September 20th, 2017


Milk and Milk Alternatives

By Jennifer Yoon, RDN, LDN, Pediatric Alliance — St. Clair



Many moms are choosing plant-based milk alternatives for various reasons. They may have been told cow’s milk formula is an inadequate or inappropriate diet for their infant. (In fact, cow’s milk formulas are completely adequate and appropriate for infants.) They may be concerned about hormones, antibiotics, or other additives, or a desire to pursue a plant-based diet for their child.

As a child weans from formula or breast milk, whole cow’s milk provides important nutrients for growth, including 8 grams of protein, 8 grams of fat, and 300 mg of calcium per 8-ounce serving. The protein and nutritional content of milk alternatives from plant sources varies widely. Plant-based milk alternatives should be researched and used with awareness and caution. Here is a breakdown of the milk alternatives and their nutritional values from Eating Well (click on chart to enlarge):













A study published in the American Journal of Clinical Nutrition looked at dietary habits and growth parameters of 5,000 children ages 1-3. Children who drank 3 servings a day of cow’s milk were 1.5 centimeters taller than children who drank milk alternatives.

“Many parents are choosing non-cow’s milk beverages like soy and almond milk because of perceived health benefits,” the authors write in the report. “However, non-cow’s milk contains less protein and fat than cow’s milk and may not have the same effect on height.”

Important things to consider are whether the child has a varied diet that includes other sources of protein, fats, and a variety of grains. The child’s growth and weight gain should be monitored. A nutrition consult may be necessary to ensure nutritional adequacy.

Other considerations:

> All milk substitutes must be fortified with calcium and vitamin D, with the exception of almond milk which is naturally high in calcium.

> Fortified products have a lower bioavailability than naturally occurring minerals.

> All plant proteins contain incomplete chains of amino acids, which is why a variety of grains are needed in a vegan diet.

> Hemp has the most beneficial mix of amino acids, and contains alpha linolenic acid, but the taste is dirty and grainy, and so it’s least acceptable.

> Soy milk is the most nutritionally adequate substitute. Animal studies, blood level data, and some uncontrolled population-based studies suggest phytoestrogens contained in soy may effect sexual development of females and males including pubertal timing, ovarian function, and endocrine dysfunction. Soy formulas have been widely used for many years resulting in circulating phytoestrogen levels thousands of times higher than normal, yet detrimental effects have not been evident in humans. There are few studies investigating estrogenic effects on male development and they are inconclusive.


*** Jennifer Yoon sees patients at the Pediatric Alliance — St. Clair office. For an appointment, please call (412) 221-2121. Read more from Jennifer on The PediaBlog here.


6 Responses to Milk And Milk Alternatives

  1. Excellent article! Looks to have involved lots of careful research!

  2. Thank you, Jennifer, for enlightening!
    This all seems to be at variance with conventional wisdom that excess consumption of whole cow’s milk in the second year of life may lead to obesity, iron deficiency, or nutrient imbalance. I think the key here is “all in moderation.” I wonder if the height differential is sustained.
    Families can “manufacture” any kind of milk these days, but the presented data stress the paramount importance of a well-rounded diet, especially with the vegetables and fruits which produce a healthy microbiome. It seems that milk has to be more than just a “chaser.”

  3. I still think pushing breast milk in the second year of life is best—–I wonder if there are data on potential deficiencies if solid feedings are not ideal.

  4. Hi Jennifer: Thank you for bringing to light the benefits of cow’s milk. I would like to add that, as a dairy farm family, we are not allowed to ship milk from cow’s that have been treated with antibiotics, so anyone thinking their store-bought cow’s milk has antibiotics in it is misinformed. Any milk that contains antibiotics has to be destroyed. If it mistakenly enters a truckload of milk, we are held responsible for paying for the entire load, and that includes any milk from other farms on our route that is co-mingled on the truck. The entire truckload that is contaminated has to be destroyed. That is a very expensive mistake. Also, years ago we signed a contract with our dairy to not to use hormone supplementation because of public concern against its use. Milk is very strictly regulated to assure public safety. Every single truckload from our farm is tested before it is unloaded at the plant. Our cow’s are tested for Brucellosis and Tuberculosis annually. Also, our farm is inspected by the dairy’s inspector, state inspector, and federal inspector, as well as our water being tested regularly by the dairy to insure the health of the herd and safety of the milk we ship. Even additives to the cattle feed is strictly regulated to prevent contamination with antibiotics or other human health hazards. As of January 1, 2017, we are not allowed to purchase antibiotics to treat sick animals without our veterinarian’s okay. Any animal treated with antibiotics has to pass testing for clearance from antibiotics before her milk can be shipped, or to be sold for meat. I hope this gives you some additional information to assure you our food regulations are strict and do work to keep the public safe.

    • That is so interesting! I did not know that and I appreciate you sharing. My family and I are big milk drinkers and I have always felt it is an important part of the diet. Where is your family farm? Any chance I could bring my kids for a little field trip sometime? My son and I went to Springhouse when he was little and were blessed to see many calves. My daughter has not been to a dairy farm and adores all animals. Everyone would enjoy the trip if that’s possible. — Jennifer Yoon.

  5. Some parents insist on their family only drinking unpasteurized milk directly obtained from the farm on the premise that the process diminishes the nutritional content of the milk. Is there any basis to this potentially dangerous rationale?


    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

  • Tags

  • Archives

    • 2017 (350)
    • 2016 (368)
    • 2015 (372)
    • 2014 (378)
    • 2013 (442)
    • 2012 (202)
  • Contact Us