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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Don't Dismiss Dairy!

September 12, 2013

By Henry H. Bernstein D.O.

For many children in the United States, June means the end of school and the start of summer vacation. It also is Dairy Month, a tradition started by dairy farmers more than 70 years ago to encourage people to drink more milk. Today, nutrition experts agree that dairy products are an important part of a healthy diet for most children (and adults), so make sure you know all the facts.

Dairy products are nutritious!
Dairy products contain many important nutrients, including calcium, protein, magnesium, potassium and vitamins A, D, and B12. For most people, dairy products are the biggest source of calcium, a mineral that is essential for building strong bones, teeth and other parts of our skeleton. Without enough calcium during childhood and early adulthood, children will not grow well and their bones may end up being thin and weak later in life (osteoporosis), making them more likely to break.

Many people do not get enough dairy products.
The new food-pyramid guidelines recommend that we all eat three servings of low-fat or fat-free milk, cheese or yogurt every day. For a small child, a serving size is ½ cup of milk or yogurt or ½ ounce of cheese; for older children and adults, it is 1 cup of milk or yogurt or 1 ounce of cheese.

According to information from the dairy industry, the average person drinks only 11.5 gallons of milk per year. That’s just ½ cup (4 ounces) per day. Young children tend to drink the most milk, which means older children and adults are not getting nearly enough. In fact, studies have shown that only about one in 10 girls and one in four boys between ages 9 and 17 years get enough calcium in their diet. To make matters worse, it turns out that only one out of every two teenagers drinks any milk at all.

While people are drinking less milk these days, they are eating more cheese. The average person eats 30 pounds of cheese per year (a little over one ounce per day), possibly because cheese now is available in a variety of flavors and packages, and many convenience foods contain cheese.

Children and adults who do not eat dairy products should pay even closer attention to the amount of calcium and vitamin D in the foods they do eat. For example, many fortified soy products contain the same amount of calcium and vitamin D as enriched cow’s milk. Note, however, that cow’s milk is fortified with vitamin D, but other dairy products such as yogurt and cheese are not. Likewise, soymilk usually contains vitamin D, but soy-based yogurt or cheese usually does not.

Some children eat too many dairy products.
Although dairy products are nutritious, they do not contain everything that we need to stay healthy, and getting too much can cause problems. Toddlers who fill up on milk may not get enough of other important foods. Starting cow’s milk too early (before one year of age) and drinking too much milk (more than 24 ounces per day after the first year of life) can lead to iron deficiency anemia. This is because cow’s milk is low in iron, makes it harder for the body to absorb iron from food, and can cause small amounts of bleeding in the intestines. Eating too much cheese sometimes causes constipation, especially in toddlers and younger children.

After age 2, choose low-fat and no-fat dairy products for your children.
Children younger than 2 years old must have enough fat for proper brain growth and development. Once they reach their second birthday, children can eat fewer high-fat foods and gradually make the transition to a heart-healthy diet, just like older children and adults. This means they should have no more than one-third of total calories from fat and no more than 300 milligrams of cholesterol per day. Low-fat and no-fat dairy products contain as much (and sometimes more) calcium as the higher fat forms.

Remember: We need vitamin D, along with calcium.
In order to get enough calcium from our diet, and then to use the calcium properly, we also must have enough vitamin D in our bodies. This important nutrient is made by the skin when it is exposed to sunlight. Unfortunately, it is impossible to know just how much sun we need in order to make enough vitamin D for our bodies. Furthermore, getting too much sun is not good for anyone, children or adults, but especially babies. (Remember: keep babies younger than six months out of direct sunlight at all times!)

Since vitamin D is added to cow’s milk and infant formula, most children and bottle-fed babies do get enough vitamin D. However, breast milk does not have much vitamin D, so babies who only drink breast milk may not be getting enough in their diet. Without enough vitamin D, an infant will develop rickets, a disease that makes bones soft and weak.

In recent years, doctors are seeing more and more children with rickets. Therefore, the American Academy of Pediatrics recommends that exclusively breastfed babies take a vitamin supplement with at least 200 IU of vitamin D, starting no later than 2 months of life.

Henry H. Bernstein, D.O. is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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