What to Know

Lactose itself is the sugar found in dairy products. Lactose intolerance is a digestive problem that can cause discomfort such as bloating, cramping, diarrhea, and gas. Because of a deficiency of an enzyme in the body called lactase, people who are lactose intolerant are unable to digest this milk sugar. The best treatment is avoiding dairy products and choosing lactose-free products. Lactose intolerance is not very common in babies and typically shows up in children after the age of 3.

While lactose intolerance is rare in babies and tots, some little ones with dairy sensitivities may actually have an intolerance or allergy to the milk proteins whey and casein (versus the milk sugar with lactose intolerance.)

A milk allergy or intolerance could potentially cause a wide range of symptoms from a rash, hives, itching, and swelling to a more life-threatening reaction such as anaphylaxis. Babies who have a milk allergy may also experience frequent loose stools that may possibly contain blood or mucus, frequent spitting up, vomiting, and discomfort.  A cow’s milk allergy is the most common food allergy in infants and young children with approximately 2.5 percent of children younger than 3 years being allergic to milk. Fortunately, most children will eventually outgrow this as they get older and their digestive systems mature.

Your pediatrician may ask for a stool sample to check for blood, as sometimes the blood is not visible to the eye. Breastfeeding moms must eliminate dairy in their diet since the milk proteins pass through breastmilk, while formula feeding moms will likely need to switch to a specialized formula.

When eliminating dairy in your own diet or trying to figure out what foods to offer your tot, reading labels is critical. The following words will indicate the presence of milk in the product:

  • Milk
  • Lactose
  • Whey
  • Casein
  • Curds
  • Milk by-products (like butter)
  • Dry milk solids
  • Nonfat dry milk powder

You may wonder how you or your child’s nutritional status may be impacted when foregoing dairy products. Fortunately, there are many foods that can supply the important nutrients that dairy provides, such as protein, calcium, magnesium, and vitamin D. All whole fruits, vegetables, legumes, nuts, seeds, meat, poultry, fish, grains, and eggs are dairy free. There are also many non-dairy substitutes on the market, such as soy yogurt or coconut milk so you can still cook and bake dairy-free with ease. When it comes to meeting your and your baby’s nutritional needs, choose a variety of these non-dairy containing foods.

What to Do

  • Observe the symptoms: Does your baby have gas and bloating? Loose stool with blood in it? Eczema or skin rash? This will help determine the problem.
  • Consult with your pediatrician if you suspect your baby may have a milk allergy or lactose intolerance.
  • Read food labels’ ingredient lists for sources of lactose or milk protein that need to be avoided.
  • Seek out non-dairy alternatives to use in cooking and baking as needed, such as non-dairy margarine and soy milk in baked goods, or canned coconut milk in creamy soups.
  • Eliminate dairy in your own diet if your breastfed baby develops a milk allergy.
  • Seek out non-dairy sources of protein such as meat, eggs, fish, tofu, and beans.
  • Seek out non-dairy sources of calcium, such as dark leafy greens, tofu, legumes, and calcium fortified non-dairy beverages.
  • Seek out non-dairy sources of vitamin D, such as salmon, egg yolks, and some fortified cereals and non-dairy beverages.

For more on this topic, check out the following articles and recipes:

The primary goal is to be your own detective, read labels, and make inquiries at restaurants or other events involving food. Allergens can be hidden in coatings, thickeners, spices, natural flavors, and other ingredients found in fresh, frozen, refrigerated, and shelf-stable foods.  Preparing meals and snacks at home can help you maintain control over food sources and help prevent cross-contamination. 

Pro Tip:

This meal plan is created for women who are truly allergic, or who are breastfeeding and need to undergo an elimination diet to determine what foods their infant may have an intolerance or allergy to. Taking these foods out during pregnancy or breastfeeding, if not warranted, may actually promote intolerance in your infant as complete avoidance will prevent the immune system from learning that these foods are not actually harmful. If you are breastfeeding and your infant is showing symptoms of allergy or intolerance, and you have discussed the issue with your and/or your infant’s healthcare provider (HCP), this meal plan may be used to eliminate the major allergens.

