The Alterna-milks: Cow’s Milk Alternatives for Toddlers

Rev: 5/19

A huge part of fully transitioning from an infant diet to a toddler diet is changing to a new source of milk. Most families easily transition their toddler to cow’s milk by the first birthday. However, with many new products in the dairy aisle, more parents are asking questions about cow’s milk options. And, some of these alternative non-dairy products are raising more questions than answers.I call them the “alterna-milks”.

Before we discuss the merits of the alterna-milks, let’s review my rules about milk for healthy toddlers.

Dr. Natasha’s Milk Rules for Toddlers:

  1. Toddlers don’t need milk. (gasp!) And, most toddlers don’t need whole milk. (double gasp!) Unlike the dietary needs of an infant, milk is no longer a source of complete nutrition after a child’s first birthday. Milk provides a convenient source of fat, protein, calcium, and vitamin D for growing bodies. But, in today’s average food lifestyle, these building blocks can be more than adequately supplied in other areas of a balanced diet. Therefore, this discussion is not promoting nor validating the need for milk in a toddler’s diet. The goal of this post is to simply discuss options for parents.

  2. Offer milk with meals, and water everyplace else. Regardless of the type of milk consumed (animal, plant, or human), the amount of milk should be limited to a maximum of 24 ounces per day (3, 8 ounce servings). Too much milk puts children at risk of vitamin deficiencies, anemia, and poor weight gain due to the changing growth needs of a toddler. Practically speaking, I encourage my families to keep the number of ounces per day under 16, as long as the toddler is getting other sources of dairy.

  3. Get rid of the bottles as soon as possible. A bottle is simply a receptacle to deliver a beverage, not a necessity of life. Using a bottle for any beverages after a year of age increases the child’s risk of cavities, teeth mal-alignment, and overconsumption. So after the age of 1-year, offer milk to toddlers in a sippy/straw cup or an open cup.

  4. Breast milk is not an alterna-milk. Breast milk is still a wonderful option for those who continue to nurse after the age of 1 year. The medical benefits of breast milk after the first year of life, however, are less firmly established. It can be generally agreed upon that if breast milk is continued to be offered to toddlers, providing whole food sources of vitamin D and iron are important. Alternatively, offering a multivitamin to provide these nutrients may need to be considered.

  5. These rules are not universal. For any child who is not growing normally, has issues with weight gain, has significant food allergies, or has other dietary restrictions; these rules may not apply. As always, your child’s pediatrician should partner with you in making nutrition recommendations, so ask what she thinks best for your toddler as the first birthday approaches.

So, why would a family choose an alterna-milk?

Most families choose an alterna-milk for personal reasons. Some families have chosen a vegan diet, or have allergies or intolerances to various dairy items. Some families simply don’t like the taste of cow’s milk.

Whatever the reason, alterna-milks are just that - alternatives. They are not nutritional replacements for a typical glass of cow’s milk.

All alterna-milks need to be supplemented with vitamins and minerals to come close to the nutrition provided by cow’s milk. Since all companies supplement differently, label reading is very important. Look for the key ingredients of fat, calcium, vitamin D, iron, and vitamin B12 in all of these products. Of note, none of these milks provide complete nutrition for infants, and should never replace breast milk or infant formula for children 0-12 months.

The alterna-milks are divided into 2 groups: Plant-based and animal-based.

Plant-based: Soy, nut, and grain milks

Plant-based “milks” are technically not milk at all because milk comes from mammals. So, plant-based “milks” are simply beverage alternatives made from the seeds of various plants. Plant-based beverages have very distinct tastes, textures, and colors. They are all cholesterol-free and contain little saturated fat.

Plant-based beverages can be loaded with sugar (cane juice or brown rice syrup as ingredients) to mask some of the naturally bitter taste. They are fortified with a less-potent vitamin D than animal-based milks, because the more potent vitamin D comes from an animal source and cannot be used in vegan beverages.

Overall, they vary in their nutritional content based upon how the beverage is fortified.

