Recommendations developed by the Academy of Nutrition and Dietetics, American Academy of Pediatric Dentistry, American Academy of Pediatrics and American Heart Association (1).

By Reed Mangels, PhD, RD

Recent headlines included “What Should Young Children Drink? Mostly Milk and Water, Scientists Say” and “Milk and Water Are OK for Kids — Juice and Plant-Based Drinks Aren’t.” These headlines accompanied news stories about the new recommendations for beverages for babies and children developed by the Academy of Nutrition and Dietetics, American Academy of Pediatric Dentistry, American Academy of Pediatrics and American Heart Association (1).

Not surprisingly, the recommendations call for babies age 0-12 months to only drink breast milk or infant formula, with small amounts of water added once solid foods are introduced. This is based on evidence that other beverages including plant milks and cow’s milk are not good choices for babies under a year old. Fruit juice is either avoided (for those under a year) or limited to a half cup or less of 100% fruit juice daily for 1-3 year olds (up to ¾ cup for 4-5 year olds). It’s better for kids to eat fruit rather than drinking juice.

So far, so good. Then things start to get confusing. The full report (identified as being for professionals) says, “Unsweetened plant milks/non-dairy beverages are not recommended for exclusive consumption in place of dairy milk (with the exception of soy milk); consume only when medically indicated or to meet specific dietary preferences.” (2)  Our interpretation – unsweetened soy milk can be used to replace dairy milk but other plant milks should only be used if medically indicated or for those avoiding cow’s milk. The version of the report for professionals seems to have a more nuanced stance than the more widely publicized recommendations aimed at parents and care-givers.

Recommendations for parents and care-givers list plant-based/non-dairy milks as something children age 1-5 years should not drink as full replacements for cow’s milk. The reasoning given is that “with the exception of fortified soy milk, many plant-based/non-dairy milk alternatives lack key nutrients found in cow’s milk.” (1). If fortified soy milk has the key nutrients found in cow’s milk, why isn’t it promoted as an alternative to cow’s milk? Is it simply that dairy products are more commonly used in this country? What sort of recommendations would be made if the dominant culture was one that did not give children animal milk?

We have other questions with the new recommendations. For example, the report says, “Even when these [plant] milks have extra nutrients added to them, our bodies may not absorb those nutrients as well as they can from regular milk.” (1) The evidence for this statement is questionable. Two studies have reported that the calcium in fortified soymilk is as well-absorbed as the calcium in cow’s milk (3, 4). We could not find research looking at the absorption of other nutrients from fortified soymilk or other plant milks. It’s not clear from the report which nutrients may not be well-absorbed. Additionally, pea protein-based milk has a similar amino acid profile to soy milk and fortified products are available. Why weren’t pea protein-based milks included as recommended beverages?

Here’s what we recommend in terms of beverages for infants and children if your family wants to avoid dairy consumption:

Birth to age 1: Breast milk or infant formula; add sips of water when solid foods are started.

Age 1 to 5:
•    Breast milk or infant formula can be continued; full-fat, unsweetened fortified soy milk or pea protein-based milk can replace or be used along with breast milk or infant formula provided the toddler is growing well and eating a variety of foods. Choose a soy milk or pea protein-based milk that is fortified with calcium, vitamin D, and vitamin B-12.
•    Water
•    Limit 100% fruit juice to no more than ½ cup per day for 1 to 3 year olds, no more than ¾ cup per day for 4 to 5 year olds.
•    Avoid:
o    Caffeinated drinks like coffee, tea, energy drinks, soda
o    Diet drinks
o    Sugar-sweetened drinks including soda, fruit drinks, fruit flavored drinks, fruit-ades, sports drinks, energy drinks, sweetened waters, and sweetened coffee and tea drinks
o    Plant milks other than fortified soy or pea protein-based milks as the child’s primary beverage: If there is a medical reason, such as allergy, for using beverages such as nut milks, rice milks, or other plant milks as the primary beverage, consult with a registered dietitian or other health care professional to be sure the child’s overall diet is nutritionally adequate.

References
1. Healthy Drinks. Healthy Kids. https://healthydrinkshealthykids.org/parents/
2. Healthy Beverage Consumption in Early Childhood. https://healthydrinkshealthykids.org/app/uploads/2019/09/HER-HealthyBeverageTechnicalReport.pdf September, 2019.
3. Zhao Y, Martin BR, Weaver CM. Calcium bioavailability of calcium carbonate fortified soymilk is equivalent to cow’s milk in young women. J Nutr. 2005 Oct;135(10):2379-82.
4. Tang AL, Walker KZ, Wilcox G, Strauss BJ, Ashton JF, Stojanovska L. Calcium absorption in Australian osteopenic post-menopausal women: an acute comparative study of fortified soymilk to cows’ milk. Asia Pac J Clin Nutr. 2010;19(2):243-9.

For more information on raising vegan children, see
https://www.vrg.org/family/kidsindex.htm#nutrition
https://www.facebook.com/groups/VRGparentsandkids/