Cow’s Milk Is Not Ideal for Children at Any Age

In Reply

We appreciate Levin and Barnard’s interest in our Viewpoint¹on recommendations for plant-based beverage intake in children aged 12 to 23 months. However, many of their concerns about the use of cow’s milk are not relevant for this age group. For example, Levin and Barnard cite an association between cow’s milk and cancers of the prostate and ovaries as well as an overload of saturated fat, estrogens, and cholesterol. An association between these cancers and use of cow’s milk from 12 to 23 months has not been demonstrated in epidemiologic studies,^2,3 and children younger than 2 years need adequate fat and energy to support growth and brain development.⁴

A major concern Levin and Barnard raised about the use of cow’s milk was regarding lactose intolerance. We appreciate that lactose intolerance is a significant concern for many families of color with older children and for adult family members, and that lactose-free or lactose-reduced cow’s milk may not be accessible to everyone. However, lactose intolerance is not a health concern for children younger than 2 years, including children of color.⁵ We agree that families with dietary patterns that do not include cow’s milk, for health or other reasons, deserve evidence-based guidance about how to ensure that all of their children’s nutrient needs are met. This is an important health equity issue, especially with children younger than 2years, who have high nutrient needs relative to their intake.⁴

If cow’s milk is not preferred by the family and children aged 12 to 23 months consume a high proportion of their beverage intake from plant-based sources, we recommended that assessment of dietary adequacy and guidance occur on an individualized basis between the family and a health professional with nutrition expertise.¹ Through this process, a family can weigh their individual preferences and situation, as well as the evidence that is available in conjunction with the other foods the child consumes, to decide if plant-based beverages or only water, plus healthy foods, are the right decision for their child. We also agree that guideline developers and professional organizations should create dissemination materials for health professionals and families that highlight different ways to adequately meet young children’s nutrient needs. These materials should represent foods from a variety of cultures⁴ and include nondairy options. In our commentary, we also advocated for research to better inform evidence-based recommendations on the use of plant-based milk for children younger than 2 years going forward.