June 19

Nutrient Deficiencies in Children with Cows’ Milk Allergy

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When your child has been diagnosed with a cows’ milk allergy, they will usually need to avoid all products which contain dairy often temporarily, but sometimes permanently.   You will find cow’s milk in many products such as yoghurt, cheese and cream as well as in less obvious products such as ready-made sauces, bread, other baked goods and many snacks like crisps.   Your child will also need to avoid other mammal milks such as goats, camel and buffalo milk.

You may feel concerned about your child’s longer-term health as your child will now need to avoid a food group that has previously provided many key nutrients.

Cow’s milk provides a variety of nutrients such as protein, calcium, iodine and riboflavin (vitamin B2) and all have important roles in the health and development of your child.  When your child can no longer consume cow’s milk, you need to ensure they are getting these nutrients from alternative sources.   Knowing which products to buy can be confusing, there are so many out there, and not all contain the nutrients your child needs.

This blog will help you ensure your child receives the correct nutrition whilst on a milk-free diet.  It will focus on calcium, and iodine as these are more common deficiencies in children with milk allergies.

Calcium

Most people have heard of calcium.  Calcium has a key role in bone and teeth development as it is an important part of their structure.  Lesser-known functions of calcium include vital roles in muscle (includes the heart), blood clotting and nerve function.

Children with cow’s milk protein allergy are likely to consume lower amounts of calcium (Boaventura et al., 2019; Darwin et al., 2021) than children without, which may lead to deficiency, in turn causing a decrease in bone mineral density (Liat Nachshon et al., 2014).

Children of different ages have the following calcium requirements:

  • 0-12 months – 525 mg/day
  • 1-3 years – 350 mg/day
  • 4-6 years – 450 mg/day
  • 7-10 years – 550 mg/day
  • 11-18 (girls) – 800 mg/day
  • 11-18 (boys) – 1000 mg/ day

(BDA, 2021)

If you were asked which foods are high in calcium you may think of dairy foods such as milk, cheese and yoghurt.  Whist this is true there are a huge selection of foods that are just as high if not higher in calcium compared to milk.   Listed below are a few of the foods that are high in calcium.  (For reference, 100ml of milk contains 120mg of calcium)…

  • Chia seeds – 631 mg/100g
  • Tofu (fortified) – 350 mg/100g
  • Almonds – 264 mg/100g
  • Kale – 250 mg/100g
  • Cannellini beans – 55mg/100g
  • Broccoli – 47 mg/100g

Meal and snack ideas which contain calcium:

breakfast-porridge-and-apricots

  • Porridge with a teaspoon of chia seeds and a quarter cup of chopped apricots. Chia seeds are tiny in size and flavourless which will make it easy to hide them in the porridge. The chopped apricots provide sweetness, and a quarter cup contains around 18 mg of calcium
  • Silken tofu chocolate pudding. This easy recipe is made by blending silken tofu with dairy-free cocoa powder, melted dark chocolate, maple syrup, and salt. There are many great recipes you can find online for this recipe such as this one here: https://foodaciously.com/recipe/silken-tofu-chocolate-mousse
  • Kale and almond pesto pasta. It can be challenging to have children enjoy eating kale but when it is blended into a delicious pesto served with pasta it has a much better chance of being enjoyed. There are plenty of vegan recipe’s for pesto and if you’d like to add cheese, opt for your favourite vegan cheese and/or use nutritional yeast for that cheesy flavour.

Calcium Supplements

Only use calcium supplements with the guidance of a doctor or dietitian as overconsumption can lead to toxicity with dangerous consequences.

Iodine

A much lesser-known micronutrient, Iodine is a mineral that has a vital role in metabolism, growth, and development which is why it is important to make sure your child is getting an adequate intake of this mineral through a balanced diet.

The recommended intake for children aged between 0-14 is 50-130 mcg/day….

  • 0-3 months – 51mcg/day
  • 4-12 months – 64mcg/day
  • 1-3 years – 76mcg/day
  • 4-6 years – 102mcg/day
  • 7-10 years – 114mcg/day
  • 11-14 years – 127mcg/day
  • 15-18 years – 140mcg/day

If a child becomes severely iodine deficient their development may be hindered, and they may develop an enlarged thyroid and/or hypothyroidism (Pearce, 2014).

Cows’ milk is a typical source of iodine as 100ml contains approximately 4.25 mcg, but there are a variety of other sources that can provide iodine for your little one.

Alternative sources to iodine include….

  • Cod – 117 mcg/100g
  • Seaweed/nori – 1,470 mcg/100g (the amount of iodine in seaweed varies and excess consumption may lead to iodine toxicity therefor you should limit giving this to your child to one to two times a week)
  • Fortified almond, oat, soya, rice etc. milk – (the amount varies based on the type of milk and brand so make sure you check the label on the product to find this information)
  • Fortified tofu – (the amount varies depending on the brand make sure to check the label)
  • Eggs – 50 mcg/100g
  • Beef – 11-14 mcg/100g

Meal and snack ideas which contain iodine

nutritional-essentials

  • Fruit smoothie with iodine fortified plant milk/yoghurt. This is a tasty way to add iodine into your child’s diet and includes lots of other valuable vitamins too
  • Baked cod with mashed potatoes. This is a comforting meal for children who enjoy fish.
  • Fish Pie with vegetables
  • Eggs are a source of iodine, containing around 25mcg per egg. This meal is also packed with protein and omega-3 fats which are also important for a child’s growth and development.

In some countries, salt is fortified with iodine but in the UK, salt is not routinely fortified.  It is possible to find in some supermarkets.  It is not recommended though, to give children, especially young children too much salt.

Summary:

  • In conclusion, whilst your child is unable to consume these nutrients from dairy it doesn’t mean there aren’t plenty of other sources that you and your child can choose from.
  • A top tip is for you to always try to opt for dairy alternatives that are fortified by making sure to check the nutrition panel on the food label.
  • Offer a variety of dairy-free foods and try and offer white fish twice a week to meet iodine requirements.
  • Make sure you stock the kitchen with lots of different sources to ensure a variety of nutrients through a balanced diet.
  • At first, it may feel overwhelming but once you become familiar with the cows’ milk-free foods that are good sources of calcium and iodine, it will become easier.

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