The Best Milk for Kids – Does It Still Come from a Cow?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut.

The new joke seems to be that you can turn anything into milk.
The new joke seems to be that you can turn anything into “milk,” even peas.

You wouldn’t think that the idea that kids should drink milk would be controversial…

Of course, it is.

The controversy is more over the type of milk now and not so much over the amounts though. Few people disagree with the American Academy of Pediatrics 2014 clinical report on Optimizing Bone Health in Children and Adolescents, in which they recommended that “Children 4 through 8 years of age require 2 to 3 servings of  dairy products or equivalent per day. Adolescents require 4 servings per day.”

Which Kind of Milk You Got?

While you used to have to go to Whole Foods to get soy milk, nearly every grocery store now has every type of “milk” you can think of, and some you haven’t.

So in addition to raw and pasteurized cow’s milk, it is possible to buy:

  • almond milk
  • cashew milk
  • coconut milk
  • flax milk (flax seeds)
  • goat milk
  • hazelnut milk
  • hemp milk
  • lactose free milk (cow’s milk without lactose)
  • oat milk
  • potato milk (as powdered milk)
  • quinoa milk
  • rice milk
  • ripple milk (peas)
  • 7 grain milk (Oats, Brown Rice, Wheat, Barley, Triticale, Spelt and Millet)
  • soy milk
  • sprouted rice milk

Complicating matters even more, once you decide on the type of milk to give your kids, you will have a lot of other options to choose from – organic, hormone free, sweetened vs unsweeted, enriched vs original, and a long list of flavors, etc.

The question is no longer simply Got Milk?

Best Milk for Kids

So which milk is best for your kids?

While each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink.

What about the idea or argument that cow’s milk is made for baby cows?

Following that logic, if you weren’t going to give your kids cow’s milk, then you probably wouldn’t give them most plant based milks, as they are commonly made from seeds. Almonds, peas, and soybeans, etc., aren’t “made” to make milk. They are produced to make more plants. But just like we pasteurize and fortify cow’s milk so that we can consume it, we have learned to use these other foods.

Best Milk for Kids with Food Allergies

While the wide availability of so many different types of milk is confusing for many parents, it has been great for pediatricians and parents of kids with food allergies and intolerances. Having more of a variety has also been helpful for vegan families.

In general, you should breastfeed or give your infant an iron fortified formula until they are at least 12 months old, avoiding milk or other allergy foods as indicated if you are breastfeeding and your child develops an allergy, or switching to a hypoallergenic or elemental formula if your child develops a formula allergy.

And then, after your toddler is old enough to wean from breastmilk or formula, you:

  • should avoid cow’s milk, lactose-free cow’s milk, and goat milk if your child has a milk protein allergy
  • should avoid almond, cashew, coconut, and hazelnut milk if your child has a nut allergy (yes, even though almonds and coconuts are really stone fruits and not true nuts, they have been rarely known to cross react and trigger allergic reactions)
  • should avoid soy milk if your child has a soy allergy
  • should make sure your child’s milk is fortified with calcium and vitamin D

Most importantly, talk to your pediatrician and/or a pediatric allergist before switching to a plant based milk if your child has food allergies and before trying to switch back to cow’s milk after you think they have outgrown their allergy.

Other Things to Know About Kids Drinking Milk

Kids don’t necessarily need to drink any kind of milk. They do need the nutrients that you commonly get from milk, including fat, protein, calcium, and vitamin D, etc. You should also know that:

