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It's a question I get all the time: how much cow's milk should my child drink?

It's a question I get all the time: how much cow's milk should my child drink?

Cow's milk can be part of a healthy diet for children; about 70 percent of children drink it on a daily basis. Milk has protein and calcium--and it's fortified with Vitamin D, a vitamin that is very important not only for healthy bone growth, but for the prevention of some chronic diseases, including autoimmune, respiratory and heart diseases. In fact, the Committee on Nutrition of the American Academy of Pediatrics (AAP) says that children who don't drink at least 1000 mL (about four cups) of milk daily should take extra Vitamin D. 

That sounds like kids should be drinking at least four cups of milk a day--but that may not be such a good idea. 

Fortified milk may be high in calcium and vitamin D, but it's low in iron. Not only is it low in iron, but drinking a lot of it interferes with the body's absorption of iron and can even cause small amounts of bleeding in the intestine, further lowering the amount of iron in the body. And when children drink a lot of milk, it can fill them up and make it less likely that they will eat enough of other healthy iron-containing foods like meat or dark leafy vegetables (I see this often in my practice). In fact, drinking a lot of cow's milk is a common cause of iron deficiency. That's why the American Academy of Pediatrics Bright Futures guidelines recommend that children should only drink two cups a day.

So which is right? Two cups or four cups? A study just released in the journal Pediatrics helps doctors and parents answer this question. Researchers in Canada studied more than a thousand children ages two to five, looking at their diets, their lifestyles, and their vitamin D and ferritin (a test that measures iron) levels. 

Their answer to the question: two cups is right--with some caveats.

The biggest caveats have to do with the fact that Vitamin D is a sunshine vitamin--our bodies literally make it with help from the sun. If you have dark skin, you don't absorb those important rays as well--and during the winter, when we all tend to stay inside more, we get less exposure to sunshine. The researchers found that dark-skinned children who didn't get extra Vitamin D during the winter would need 3-4 cups of milk to get enough Vitamin D--but when they got that much, their iron levels went down. So supplementation is probably the better way to go.

Another interesting caveat had to do with bottles. Kids who drank milk from bottles didn't seem to get the same bump in Vitamin D from drinking more--and were more likely to have iron deficiency. The researchers weren't sure why this is, but said maybe parents don't realize how much milk their kids drink when they use a bottle--and kids who take milk from bottles might drink other things like juice from it too, and be otherwise more likely to fill up on fluids instead of eating a healthy diet.

So--here are the bottom lines for parents when it comes to cow's milk:

• Give your child two cups a day.
• Have your child play outside whenever possible, not only for Vitamin D levels but for overall health.
• If your child is dark-skinned, or you spend very little time outdoors, talk to your doctor about taking a Vitamin D supplement, especially in the winter.
• Ditch the bottle as soon as possible (by a year--sooner if you can).

Cow's milk isn't absolutely necessary for a healthy diet--there are other ways to get the nutrition it offers. If your child isn't drinking cow's milk for whatever reason, talk to your doctor about the best way to be sure that he or she is getting enough calcium, vitamin D and protein.

For more information on healthy diets for children, visit the Nutrition page of the AAP's healthychildren.org website and KidsEatRight.org, which has great (and practical) information from the American Academy of Nutrition and Dietetics.

2 cups of cow’s milk daily best for kids’ health

Published: Tuesday, Dec 18, 2012, 10:47 IST  Place: Washington, DC | Agency: ANI

One of the most common questions parents ask their doctors is ‘How much milk should I be giving my children? Now they have got their answer from a new research and the answer is two cups per day. “We started to research the question because professional recommendations around milk intake were unclear and doctors and parents were seeking answers,” said Dr. Jonathon Maguire, a paediatrician at St. Michael’s Hospital and the lead author of the study. Dr. Maguire and his team looked at how cow’s milk affected body stores of iron and vitamin D – two of the most important nutrients in milk – in more than 1,300 children aged two to five years. They found that children who drank more cow’s milk had higher Vitamin D stores but lower iron stores. “We saw that two cups of cow’s milk per day was enough to maintain adequate vitamin D levels for most children, while also maintaining iron stores. With additional cow’s milk, there was a further reduction in iron stores without greater benefit from vitamin D,” Dr. Maguire said. The researchers recruited healthy children during routine doctor’s appointments between 2008 and 2010. Parents were asked to fill out an extensive questionnaire about their children’s milk drinking habits and other factors that could affect iron and Vitamin D stores. A blood sample was obtained from each child to determine body stores of iron and Vitamin D. The children were participating in TARGet Kids!, a unique collaboration between children’s doctors and researchers from St. Michael’s Hospital and The Hospital for Sick Children. The program follows children from birth with the aim of understanding and preventing common nutrition problems in the early years and their impact on health and disease later in life. The study also suggested that children with darker skin pigmentation may not have enough vitamin D stores during the winter months. Dr. Maguire suggested that instead of consuming more milk to increase these levels, wintertime vitamin D supplementation may be a more appropriate way of increasing vitamin D stores while preserving iron stores. “Vitamin D deficiency in children has been linked to bone health issues and iron deficiency has been linked to anemia and delays in cognitive development,” Dr. Maguire said. “Being able to answer parent’s questions about healthy cow’s milk intake is important to avoiding these potentially serious complications of low vitamin D and iron stores,” he stated. But the Canadian Paediatric Society recommends that cow’s milk should not be started before one year of age. The results of the study appeared online in Pediatrics.

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