This diet can be tricky. Make sure to work closely with your HCP as he or she knows what is best for you and your baby. To determine which foods were not tolerated by your baby, your HCP may have you add these foods back into your diet one at a time after they have been eliminated for 2-4 weeks, or until your infant stops having symptoms.

Choosing meals and snacks from the below listed options will help eliminate major allergens (dairy, soy, eggs, gluten, and peanuts) while helping you maintain adequate nutrient intake.

Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.

During pregnancy, vitamin B12 is believed to combine with folic acid to help prevent spina bifida and other spinal and central nervous system birth defects in your baby.

Vitamin B12 that is found in food needs the acidic environment of the stomach to separate it from the protein that it is bound to. The synthetic B12 found in supplements does not need to be separated, so if you have a low acid level (maybe you are taking medication to treat reflux or peptic ulcer disease for an extended time period) then you may have low blood levels of B12 and a supplement taken by mouth should be just fine.

Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods however it is commonly fortified and found in breakfast cereals, soy and other plant-based milks, nutrition bars, meat substitutes, and Red Star Vegetarian Support Nutritional Yeast.

The top food sources of Vitamin B12 are clams, liver, certain fortified breakfast cereals, fish, beef and dairy products.

Supplemental vitamin B12 for vegans and lacto-ovo vegetarians is recommended during both pregnancy and lactation to ensure that enough vitamin B12 is transferred to the fetus and infant. Pregnant and lactating women who follow strict vegetarian or vegan diets should consult with their health care practitioner regarding vitamin B12 supplements for themselves, their babies and their children.

Recommended intakes for vitamin B12 vary.  They are as follows:

  • Babies 0-6 months require .4 micrograms
  • Infants 7-12 months require .5 micrograms
  • Children 1-3 years require .9 micrograms
  • Children 4-8 years require 1.2 micrograms
  • Children 9-13 years require 1.8 micrograms
  • Ages over 14 years require 2.4 micrograms
  • If you are pregnant you require 2.6 micrograms
  • If you are lactating you require 2.8 micrograms

What To Do

Include foods supplemented with vitamin B12 such as breakfast cereals fortified with 100% of vitamin B12.

Include foods that are naturally high in vitamin B12 such as clams, liver, sockeye salmon and rainbow trout.

If you are a vegan or vegetarian, talk to your health care practitioner about a vitamin B12 supplement.

If your diet is low on animal foods such as meat, fish, poultry, milk, cheese and eggs look for fortified vitamin B12 foods. Check nutrition labels because not all fortified foods have the same amounts.

If you are a long time user of certain medications to treat gastroesophageal reflux, peptic ulcer disease or are on metformin, talk to your health care practitioner about checking your vitamin B12 levels or supplementation.

Tip #1: Try to think of a snack as a mini meal. No need to forego foods that you normally eat at meals in favor of more traditional packaged snacks. Got some left over roasted veggies from dinner? Those can be a great snack! Got leftover meatballs? Have one with some veggies for a snack!

Tip #2: Fruits and Veggies. Most of us could could include more fruits and vegetables in our daily diet, in fact,  half of our plates should be filled with them.  Your snacks can include  healthy fruits and veggies too! Start your snack with a fruit or vegetable, and add to it. Think apples, cherry tomatoes, tangerines and bananas,  – all portable “fast food” for mom and perfect if cut up for your toddler. Make sure to cut up small circular fruits (like grapes, tomatoes, etc.) and veggies into small pieces for your toddler, to avoid any choking hazards.

Buy your veggies and slice them in advance so you have them ready to grab and go in your fridge. Sliced green, red and yellow peppers and washed berries, cut up mango and melon are also nice to keep on a shelf in the fridge for an easy-to-grab snack, on the go.