  • the American Academy of Pediatrics recommends that most toddlers drink whole milk until they are two years old, when they should switch to reduced fat milk.
  • switching to reduced fat milk can be appropriate for some toddlers who are already overweight or if their pediatrician is concerned about their becoming overweight or about their cholesterol, etc.
  • most cow’s milk that you buy in your grocery store doesn’t have any added growth hormone (labeled rBST-free), even if it isn’t organic
  • the AAP, in a report on Organic Foods: Health and Environmental Advantages and Disadvantages, states that “there is no evidence of clinically relevant differences in organic and conventional milk”
  • if a company makes more than one type of non-dairy milk, such as rice, almond, and soy, then cross-contamination could be a problem for your child with food allergies
  • most kids with a lactose intolerance can tolerate some lactose in their diet, so may be able to drink some cow’s milk and eat cheese, yogurt, and ice cream, even if they can’t tolerate a lot of regular cow’s milk
  • while plant based milks are lactose free and some are unsweetened, others might have added sugar, including cane sugar or cane syrup
  • unlike cow’s milk, most plant based milks are very low in protein
  • although they aren’t labeled as 1% or 2%, plant based milks typically have less fat than whole milk
  • phytoestrogens in soy milk are a concern for some people
  • most milk, even oat milk, is gluten-free, with the exception of 7 grain milk, which obviously contains wheat
  • UHT milk undergoes ultra-high temperature processing or ultra-pasteurization to allow it have a longer shelf life, even if not refrigerated, at least until the carton is opened
  • although some experts warn about cross reactivity, like between peanuts and green peas, the Food Allergy Research & Education website states that “If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food.”
  • raw cow’s milk, in addition to being a risk for bacterial contamination and outbreaks of Escherichia coli, Campylobacter, and Salmonella, is very low in vitamin D and has no proven health benefits over pasteurized milk
  • reduced-calorie and no added sugar flavored cow’s milk often use artificial sweeteners
  • some brands of almond milk contain only about 2% of almonds, which leads some critics to say that you should just eat a few almonds to get even more nutritional benefits

But don’t forget about cost. Plant based milk can be at least two to four times more expensive than cow’s milk.

So again, remember that while each type of milk has its fans, in general, unless your child has food allergies or intolerances, the best milk is going to be the one you can afford, with the nutrients your child needs, and which he is going to drink, whether it comes from a cow, soybean, almond, or hazelnut, etc.

For More Information On The Best Milk For Kids:

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What Does Polio-Like Mean?

Learn why at least 350 children have developed acute flaccid myelitis since 2014.

Breaking News – 90 cases of AFM in 27 states have been confirmed so far this year, and are among 252 cases that are under investigation.

afmPolio has been in the news a lot lately.

Well, not exactly polio.

The term “polio-like” has been in the news.

This follows a large outbreak of enterovirus D68 (EV-D68) respiratory infections in 2014, some of which seemed to be associated with the development of acute flaccid myelitis (AFM).

While there were no reports of EV-D68 infections in 2015, there have been “limited sporadic EV-D68 detections in the U.S. in 2016.”

And 2017.

And 2018.

But after we saw 149 cases in 39 states in 2016, there were only 33 cases in 16 states in 2017.

And there have been about 38 cases in 16 states in 2018, coming out of the peak season for AFM cases – August to October.

Polio-Like Syndromes

Similar to coxsackievirus, which causes hand, foot, and mouth disease, EV-D68 is a non-polio enterovirus. On the other hand, the virus that actually causes polio is just a different type of enterovirus.

Because they are all enteroviruses, some get differentiated as being non-polio.

To make it even more confusing, some non-polio enteroviruses can cause a polio-like syndrome.

And both polio and non-polio enteroviruses can cause acute flaccid myelitis.

It is important to note that only some, but not all, of the kids with AFM have been positive for enterovirus D68. In Colorado this year, 9 of 14 cases were linked to EV-A71 infections.

Acute Flaccid Myelitis

What is acute flaccid myelitis?

AFM is a syndrome characterized by sudden onset of limb weakness, sometimes accompanied by cranial nerve dysfunction (such as facial drooping or difficulty speaking). In many cases, distinctive lesions in the gray matter (nerve cells) of the spinal cord may be seen on neuroimaging.

CDC definition

Acute flaccid myelitis caused by the polio virus can usually be recognized because it is associated with an unvaccinated person who traveled to an area that still has cases of polio and who has “one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss. Paralysis usually begins in the arm or leg on one side of the body (asymmetric) and then moves towards the end of the arm or leg (progresses to involve distal muscle groups).”

