rice, coconut or almond, use coconut or almond milk on the children's cereals, oat milk or almond milk in my tea, hemp milk in curries....... we have them all. And my guilty pleasure, safely in the utility fridge with MUM ONLY written all over in Sharpie pen.... soya milk in my coffee frothed in the aeroccino !!!!