Tip #3: Add protein or healthy fat. Once you have your fruit or vegetable, add a little protein or healthy fat such as nut butters, nuts*, hummus, beans, avocado, yogurt, cheese stick, etc.  Combining a protein or healthy fat with a fruit or vegetable makes for a more satisfying snack that will keep you feeling full, longer.

*For your toddler, a thin layer of nut butter is advisable vs a spoonful, to prevent choking.

Tip #4: Make it well-rounded. Combine multiple food groups  for a balanced, healthy snack. Eating crackers alone for a snack may not be very satisfying but if you add hummus  and sugar snap peas , you’ve got yourself a satisfying, healthy snack that could also be considered a mini meal!

Putting all of the above tips together, here are some healthy, satisfying snack examples:

  • plain yogurt + blueberries + ground flax seeds
  • whole grain pita bread, + scrambled egg + salsa
  • cheese stick + orange
  • almond butter + banana
  • avocado toast
  • whole grain English muffin pizza with shredded carrots
  • ½ whole grain tortilla with smear of refried beans + chopped bell pepper
  • hard boiled egg + whole grain crackers + tomatoes
  • edamame + corn + bell pepper with salad dressing
  • canned salmon + baby spinach + whole grain crackers

Note: The following is a list of foods that are not suitable for children under the age of 4, due to choking hazard:

  • Hot dogs
  • Nuts and seeds
  • Chunks of meat or cheese
  • Whole grapes
  • Hard or sticky candy
  • Popcorn
  • Chunks of peanut butter
  • Chunks of raw vegetables
  • Chewing gum

Two forms of vitamin A are available in the diet.  Preformed vitamin A is found in foods from animal sources including dairy products, fish, poultry,  and meat. Provitamin A is found in plant products. Beta-carotene is the most common type of Provitamin A (think yellow, orange, red and dark green fruits and vegetables). Provitamin A can be made into vitamin A by the body.

Common food sources of Vitamin A include:

  • Orange/red vegetables such as sweet potatoes, carrots, squash, red bell peppers
  • Fruit such as cantaloupe, oranges, mango, apricot
  • Beef liver and organ meats (high in cholesterol, so go easy)
  • Milk with Added vitamin A and D
  • Green leafy vegetables and other green vegetables such as broccoli, kale
  • Fortified breakfast cereals

Vitamin A listed on food and supplement labels are in international units (IU), however the RDA lists vitamin A in micrograms (mcg) of Retinol Activity Equivalents (RAE) to account for how different forms of vitamin A have different bioactivities (how well your body can use various forms).  Converting these is complicated because different forms of vitamin A have different usable amounts for the body. Here are the requirements:

  • Babies 0-6 months require 400 mcg RAE
  • Infants 7-12 months require 500 mcg RAE
  • Children 1-3 years require 300 mcg RAE
  • Children 4-8 years require 400 mcg RAE
  • Children 9-13 years require 600 mcg RAE
  • Adolescent males  require 900 mcg RAE
  • Adolescent females require 700 mcg RAE (females)
  • Adults males require 900 mcg RAE
  • Adult females require 700 mcg RAE
  • Pregnant Teens require 750 mcg RAE
  • Pregnant Adults require 770 mcg RAE
  • Breastfeeding teens require 1200 mcg RAE
  • Breastfeeding adults require 1300 mcg RAE

Vitamin A deficiency is rare in the United States.  Americans are more likely to get too much vitamin A from their diets, than too little.  Excessive Vitamin A is mostly a concern from  over supplementation. This can cause adverse effects and is of particular concern for women who are pregnant.  It would be difficult to consume excessive vitamin A from food sources alone.

What to Do

  • Include a variety of fruits and vegetables:  A rainbow assortment of fruits and vegetables will help you to meet your requirements for vitamin A, so include the following on a regular basis:
  • Sweet potato, spinach, carrots, pumpkin, cantaloupe, red peppers, mangos, dried apricots broccoli, spinach, and kale.
  • Dairy products such as ricotta cheese, milk and yogurt can be included in a healthy diet and will help you to meet your requirements for vitamin A.