Since 2014, at least 350 children have developed acute flaccid myelitis. Most had some improvement in function and a small number had a complete recovery, just as a small number had no improvement.

And of course, none of them had polio. In fact, the last polio outbreak in the United States was in 1979.

So maybe we should stop saying “polio-like,” as it likely just confuses people, few people likely know what “polio-like” symptoms actually are, and these cases have nothing to do with the polio virus.

Unfortunately, “despite extensive testing, CDC does not yet know the cause of the AFM cases.”

AFM isn’t caused by vaccines though…

Still, the CDC recommends standard precautions to try and avoid AFM, including handwashing, avoiding other people who are sick, getting vaccinated (to avoid polio), and protecting your kids from mosquitoes (West Nile virus can cause AFM too).

For More Information on Polio-Like Syndromes

Updated November 13, 2018

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What to Know About Fifth Disease

Fifth disease is a common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

Fifth disease, also called erythema infectiosum, is a very common viral infection that most kids get in early childhood.

It got its name because it was the fifth disease that was known to cause a fever and rash.

Measles was the first.

Symptoms of Fifth Disease

Fifth disease can cause a child to look like they have slapped cheeks.
Fifth disease can cause a child to look like they have slapped cheeks. Photo by Dr. Philip S. Brachman

It is caused by parvovirus B19.

Symptoms start with a red rash on your child’s cheek, giving them the appearance that they have been slapped. And that’s where fifth disease’s other name comes from – slapped cheek disease.

This slapped cheek rash is often subtle, so that many parents might think that the rash is from the sun or wind. They often don’t even consider that their child might be ‘sick’ until a few days later, when they get a pink, lacy rash on their arms and legs. Even then, they might mistake the rash for hives, poison ivy, or any number of other common childhood rashes.

Diagnosis of Fifth Disease

Unless you understand that the fifth rash can come and go, being more obvious when your child is overheated, it can be easy to see why it isn’t quickly recognized by some people. It can also be confusing because the rash could also appear on a child’s back, chest, and leg – it doesn’t have to be limited to the cheeks and arms.

And the rash, which can be itchy, can linger for weeks or even months.

While a blood test can be done, it is this pattern of symptoms that makes the diagnosis.

Most importantly, understand that fifth disease eventually does goes away without treatment. While not usually necessary, anti-itch treatments may be tried.

Can your kids go to school with fifth disease?

Fortunately, kids are not contagious while they have this rash, so they can go to school and participate in other activities. You might need a note from your pediatrician to convince folks though. They were contagious during the week before they developed the rash though, so it can be a good idea to tell people, so they can look for symptoms too.

Facts About Fifth Disease

Other things to know about fifth disease include that:

  • Fifth disease is caused by the parvovirus B19 virus and is most common during the spring and school outbreaks are no uncommon.
  • The incubation period for fifth disease is very long – up to 4 to 21 days. That means you can get this virus about 4 to 21 days after being exposed to someone else that had it, especially if you were exposed to their respiratory secretions (coughing and sneezing) just before they developed their rash.
  • Prodromal symptoms of fifth disease, which can start 7 to 10 days before the rash, might include a few days of mild fever, muscle aches, headache and decreased activity.
  • In addition to a rash, adults with fifth disease can also have joint pain and arthritis.

It is also important to know that like roseola, fifth disease can be more serious for those with immune system problems. It can also be serious for pregnant women who aren’t immune and for those with hemolytic anemia and sickle cell disease.

What to Know About Fifth Disease

Fifth disease is a very common viral infection that causes a characteristic rash on a child’s cheeks, arms, and legs that can linger for weeks.

More Information About Fifth Disease

Pediatrics Health Library

An A to Z guide to pediatrics and parenting.

From acne to zika, we will get you the information you need to keep your kids safe and healthy:

Please check back often as we get all of these topics updated.

