Friday, July 17, 2015

Calcium requirements/ The milk transition



The Milk transition!

Calls about the transition from breast milk or formula over to whole milk rank up there in the "frequently asked questions" category.
   
If you are breast feeding and it works for you to continue to nurse beyond the first birthday, good for you! Don't be in a rush to stop. It is a very individual and personal decision. For those moms who choose to nurse beyond the first year, that breast milk feels like a godsend if your child doesn't feel well. Not only is nursing a comfort, but breast milk is great for tummy bugs, eye issues and all sorts of stuff. One parent was poking a bit of fun at me and said "if you call Nurse Judy, she will just tell you to put breast milk on it."

On the other end of the spectrum, many moms (myself included) end up weaning sooner for any number of reasons. In our practice, the first birthday is probably the average age that the milk transition occurs. Keep in mind that if your baby is on formula and tolerating it well, there is no hurry to get off (except for the expense and the hassle). If you have a case of formula left over, by all means use it up.

While it is fine to carefully introduce milk-based products such as cheese or yogurt to your children once they are over 6 months, plain cow's milk is not an appropriate substitute for formula or breast milk in the first year, as it lacks some important nutrients.  

The first birthday is also usually when we  recommend a blood test that checks the iron level. Formula has more iron than cow's milk, so if your child is a fussy eater it is important to make sure the iron levels are adequate before we switch over to plain milk. At our office, we usually send the patients to a local lab to have both the iron and lead levels done with one poke. If there are obvious concerns about diet or lead exposure, your doctor may end up doing the labs sooner.

Once you move along to cow's milk, I prefer that you use whole (full fat) milk. If possible, and you can afford it, go ahead and buy organic. I know there are folks out there that tout the benefits of raw milk, but I have a strong opinion that milk should be pasteurized. I have had parents asking me about vat pasteurization, and that does seem adequate.

Most kids who were on a milk-based formula have no trouble moving on to cow's milk. It is fine to do it gradually so that they get used to the taste (add a few ounces to the formula and see how they do). Intolerance will likely show up as tummy aches, poop changes or rashes. My older daughter got a terrible flare up of eczema when we first got her on milk (Eczema post). I put her back on her formula for a couple of months and when we retried the milk she was just fine with it.

But if you thought that the main choices about cow's milk were organic or fat content, think again. Along comes the choice between A1 and A2. Huh??? It turns out that there are indeed two kinds of cows out there (don't worry there won't be a test on the following paragraph).

A1 and A2 beta-casein are genetic variants of the beta-casein milk protein that differ by one amino acid. The A1 beta-casein type is the most common type found in cow's milk in Europe (excluding France), the USA, Australia and New Zealand. This is what most of us have grown up drinking. African and Asian cows are predominantly A2 cows. Milk from goats and humans contains only the A2 beta-casein.

There is a lot of buzz about this (especially in Noe Valley perhaps?). The claim is that folks who have trouble with our common (A1) milk may in fact be able to tolerate A2 milk without any issues. The jury is still out. As you can imagine, there is passion on both sides. If you want to spend the money, I am sure that the A2 milk is healthy and delicious, but at this point I don't know if it is all hype or if there is any real validity to the claim.

Milk is a great source of calcium, protein, vitamin D and the fat that your child needs for brain development. If you have a hard time getting your child(ren) to drink milk, it is important to make sure they are meeting those nutritional needs through other sources. If you choose to use a milk alternative such as goat, soy, rice, almond, coconut (seriously, there is a wide array of choices)...read the labels and see how they compare. In general:

Cow's milk and soy milk are both great sources of protein and calcium. Goat's milk is also good for protein and calcium, but doesn't have as much vitamin B-12. Almond milk and coconut milk have significantly less protein but are good sources of calcium.

We want kids at this age to be getting at least 700 mg of calcium per day. You can see from the chart below that this should be reasonably easy if they are eating cheese and yogurt.

Yogurt1 cup400 mg
Milk1 cup300 mg
Cheddar cheese3 ounces325 mg
Tofu1/2 cup200 mg
Mozzarella cheese1.5 ounces275 mg
Fortified OJ6 ounces200 mg
Kale1 cup cooked95 mg
Ice cream1/2 cup85 mg
Almonds1 ounce75 mg
Broccoli1/2 cup21 mg
Corn tortilla1 small42 mg




 Interestingly, breast milk doesn't have quite as much calcium per ounce as cows milk, but the calcium it does have has twice the bio-availability.  

I personally don't feel the need to be completely off of the bottle at 12 months, but I NEVER want a bottle in bed (if they fall asleep and keep the bottle in their mouth it can rot their teeth.) I am perfectly fine with a snuggle bottle when first waking up or going to sleep for an extra couple of months.

Try to transition most of the fluid intake to a cup. However, many kids significantly decrease their milk intake once you start moving away from the bottle and transitioning to a sippy cup. Kids just don't like to drink as much milk from a cup. I couldn't tell you why. Some parents feel a little better assuring at least some milk by giving it in the bottle.

If you are trying to encourage your child to drink the milk from a cup, try adding a few drops of vanilla or a dash of cinnamon. Some kids might like it better warm. You can also try frothing it. I am not in favor of adding unnecessary sugar into your kids lives, so I would not suggest adding chocolate or strawberry flavor to the milk on a regular basis. Consider making smoothies with milk as the base. Kids like adding things into and turning on the blender. You can get a special cup that they pick out. If you are using any alternative milks, watch out to make sure you aren't getting a sweetened version that is adding all sorts of sugar.

 Kids who drink too much milk are often anemic because  they fill up on milk and don't eat enough solids. Those are the 'milkaholics'.
Once your little one is over a year, 12-24 ounces a day is a fine range. Try to find the balance.  

  





 Interestingly, breast milk doesn't have quite as much calcium per ounce as cows milk, but the calcium it does have has twice the bio-availability.  

I personally don't feel the need to be completely off of the bottle at 12 months, but I NEVER want a bottle in bed (if they fall asleep and keep the bottle in their mouth it can rot their teeth.) I am perfectly fine with a snuggle bottle when first waking up or going to sleep for an extra couple of months.

Try to transition most of the fluid intake to a cup. However, many kids significantly decrease their milk intake once you start moving away from the bottle and transitioning to a sippy cup. Kids just don't like to drink as much milk from a cup. I couldn't tell you why. Some parents feel a little better assuring at least some milk by giving it in the bottle.

If you are trying to encourage your child to drink the milk from a cup, try adding a few drops of vanilla or a dash of cinnamon. Some kids might like it better warm. You can also try frothing it. I am not in favor of adding unnecessary sugar into your kids lives, so I would not suggest adding chocolate or strawberry flavor to the milk on a regular basis. Consider making smoothies with milk as the base. Kids like adding things into and turning on the blender. You can get a special cup that they pick out. If you are using any alternative milks, watch out to make sure you aren't getting a sweetened version that is adding all sorts of sugar.

 Kids who drink too much milk are often anemic because  they fill up on milk and don't eat enough solids. Those are the 'milkaholics'.
Once your little one is over a year, 12-24 ounces a day is a fine range. Try to find the balance.  

 

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