Submitted by
Kerri Staden, Dietitians of Canada
Are plant-based beverages suitable for infants?
While there is evidence that eating more plant foods is of benefit to our health, the trend for consuming plant-based beverages has recently highlighted concerns of feeding these beverages to infants and young children.
A recent article published in the Canadian Medical Association Journal reports that in Canada “children who drank only non-cow's milk were more than twice as likely as children who drank only cow's milk to have a 25-hydroxyvitamin D level below 50 nmol/L” (1). Low blood levels of vitamin D are only part of the story.
Nutrients in plant-based beverages are insufficient for infants
Plant-based beverages are generally lower in fat, protein, and some vitamins and minerals compared to whole cow’s milk and infant formulas (2,3). In addition, samples of rice beverage have been found to contain high levels of arsenic. Some soy and rice beverages have amounts of manganese that increase the risk of adverse neurological effects if these beverages are consumed by infants as the sole source of nutrition. There have been reports of kwashiorkor and rickets in infants fed rice, soy or nut beverages (2), including one death in a 2.5 month-old infant secondary to hyponatremia and respiratory acidosis (4).
While some plant-based beverages are fortified with additional nutrients, the amount of nutrients added varies between products. Even after supplementation, most of these beverages are not nutritionally equivalent to cow’s milk. For example, the amount of protein in whole cow’s milk is 3.2 g/100 g compared to 0.2 g, 0.4 g, and 2.6 g/100 g of enriched rice, almond and enriched soy beverages, respectively (2). A chart detailing the nutritional breakdown of whole cow’s milk, almond beverage, and enriched soy and rice beverages is found on PEN
® here.
Recommendation for Plant-Based Beverages
Plant-based beverages such as rice, soy, hemp, flax, oat, or nut (e.g. almond, chestnut, coconut, cashew) are not recommended as the main milk source or as a replacement for breastmilk, infant formula or whole cow’s milk for children for the first year of life. Breastmilk is the best option for the first six months and breastfeeding can continue for two years and beyond. When breastfeeding is not an option, infant formula should be given.
After an infant turns one year, country recommendations are as follows:
Country Guidelines for Plant-based Beverages
Australia
| After 12 months of age and under the supervision of a health care professional, fortified soy drink or calcium-enriched, full fat rice or oat drinks may be introduced (5). Alternative sources of protein and B12 should be added to the diet.
|
Canada
| After two years of age, soy, rice, almond and coconut beverages may be introduced (6). After six months of age, full fat, fortified, unflavoured soy can be given as an occasional complementary food. |
New Zealand
| For toddlers, plant-based beverages fortified and supplemented with vitamin D, B12, riboflavin and calcium may be provided (7).
|
United Kingdom
| After 12 months of age, full fat, fortified, unsweetened soy beverage may be given as part of a good, mixed diet (8). Rice milk is not recommended for toddlers and young children due to the potentially high levels of arsenic (8).
|
Practice Point
Dietitians need to be aware of the recommendations and nutritional content of local plant-based beverages to provide guidance to parents and caregivers whom may be giving these drinks to infants, toddlers and young children.
For more information on feeding infants and toddlers, see:
Written by Kerri Staden BSc, RD
PEN® Resource Manager
Dietitians of Canada
References
- Lee GI, Birken CS, Parkin PC, Lebovic G, Chen, Y Consumption of non-cow’s milk beverages and serum vitamin D levels in early childhood. CMAJ. 2014 Nov 9;186(17):1287-93
- Dietitians of Canada. What are the recommendations for the use of plant-based beverages (e.g. soy, rice, almond, coconut and oat milk/beverage) during the complementary feeding period in infants? In: PEN: Practice-based Evidence in Nutrition®. 2014 Apr 25 [cited 2015 Jan 7]. Available from: http://www.pennutrition.com. Access only by subscription. Free trials available. Click Subscribe on log in page.
- Dietitians of Canada. What types of formulas are suitable for formula-fed infants and for what duration? In: PEN: Practice-based Evidence in Nutrition®. 2014 Apr 25 [cited 2015 Jan 14]. Available from: http://www.pennutrition.com. Access only by subscription. Free trials available. Click Subscribe on log in page.
- Fourreau D, Peretti N, Hengy B, Gillet Y, Courtil-Teyssedre S, Hess L, et al. [Pediatric nutrition: severe deficiency complications by using vegetable beverages, four cases report]. Presse Med. 2013 Feb;42(2):e37-43. [French]. Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/23021957
- National Health and Medical Research Council. Infant feeding guidelines: information for health workers (2012). 2012 Dec [cited 2015 Jan 7]. Available from: http://www.nhmrc.gov.au/guidelines/publications/n56
- Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for healthy term infants: recommendations from six to 24 months. 2014 [cited 2015 Jan 7]. Available from: http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/recom-6-24-months-6-24-mois-eng.php
- Crawley H, Westland S. Infant milks in the UK: a practical guide for health professionals. First Steps Nutrition Trust; 2012 Nov [cited 2015 Jan 7]. Available from: http://www.firststepsnutrition.org/pdfs/FSNT_Infant%20milks_WEB.pdf