Updated September 26, 2017

Roseola

Roseola is a common viral infection that most kids get in early childhood.

Roseola is a very common childhood infection.

It was first described in the journal Pediatrics in 1910 by J. Zahorsky.

Also called roseola infantum or exanthem subitum (sixth disease), it is caused by human herpes virus type 6 and 7. That fact wasn’t discovered until 1986 though.

Roseola is best known for causing a high fever for about three to five days, but even more characteristically, roseola often causes a rose-pink or red rash on your child’s trunk once the fever breaks.

Infections can also be asymptomatic.

There are no treatments and it rarely causes complications. Even febrile seizures that can be triggered by roseola, which happens commonly, are not thought to be serious.

Roseola, even reactivation of an old infection, can be a serious for children or adults with immune system problems though, especially those who have had a stem cell transplant.

What To Know About Roseola

Roseola is a common viral infection that most kids get in early childhood. The biggest problem when having roseola is that by the time you get diagnosed, because the fever is gone and your child has a rash, it is basically over.

For more information:

Vaccine Preventable Diseases

Kids routinely get 13 vaccines that protect them against 16 vaccine preventable diseases.

There are over 25 vaccine-preventable diseases, including:

  • Anthrax – military use only
  • Adenovirus – military use only
  • Cervical Cancer (HPV)
  • Cholera
  • Diphtheria (DTaP)
  • Hepatitis A
  • Hepatitis B
  • Hepatitis E
  • Haemophilus influenzae type b (Hib)
  • Influenza (Seasonal Flu)
  • Japanese Encephalitis (JE) – travel
  • Measles (MMR)
  • Meningococcal disease (MCV4 and MenB)
  • Mumps (MMR)
  • Pertussis (DTaP)
  • Pneumococcal disease (Prevnar 13 and Pneumovax 23)
  • Poliomyelitis (IPV)
  • Rabies – after bites
  • Rotavirus
  • Rubella (MMR)
  • Shingles (Herpes Zoster) – for seniors only
  • Smallpox – eradicated
  • Tetanus (Tdap)
  • Tick-borne encephalitis
  • Tuberculosis (BCG)
  • Typhoid Fever – travel
  • Varicella (Chickenpox)
  • Yellow Fever – travel

Of course, kids don’t actually get vaccinated against all of these diseases.

They do routinely get 13 vaccines (bolded above) that protect them against 16 vaccine preventable diseases.

For more information:

Breastfeeding Recommendations

The AAP recommends exclusive breastfeeding for about six months and to continue for at least the first year.

Parents often have a lot of questions about breastfeeding.

One thing that they shouldn’t question is that breastfeeding provides a number of “short- and long-term medical and neurodevelopmental advantages” for their baby.

That’s why the American Academy of Pediatrics, in their 2012 policy statement on Breastfeeding and the Use of Human Milk recommended:

“Exclusive breastfeeding for about six months…”

And for breastfeeding “to continue for at least the first year and beyond for as long as mutually desired by mother and child…”

Since the AAP has concluded that “breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development,” be sure you get all the help you need to effectively breastfeed your child.

And remember, if breastfeeding was easy, we wouldn’t need lactation consultants. So don’t be afraid to ask for help.

For more information:

Circumcision

The American Academy of Pediatrics policy statement has shifted over the years.

They still don’t recommend that boys routinely get circumcised though.

Instead, the latest recommendation, which was published in a 2012 policy statement, states that:

…the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.

While the health benefits of getting circumcised, including prevention of UTIs, penile cancer, and transmitting some STIs, outweigh the small risks of the procedure, the AAP states that parents still need to decide if circumcision is in the best interest of their male child, thinking about their own “religious, ethical, and cultural beliefs and practices.”

Don’t get your child circumcised because you think it will be too hard to clean his intact penis and don’t get your child circumcised because you think everyone else is doing it and he will have problems in the locker room. Those aren’t good reasons.