Preventing Foodborne Illness

There are many ways to prevent foodborne illness in babies and toddlers including:

  • Good hygiene- Hand washing is the most effective measure you can take in preventing foodborne illness in your baby or toddler.
  • Avoiding at risk foods- Certain foods are more susceptible to bacterial growth and should not be given to your baby. These include:
    • Unpasteurized dairy products, including milk
    • Raw and undercooked eggs and foods containing raw or undercooked eggs
    • Raw and undercooked meat and poultry
    • Raw and undercooked fish and shellfish
    • Unpasteurized juices (unless freshly squeezed yourself)
    • Raw sprouts
    • Honey-do not give to children less than 12 months old due to the risk of botulism, a foodborne illness
  • Proper cleaning and sterilization of bottles, sippy cups, breast pump parts, and other baby feeding supplies
  • Proper handling, storage and reheating of breastmilk (See: Breastmilk pumping: Safe storage)
  • Proper handling and preparation of infant formula

Other Food Safety Considerations

Choking– Don’t let those pearly whites fool you. Just because your child has teeth, does not mean he is ready to handle all types of food. Babies and toddlers are at an increased risk of choking, so it’s important to provide age appropriate textures and appropriately sized foods.

Mercury– Certain types of seafood have a high mercury content, including albacore tuna, swordfish, mackerel, and tilefish. Fish is a great source of lean protein and can be included in your baby or toddler’s diet. When choosing fish, opt for low mercury choices like salmon, cod, chunk light tuna (in the can), pollock, tilapia, and catfish.

What to Do

  • Practice good hand hygiene– Wash your hands frequently with warm, soapy water for at least 10-20 seconds.
  • Avoid high risk foods –Refrain from giving your baby unpasteurized milk, cheese and juice, raw or undercooked meat, poultry, fish or eggs, raw sprouts, and honey if under 12 months old. These foods are more susceptible to bacterial growth.
  • Cook foods thoroughly– Cook foods like meats and poultry to recommended internal temperatures (below) to ensure harmful bacteria are killed.
    • Beef, pork veal and lamb- 145 degrees
    • Ground meats- 160 degrees
    • Poultry-165 degrees
    • Fish and shellfish-145 degrees
  • Don’t “double dip”- Feeding your baby straight from the jar can introduce bacteria from your baby’s mouth from the spoon into the food. Instead, spoon a small amount into a bowl and feed your baby from there. Throw out any food from the bowl that your baby did not eat. You can place whatever is left in the jar (that did not come into contact with your baby’s saliva) back in the refrigerator for later use.
  • Timing is key-Be familiar with recommended “safe times” for opened baby food
    • Strained fruits or veggies- 2-3 days
    • Strained meats- 1 day
    • Veggie and meat combos-2 days
  • Clean and sterilize- Be sure to wash bottles, sippy cups, feeding utensils, breast pump parts and other feeding supplies in hot, soapy water then rinse thoroughly.
  • Follow proper handling, storage and reheating of breastmilk guidelines- (See: Breastmilk pumping: Safe storage.)[
  • Follow proper handling and preparation of infant formula
    • Mix formula with safe water source
    • Prepared formula must be discarded within 1 hour after feeding your baby
    • Prepared formula that has not been given to a baby can be stored in the refrigerator for up to 24 hours
    • An open container of ready to feed or concentrated formula should be covered, refrigerated and discarded after 48 hours if not used
  • Prevent choking-Take these precautions to minimize the risk of your child choking.
    • Foods that pose a risk of choking should be avoided. Examples include nuts, whole grapes, hot dogs, raw carrots, raisins, popcorn, and portions of food that are too large.
    • Stay close to your baby during meals to make sure he is tolerating the foods appropriately
    • Make sure your baby or toddler is in a designated feeding chair like a high chair or booster seat
    • Allow baby to eat at his own, comfortable pace
  • When it doubt, throw it out – If you can’t remember whether the leftovers are from two days ago or last week, throw it out.

