Does a toddler or an older child require supplementation when milk is eliminated from the diet?

Particular attention should be paid to the nutritional state during a milk-free diet. A dietitian should be involved in the care.

The taste of supplementary products is peculiar, even unpleasant, and toddlers and older children are often not keen to drink them.

A population-based follow-up study (n = 3,289) monitored food-related symptoms with the aid of a questionnaire . When the children were 2 years of age, 83 % responded. Eighty-six children were investigated, 46 agreed to keep a food diary, and 28 were included in the final assessment (age 33 months).

In children on a milk-free diet the intake of the following was below the recommended limit: energy (7 of 10 less than the recommended 85 kcal/kg), protein (2 of 10 less than the recommended 1.5 g/kg), fat (3 of 10 less than the recommendation, i.e. < 20 % of energy intake), calcium (10 of 10 less than the minimum of 300 mg/day), iron and vitamin D. The findings were similar, but less marked, in those consuming milk products and supplements. The associated risks may include: retarded growth, lack of essential fatty acids due to the low intake of fat and problems with skeletal development. There is insufficient data on the long-term effects.

Similar results on the effects of milk-free diets have been obtained in studies carried out in specialist care patients in Finland , .

Comment: No input by a dietitian . How representative are the samples (all three studies)?

Ədəbiyyat

1. Henriksen C, Eggesbø M, Halvorsen R, Botten G. Nutrient intake among two-year-old children on cows' milk-restricted diets. Acta Paediatr 2000 Mar;89(3):272-8.
2. Paganus A, Juntunen-Backman K, Savilahti E. Follow-up of nutritional status and dietary survey in children with cow's milk allergy. Acta Paediatr 1992 Jun-Jul;81(6-7):518-21.
3. Tiainen JM, Nuutinen OM, Kalavainen MP. Diet and nutritional status in children with cow's milk allergy. Eur J Clin Nutr 1995 Aug;49(8):605-12.