It is also important to keep in mind that if your child is circumcised, the AAP also states that babies should be given “adaquate analgesia,” (that’s pain control) including:

  • penile nerve block techniques
  • nonpharmacologic techniques, like positioning and sucrose pacifier, can be used as an adjunct to a penile nerve block

And of course, the AAP came out with a policy statement in 2010 against the “traditional custom of ritual cutting and alteration of the genitalia of female infants, children, and adolescents, referred to as female genital mutilation or female genital cutting (FGC).”

For more information:

Helping Kids Cope With Stress

Get help recognizing signs and symptoms of stress in your kids and helping them cope when stress gets to be too much to handle.

Children, especially teens, often have stress in their lives.

Whether caused by the loss of a friend or loved one, a recent move, being teased or bullied, difficulties at home, or problems at school, childhood stress can lead to behavioral problems, anxiety, depression, headaches, drug use, and insomnia, among many other symptoms and medical problems.

Other symptoms of stress can include mood swings or temper tantrums in a younger child, withdrawing from friends and family, and aggression.

What Causes Kids to Have Stress?

Unfortunately, the source of stress for a child is frequently not so easy to recognize and parents are not always very good at noticing things that could be stressors, which can include things like:

  • a change at daycare for preschool age children, including attending daycare for the first time, moving to a new room, having a new teacher, or changing to a new daycare, etc.
  • having too much homework
  • being over-scheduled with sports and other extracurricular activities
  • having expectations for his performance that are unrealistic and too high or a fear of failure, despite of having good grades, having a lot of friends, etc.
  • a divorce or death in a friend’s family, which can raise fears that the same thing could happen to his own parents
  • poor self esteem
  • watching something stressful on the news, such as a school shooting, terrorist attack, or natural disaster
  • a chronic medical problem, like asthma or diabetes, or an acute medical problem, like a burn or broken leg
  • a medical problem in a family member
  • a traffic accident
  • financial problems at home

Keep in mind that common childhood transitions, such as moving to a toddler bed, starting kindergarten, going to camp, starting puberty, beginning high school, and going off to college, etc., can be very stressful for some children.

The other confusing thing about stress is that the symptoms of being stressed do not always immediately follow whatever is causing the stress and the same situations don’t cause stress in all children or even for the same child at different stages in their life.

Helping Kids Cope With Stress

Although overlooked as many parents and children look for a quick fix for their problems with stress, it is important not to overlook the importance of regular exercise, a healthy diet, and a good night’s sleep to help them cope with any problems with any stress they are having.

Other ways to help your child cope with stress can include:

  • scheduling more free time for your child, especially if being too busy is the source of her stress
  • spending quality time with your child and give them plenty of opportunities to talk about their worries and problems
  • eating dinner together each night as a family and having other routines or rituals that you stick to on a regular basis
  • helping your child set realistic expectations for himself
  • be prepared for stressful situations that you can anticipate, such as the birth of a new sibling, a move to a new city, or a parent who is going to have surgery
  • giving your child age appropriate responsibilities and allowing him to overcome simple challenges on his own without always bailing him out, which can help teach them basic problem solving skills that he will need throughout his life
  • teaching your child ways to relax, including diaphragmatic breathing, progressive muscle relaxation, visual imagery, listening to music, reading, keeping a journal, and drawing, etc.

Your pediatrician can be a good resource if your need help managing your child’s level of stress, especially if your child’s symptoms from the stress are not temporary. A mental health professional, such as a counselor, child psychologist, and/or child psychiatrist, can also be very helpful for the overly stressed child or even for a child who does not routinely handle stress well.

Sources:

American Academy of Child and Adolescent Psychiatry. Facts for Families. No. 66; Updated Feb 2013. Stress Management and Teens. Accessed May 2016.

Rotavirus Vaccines and Infections

Rotavirus is a life-threatening disease that was once very common in childhood but can now be easily prevented with either the RotaTeq or Rotarix vaccines.

Rotavirus is a now vaccine-preventable disease that can cause vomiting and diarrhea in young children.

