This article was written by Noelle Martin, MScFN RD
We recently chatted about breast milk and lactose intolerance in babies. Today we wanted to take this one step further and talk about how to handle lactose intolerance once a baby formula alternative stops nursing to ensure that their GI system is happy and they are well-nourished. Ideally children 2 and up will drink 16 oz. of milk per day for the nourishment they need, but how can we reach this goal for a lactose intolerant child?
The first thing to consider is the age of the child. If they are under one year of age, then a lactose free formula is best. From 12-24 months there are two main options. One is to continue with the lactose free formula. The other is a lactose free whole milk. Whole milk (or homogenized) is 3.25% fat. This is the best milk choice for children age 12-24 months who are no longer breastfed due to its high fat content. Fat is essential for brain and eye development in children and choosing a lower fat milk product at this age would take away from the fat in their diet. For lactose intolerant children ages 2 and up, lactose free 2% milk is a good choice as it has sufficient fat. So how does this lactose free milk work? Let me explain.
Cow’s milk contains lactose, which is a sugar made up of glucose and galactose. During digestion our intestinal villi secrete the enzyme lactase to break down lactose back into glucose and galactose. Lactose free cow’s milk has lactase added to it so the breakdown occurs in the milk, rather than our digestive system. There are many micronutrients that naturally occur in cow’s milk such as calcium, magnesium, and vitamin B12 (among others), and then vitamin A and D are added per government regulations. The nutrients in milk work together to help us build and maintain strong bones and teeth, but also serve many other purposes as well. For some children they may have further restrictions, such as a casein allergy. From there it gets a little more complicated.
Breast Milk Alternatives
Soy milk has the same fat percent as 2% milk, so it is a suitable option for children over 2 years of age. It is recommended to avoid soy formula and soy milk for infants. Soy milk also provides the same amount of “complete protein” as one cup of cow’s milk. It does not, however, contain all the micronutrients (vitamins and minerals) as cow’s milk. So if you are choosing soy milk, then please ensure that you choose one that is fortified with calcium, vitamin D, and vitamin B12 at least, and ideally others as well. Because the micronutrients are added, they do not stay suspended in the milk very well so it is best to shake the carton of soy milk very well before pouring it to ensure that your child is actually ingesting what you have paid for. Some people do not want to consume soy milk because of its estrogenic properties, so then we have to look at other milk alternatives.
Coconut milk is the next best option for children as it has the same fat content as 2% milk and soy milk. However, that is where the similarities end. Coconut milk is not a source of protein or any micronutrients. If a parent is choosing coconut milk for their child, then they need to replace the 16-18 grams of protein that would be provided by 2 cups of cow’s milk or soy milk each day and ensure that the coconut milk is fortified and (as I said above) shake the carton well. A nice way to add a complete protein into coconut milk is to blend in hemp hearts. These are packed with complete protein and omega-3 fatty acids and add to the creamy nutty flavor that is already in coconut milk.
Other Milk Alternatives
Two other milks that are commonly considered are almond and rice milk. These milks are not a source of fat or protein and are only a source of micronutrients if fortified. These milks are not suitable for young children unless they are mixed with higher fat and protein sources such as hemp hearts and chia seeds.