  • Soy milks

Soy milk is the most commonly available and popular of the alterna-milks. Soy milk has about the same amount of protein as cow’s milk and some iron, but little calcium unless fortified. Soybean crops are often heavily treated with pesticides, so an organic product may be preferred.

A debate among researchers is the presence of isoflavones in soy products. These components in soy products have been shown to modestly decrease LDL-cholesterol or“bad cholesterol” levels. However, some isoflavones (called phytoestrogens) have been associated with problematic stimulation of the reproductive systems of animals and humans. Therefore, it is under very rare and specific circumstances that soy milk and soy infant formulas are recommended for children.

  • Nut milks

Nut beverages are created by grounding nuts, straining, then liquifying the final product. The products are deficient in Vitamin B12 and have very little protein compared to soy.

Of all the nut milks, almond milk is the most nutritious based on the health benefits and contents in almonds themselves. Almonds have natural vitamin E which is thought to decrease the development of certain cancers. However, the actual amount of almonds used by companies to make the beverage is varied due to the nut’s expensive cost. It is impossible to know, therefore, how much of the final product will contain the almond nut benefits. In other words, you are likely better off just eating a handful of almonds.

Coconut milk is a source of fat and a pleasantly sweet taste. However, it offers little else.

Macadamia milk is higher in calcium and vitamin E than other nut milk sources, but has no protein.

  • Grain milks

Grain milks are created from fermented grain or flour. These products offer the natural benefit of fiber from the grain, however have very little protein.

Rice milk is processed from brown rice. It is a low fat, low protein, and lactose-free option. It is known as the the least allergenic alterna-milks for allergy-senstive families. The nutritional value of rice milk is very small, however, except for the fortified additives. For a vegan child or adult, soy milk remains a better alternative.

Hemp milk is newer to the alterna-milk family. It does contain natural protein, iron, magnesium, phosphorous, and vitamin E. Hemp milk is high in omega fats, and lactose-gluten-free. It is also well tolerated for people with soy, dairy, or tree-nut allergies. Of note, these milks contain no THC (the active psychogenic agent in marijuana). Although increasingly popular, hemp milks are more difficult to find in neighborhood grocery stores. And due to the recent commercially availability, the nutritional benefits are largely unstudied.

Flax milk is made by cold-pressing flax seed oil. It contains no saturated fat and no protein, but does contain omega-3 fatty acids. It is an option for those with soy allergy and is naturally lactose-free. Most have added sugars, some have added protein from other sources.

  • Veggie milk

Pea milk is gaining popularity due to its smooth taste that is very similar to cow’s milk. It contains calcium and vitamin D, plus has the same amount of protein per ounce as cow’s milk. You can find this option without sweeteners, as well.

Animal-based: Fermented, goat, and canned

Kefir is a cultured dairy product (from cow, sheep, or goat milk) that creates a yogurt-like drink. The milk is made by the addition of “kefir grains” to a dairy product, which are combinations of various bacteria and yeast. The health benefits of kefir have been claimed since ancient times; including anti-cancer effects, gut health, and even good face cream. Kefir may be a wonderful addition to a diet that includes cow’s milk products, but is practically cost-prohibitive for most families to use as an exclusive milk source.

Goat milk is more easily available in our region. Some claim that goat milk is more similar in composition to human breast milk. It also shares many proteins with cow’s milk, and includes lactose. In other words, for kids with cow’s milk allergy most will also have similar problems with goat milk. However, goat milk contains no iron, folate, or vitamin B12. If goat milk is going to be the primary choice in the home, a multivitamin including iron and B-vitamins is needed.

Toddler formula is a canned milk option, but rarely needed for healthy toddlers. Consult with your pediatrician about this milk choice before purchasing.

The alterna-milk bottom line:

For healthy toddlers, milk is just a drink. It is no longer a exclusive source of daily nutrition. In a society that typically drinks too many unnecessary calories; it is preferred that children develop a preference for low-fat, low-calorie, unsweetened beverages. So, regardless of the type you choose for your family, feel confident that milk is a great choice to partner with a plate of healthy food at every meal.

Good luck!