Salt

Too much salt can actually be harmful for babies’ kidneys, which is why it’s important to be aware of sources in your child’s diet. The American Academy of Pediatrics and American Heart Association recommend children age 1-3 get no more than 1500 mg per day of sodium. And for babies between 6 and 12 months, the recommended Adequate Intake (AI) is 370 mg sodium.

When you start serving your baby solids, aim to  rely on foods’ natural flavors – such as the sweetness that comes from roasting root vegetables – to please your baby’s palate. As for salt, no need to sprinkle it on! To enhance the flavor of foods, try using fresh or dried herbs and spices that add flavor without sodium.

Most pre-made foods that are marketed for infants (up to 12 months old) are low in sodium. However, this is not always the case for foods aimed at toddlers (12-36 months old), such as pasta with sauce, dips and dressings for veggies, crackers, pretzels, processed meats and cheese.

How can parents reduce the amount of sodium in their child’s diet? When feeding babies, select foods that are designed for infants since they have lower sodium levels, or prepare homemade foods that are made with no added salt. Be cautious of “convenience foods” marketed to toddlers as they may contain a high amount of sodium. Compare Nutrition Fact Panels to find products lower in sodium.  And whenever possible, provide fresh, whole foods for meals and snacks, enhancing the flavor of foods using herbs, spices and different cooking techniques.

Sugar

Unfortunately, many packaged foods aimed at babies and toddlers contain added sugar – that is, sugar that has been added to the product and is not naturally occurring. While babies naturally gravitate towards sweet tasting foods, that does not mean their meals and snacks need to be enhanced with added sources of sugar.

Look at the ingredient list of kid-friendly foods such as cereals, bars, juices or fruit snacks and you’ll likely see sugar has been added. Added sugars to be aware of include: cane sugar, malt or corn syrup, evaporated cane juice, brown rice syrup, honey, and high fructose corn syrup – to name a few.  When shopping, look for products with minimal or no added sugars in the ingredient list.

Much like with sodium, the best way to minimize added sugar in your child’s diet is to rely on whole, fresh foods as much as possible such as fruit, vegetables, minimally processed dairy, beans, legumes, meat, fish, and whole grains. Enhancing the natural sweetness of foods can be as easy as mashing a ripe banana in yogurt or oatmeal, or roast sweet potatoes with a dash of cinnamon.

While it’s difficult to cut out convenience foods such as jarred sauces and canned beans, added sugar and salt in your child’s diet can be minimized by using fresh, whole foods as much as possible. This will not only expose your little one to a variety of delicious foods, flavors and textures, but also set taste preferences and help children make healthy food choices for life.

What to Do

  • Use fresh or dried herbs and spices to enhance the flavor of foods. Try cinnamon on roasted root vegetables, dill on baked fish, or a dried herb blend mixed into soft cooked noodles.
  • Use fresh fruit or purees to enhance the sweetness of foods. Try mashed banana in yogurt or applesauce mixed with oatmeal.
  • Read food labels and ingredient lists so you’re aware of which foods contain added salt or sugar and how much. The new nutrition facts label will list how much added sugar a product has!
  • Opt for whole, fresh foods for your child’s snacks over “toddler friendly” foods that contain added salt and sugar. Fresh cut fruit, veggie sticks dipped in hummus, hard boiled eggs or yogurt make great snacks for little ones.
  • Babies and toddlers can eat what the family eats as long as the food is safe in size and texture. Cook without using salt and add it to the adult portions only, as needed, so your baby can share in the family food.

While lactose intolerance is rare in babies and tots, some little ones with dairy sensitivities may actually have an intolerance to the milk proteins whey and casein (versus the milk sugar with lactose intolerance.)

