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Posted by Dr. Claire McCarthy July 10, 2013 06:51 AM
It's a question I ask parents all the time: how much milk does your child drink?
The answer I'm generally looking for is 2 to 3 cups a day (I even wrote a post about it). But if they say that their child doesn't drink any milk, I'm actually okay with that. In the interest of full disclosure, my youngest son doesn't drink milk (except some chocolate milk at school, something he doesn't get at home). He just doesn't like it.
There are definitely nutritional benefits to milk. It's a great source of calcium, vitamin D (assuming it's fortified--vitamin D isn't naturally in milk) and protein. These are all nutrients that children need. And for many children who are picky about what they eat, drinking milk is a good way to get those nutrients.
But milk isn't the only way to get them. There are cultures all around the world that don't have dairy in their diets--and according to an interesting commentary in JAMA written by my colleague Dr. David Ludwig along with Dr. Walter Willett from the Harvard School of Public Health, bone fracture rates tend to be lower in countries without dairy in their diets, and drinking milk doesn't seem to protect against fractures in adults.
Drinking too much milk can lead to anemia. It can also lead to obesity, and the commentary points out that drinking lowfat milk doesn't necessarily help. Drinking lowfat milk can leave you feeling less full, the authors say--and more likely to reach for more food, like an extra cookie.
I have many patients who don't tolerate milk because of the lactose in it--they get stomachaches and diarrhea. More importantly, we don't really know all the long-term effects of drinking milk. If you think about it, milk really is meant for humans and other mammals when they are very young--and it has hormones and growth factors to help young mammals grow. What we don't understand fully are all the possible effects of getting those hormones and growth factors for years, long after you are very young.
I don't discourage drinking milk among my patients, as long as they aren't drinking more than 2-3 cups a day (and unless they are underweight, I generally recommend low-fat or skim milk). It is a quick and easy way to get some good nutrition. But if they don't like or don't drink much milk, as is the case with my son, here's what we talk about:
Calcium. You can get calcium from other dairy products (which have some of the same issues, obviously). You can get it from fortified orange juice. You can also get it from salmon, sardines, beans (like black-eyed peas or baked beans), blackstrap molasses, and other food sources.
Vitamin D. Ultimately, this is a sunshine vitamin. Spending time in the sun is the best way to get enough Vitamin D, and that may be a big part of what other cultures do that we don't. Yes, sun exposure can lead to skin cancer, so you do have to balance your risks. But just getting your kids outside to play regularly (which also helps bones, because weight-bearing strengthens them) can make a big difference. You can also get Vitamin D from other fortified foods, as well as from egg yolks, salmon, tuna, cod liver oil and other sources. I often recommend a daily multivitamin for my particularly picky eaters, to be extra sure they get enough (my son takes one!)
Protein. This is easy--you really don't need milk for protein. You can get it from meat, fish, beans, tofu as well as other dairy. The Harvard School of Public Health has some great information about the healthiest ways to get the protein you need.
For more on this topic, check out Deb Kotz's great post. My friend Dr. Natasha Burgert has a terrific post on "alterna-milks", as well. But the best person to talk to about your child's diet is your doctor; together you can figure out what your child should eat and drink to get and stay healthy for life.
Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
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