While rotavirus isn’t the only cause of diarrhea in children, it was once the most common cause of severe diarrhea in young children.

Norovirus, several bacteria (Salmonella and Shigella), parasites, and other organisms still cause gastroenteritis (stomach flu) in children, but we don’t see rotavirus as much anymore. The National Respiratory and Enteric Virus Surveillance System (NREVSS) now reports low levels of rotavirus infection each year, with only about 5% of rotavirus tests now being positive during the peak of rotavirus season vs over 25% in the pre-vaccine era.

Rotavirus Infections

Children can develop symptoms of rotavirus symptoms about 1 to 3 days after being exposed to someone else who is sick with a rotavirus infections (the incubation period). These symptoms could include vomiting, watery diarrhea (without blood or mucus), fever, and abdominal pain. Although the fever and vomiting typically only last a few days, the diarrhea can often last at least 3 to 8 days or longer.

A rapid antigen stool test is available to test for rotavirus, but the diagnosis a typically made clinically, which means without testing and based on your child’s symptoms, especially if rotavirus infections are going around in your community.

Of course getting diagnosed with rotavirus is much less likely these days, now that we have a safe and effective vaccine.

While rotavirus was once the most common cause of severe diarrhea in children, leading to about 3 million cases of diarrhea, 55,000 hospitalizations, and 20 to 40 deaths in the United States each year, that has been greatly reduced in the post-vaccine era.

During the 2007-2008 rotavirus season, rotavirus activity decreased by more than 50% as compared to the 15 previous rotavirus seasons from 1991 to 2006. And during the 2010 to 2012 seasons, “the number of positive rotavirus tests declined 74%-90% compared with the pre-vaccine baseline and the total number of tests performed annually declined 28%-36%.”

Rotavirus Vaccines

The first rotavirus vaccine, Rotashield was quickly taken off the market in 1999 after it was found to be associated with an increased risk of intussusception, a type of bowel obstruction.

Newer rotavirus vaccines include:

  • RotaTeq – approved in 2006 and given to infants as a 3 dose vaccine series, it provides protection against five common strains of rotavirus, including serotypes G1, G2, G3, G4 and P1
  • Rotarix – approved in 2008 and given to infants as a 2 dose vaccine series, it provides protection against the most strain of rotavirus that most commonly gets kids sick

Both are live vaccines that are given orally and are thought to provide protection for at least two to three rotavirus seasons.

How good is that protection?

Completing either series of vaccines has been found to provide up to 98% protection against severe rotavirus gastroenteritis and up to 87% against any rotavirus gastroenteritis.

Infants should not get a rotavirus vaccine if they have had a severe allergic to a previous dose of the vaccine, to latex, if they have a history of intussusception, or if they have severe combined immunodeficiency (SCID).

They can usually get the rotavirus vaccine if they simply have some chronic stomach issues, like acid reflux or a milk intolerance, or if someone in the house has a problem with their immune system (just wash your hands after diaper changes). An immune system problem that is not SCID, an episode of acute, moderate or severe gastroenteritis, or other acute illness would be considered precautions to getting the rotavirus vaccine.

What To Know About Rotavirus

Rotavirus is a life-threatening disease that was once very common in childhood but can now be easily prevented with either the RotaTeq or Rotarix vaccines.

 

Sources:

American Academy of Pediatrics. Rotavirus infections. In:Pickering LK, Baker CJ, Long SS, eds. RedBook: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2015

Gershon: Krugman’s Infectious Diseases of Children, 11th ed.

Live attenuated human rotavirus vaccine, Rotarix. Bernstein DI – Semin Pediatr Infect Dis – 01-OCT-2006; 17(4): 188-94.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013. MMWR. December 11, 2015 / 64(SS12);1-16

Tate JE et al. Trends in national rotavirus activity before and after introduction of rotavirus vaccine into the national immunization program in the United States, 2000 to 2012. Pediatr Infect Dis J. 2013;32(7):741-744.