A milk allergy or intolerance could potentially cause a wide range of symptoms from a rash, hives, itching and swelling to a more life-threatening reaction such as anaphylaxis. A cow’s milk allergy is the most common food allergy in infants and young children with approximately 2.5 percent of children younger than three being allergic to milk. Fortunately, most children will eventually outgrow this as they get older and their digestive systems mature.

Babies who have a milk allergy may be experiencing frequent loose stools that may possibly contain blood or mucus, frequent spitting up, vomiting, and discomfort. Your pediatrician may ask for a stool sample to check for blood, as sometimes the blood is not visible to the eye. Breastfeeding moms must eliminate dairy in their diet since the milk proteins pass through breastmilk, while formula feeding moms will likely need to switch to a non-dairy formula.

When eliminating dairy in your own diet or trying to figure out what foods to offer your tot, reading labels is critical. The following words will indicate the presence of milk in the product:

  • Milk
  • Lactose
  • Whey
  • Casein
  • Curds
  • Milk by-products (like butter)
  • Dry milk solids
  • Nonfat dry milk powder

You may wonder how you or your child’s nutritional status may be impacted when foregoing dairy products. Fortunately, there are many foods that can supply the important nutrients that dairy provides, such as protein, calcium, magnesium, and vitamin D. There are also many non-dairy substitutes on the market, such as soy yogurt or coconut milk so you can still cook and bake dairy free with ease. All whole fruits, vegetables, legumes, nuts, seeds, meat, poultry, fish, grains and eggs are dairy free. When it comes to meeting your and your baby’s nutritional needs, choose a variety of these non-dairy containing foods.

WHAT TO DO

  • Observe the symptoms: Does your baby have gas and bloating? Loose stool with blood in it? This will help determine the problem.
  • Consult with your pediatrician if you suspect your baby may have a milk allergy or lactose intolerance.
  • Read food labels’ ingredient lists for sources of lactose that need to be avoided.
  • Seek out non-dairy alternatives to use in cooking and baking as needed, such as soy milk in baked goods or canned coconut milk in creamy soups.
  • Eliminate dairy in your own diet if your breastfed baby develops a milk allergy.
  • Seek out non-dairy sources of protein such as meat, eggs, fish, tofu, and beans.
  • Seek out non-dairy sources of calcium, such as dark leafy greens, tofu, legumes, and calcium fortified non-dairy beverages.
  • Seek out non-dairy sources of vitamin D, such as salmon, egg yolks, and some fortified cereals and non-dairy beverages.

So what causes this discomfort and how can you help your little one avoid it? Inadequate hydration is the likely constipation culprit, along with eating a diet low in fiber.

It is important for babies and toddlers to drink enough fluids to keep their bodies properly hydrated and bowels moving regularly. And when increasing the amount of fiber in your child’s diet, it is important to keep increasing the amount of water to help process the added fiber.

Healthy babies under 6 months are unlikely to experience constipation because they receive adequate hydration and nutrients from breastmilk or formula or a combination. If your baby is experiencing constipation, here are some reasons it may be occurring:

  • Incorrect preparation of formula. Always make sure to add water first, then the formula powder so that baby is getting enough fluids and to ensure the formula is not concentrated.
  • Intolerance or allergy. Certain proteins in formula may cause constipation if your baby is not tolerating them well. And while rare, a breastfed baby may experience constipation if allergic to some of the foods mom is eating.
  • Solid foods before 4 months. Adding cereal or other solid foods before baby is 6 month old may also create constipation and other issues.

Contrary to popular belief, recent studies have found that formulas with iron do not necessarily cause more constipation than formulas without iron.

