By Stephanie Greunke, Registered Dietician and co-creator of Healthy Mama, Happy Baby.

The information in this post is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Always consult your healthcare provider to determine the appropriateness of the information for your own situation, or if you have any questions regarding conception, pregnancy, or your prenatal treatment plan. For more FAQ posts, click here. Have a question for our team? Click here to e-mail us.

This is a common question because many mamas find our resources through prior knowledge of the Whole30 program, which eliminates dairy for 30 days. You may have read about potential issues with cow’s milk consumption in It Starts With Food, experienced health benefits for yourself or your breastfed baby by avoiding it, or noticed an improvement when switching your formula-fed infant to a dairy-free or hydrolyzed formula.

Per usual, there’s no one-size-fits-all answer. I’ll discuss why cow’s milk is recommended at one year, what the calcium recommendation is for toddlers and how to reach that recommendation from dairy and non-dairy food sources. I’ll also lay out some options for milk substitutes. From there, you can discuss this issue with your child’s pediatrician/dietitian to decide what’s best for your family. I’m happy to share what I did with my two boys, but it’s certainly not my place to tell you what’s best for yours. Trust your intuition, mama!

Why cow’s milk is recommended

In short, cow’s milk does include key nutrients that your toddler needs, such as protein, fat, vitamin D, and calcium.

According to the American Academy of Pediatrics, unless there is a known milk allergy, at one year, children should consume approximately 2 servings of dairy per day. Until they’re two years old, full-fat milk is recommended to ensure toddlers are meeting their calcium requirements, consuming fat (for brain/visual development), and getting a source of vitamin D (for bone health and to optimize calcium absorption). Full-fat milk is fortified in vitamin D, helping toddlers reach the established recommendation of 600 IU/day.

The recommendations state children should not exceed 24 ounces (or 3 cups) of whole milk per day. Consuming too much liquid milk can interfere with iron absorption and can fill a toddler’s stomach, displacing other nutrient-dense foods. This amount helps them meet the recommended amount of calcium for a 1-3 year old, which is 700 mg/day. Interestingly, in the UK the recommendation is 350 mg/day.

What does this mean for parents choosing to avoid dairy or cow’s milk? You’ll want to make sure your little one is eating a variety of healthy fats (such as sliced avocado and coconut) and protein (such as scrambled eggs or wild salmon), and consider non-dairy sources of calcium and vitamin D. In short, it’s true that the avoidance of dairy or cow’s milk requires more consideration by the parents/provider to ensure that a child meets his/her nutrient needs. However, this does not mean that calcium needs cannot be met with non-dairy foods.

Suggested serving sizes and amounts of calcium

I’ll list a few common foods that contain calcium to help you understand what 700 mg/day looks like. Please note that these amounts do not take into consideration the variety of factors that influence calcium absorption. For example, the presence of certain nutrients (such as vitamin D/K2) increases calcium absorption, but others (such asiron, phytic acid, and oxalic acid) decrease absorption. The form of calcium plays a role as well. In fact, the amount absorbed from certain green vegetables (such as broccoli, bok choi, and kale) is nearly double that of dairy and fortified foods. I know that your little one may be refusing anything green at this age, so here are several options:

Dairy sources (toddler serving)*
4 ounces of goat’s milk: 160 mg
1 oz. full-fat cheddar cheese: 200 mg
1 oz. full-fat mozzarella cheese: 140 mg
4 ounces of full-fat cow’s milk:  140 mg
½ cup plain, full-fat yogurt: 150 mg
½ cup full-fat cottage cheese: 70 mg

Non-dairy sources (toddler serving)*
4 ounces of fortified nut-milk alternative such as Ripple or unsweetened almond milk: 225 mg
1.5 ounces of sardines, canned in oil, with bones: 160 mg
3 ounces orange juice, calcium-fortified: 130 mg
1.5 ounces salmon, pink, canned with bone: 90 mg
1 T. sesame seed butter: 65 mg
1/4 cup cooked bok choi: 40 mg
1 T. almond butter: 40 mg
1/4 cup cooked kale:  25 mg
1/4 cup cooked broccoli: 15 mg
4 ounces of homemade bone broth: varies

*Note: These portion sizes are rounded estimations. Your child may be eating much more or less than what’s listed.

Here’s the takeaway: Try offering calcium-rich food at each meal. If your child is not consuming dairy or refusing non-dairy sources of calcium, it may be a good idea to include a fortified milk alternative and work with a provider to ensure adequate intake of calcium and bone-supporting nutrient cofactors like vitamin D, K2, and magnesium. If your baby is still breastfeeding, don’t forget they’re also getting calcium (and other important nutrients and co-factors) from your breastmilk.

What about milk substitutes?

Not all milk substitutes are the same.  I recommend skipping soy milk and any milk alternatives that include carrageenan. Carrageenan is often used as a thickener and may play a role in intestinal inflammation. Fortified coconut milk in a carton is higher in healthy fat (such as lauric acid) than other milk substitutes, but lower in protein than most options. Rice milk is higher in sugar than other milks. You can see a nice breakdown for each milk alternative here. Note that homemade nut milks are also not fortified, and neither is canned coconut milk (although it’s still a nice source of fat!).

As you can see, there’s no “right” answer to this question. It depends on what so many factors, like what foods and how much your child is currently eating. Just remember that you do have options. As always, our team is just an email away if you have any questions. If you want to join a supportive community of like-minded mamas to be who often discuss questions like these, make sure to check us out on Instagram or join our Healthy Mama Happy Baby Program.


Stephanie Greunke is a registered dietitian with a master’s degree in nutrition who specializes in women’s health. She is a certified personal trainer and prenatal and postnatal corrective exercise specialist. Stephanie guides and supports women locally and globally through her web-based private practice, RockYourHormones.com.

 

 

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