Once your baby begins eating solid foods (likely around 6 months), constipation may occur. The transition from breastmilk or formula to solid foods is one of the most common times for children to become constipated because the digestive system needs time to adapt. Some straining during bowel movements is normal (babies still have weak abdominal muscles). But if your baby exhibits any of these symptoms, he may be constipated:

  • dry, hard stools with pain upon passing
  • blood streaks along the outside of the stool
  • abdominal pain with hard and infrequent stools
  • pellet sized stools passed with straining or grunting
  • standing on tiptoes and rocking back and forth
  • clenching buttocks muscles
  • making dancelike movements
  • stool in underwear, and urinary incontinence or “wetting the bed”

Once in toddlerhood, constipation can occur if your child holds in his stools. Many children do this as they learn to control their bowels, during potty training or when they transition to preschool or daycare.

Although constipation is more common in toddlers than babies, most cases aren’t serious and generally last a short amount of time. Even though most cases aren’t dangerous, it is important not to ignore symptoms or leave constipation untreated because it can lead to more serious health problems (such as fecal impaction, anal fissures, and rectal prolapse).

What to Do

Keep your child hydrated

Keeping your child well hydrated will help prevent and alleviate constipation. Choose water as the main source of hydration and limit drinks such as fruit juices (and no juice under the age of 1). And remember that in addition to fluids, fresh fruits and vegetables can also contribute to proper hydration.

Constipation in infants

When preparing formula, add water first and then the powder to ensure baby is getting enough fluids. If constipation is consistent even with correct preparation of formula, speak with the pediatrician about additional signs that your little one may not be tolerating the formula well.

Even though research indicates that iron in formula may not cause constipation, all babies are different. If you feel this is the cause, call the pediatrician before switching to a low -iron formula, as iron is important for growth and development.

If you are breastfeeding and are concerned about your baby having an intolerance or allergy to foods you are eating, contact the pediatrician for more information.

If needed, a small amount of 100% prune, apple, or pear juice may be added to formula or breastmilk as long as baby is older than 4 weeks. The general recommendation is to give 1 oz per day for every month of life up to 4 months. For example, a 3 month old would be allowed to have 3 oz per day. Be sure to discuss with your doctor before providing your baby with juice. Note that juice is not recommended for infants younger than 1 year old at any other time.

If these dietary changes do not work, or if you are at all concerned, call the pediatrician.

Include lots of fiber in your child’s diet, from vegetables, fruits, beans and whole grains in your child’s diet

The recommended amount of fiber for toddlers (children 1-3 years old) is about 19 grams of fiber per day.

Examples of foods with fiber include apples and pears (keep the skin on for added fiber), berries, prunes, sweet potatoes, peas, broccoli, beans, oatmeal and whole grain bread or pasta. You can’t go wrong with vegetables and fruits so offer a variety to your child daily.

For reference, half a cup of cooked beans has about 6-9 grams of fiber, 1 small apple with skin has about 3 grams of fiber and half a cup of broccoli or greens has about 3 grams of fiber.

Check the nutrition facts panel on whole grains to determine the amount of fiber they provide.

Avoid too many low fiber foods

Examples of foods that are either low in or don’t have any fiber include cheese, chips, ice cream, meat and many processed foods. Try swapping out low fiber foods for those high in fiber.

Try probiotics

Probiotics, or healthy gut bacteria, may also be helpful in relieving constipation. Try adding yogurt or other foods with added probiotics

Breastmilk contains both probiotics and prebiotics, which have been shown to be beneficial for gut health in people of all ages. Research on formulas with prebiotics shown that they may lead to better stool consistency and frequency in infants. So if your baby struggles with constipation and all other dietary changes have not helped, choosing a formula with prebiotics may be beneficial.

Massage your baby

The “I love you” massage for babies and toddlers can be helpful in reducing constipation, abdominal pain, bloating, and gas. Read Baby massage: Benefits and techniques for all the details.

Encourage your child to move his bowels

When potty training, ask your child frequently if he needs to use the bathroom and visit the bathroom regularly even if your child does not ask to go. Help your child feel comfortable using the bathroom in places other than your own home.

If constipation persists, contact your healthcare provider

If your child is experiencing persistent constipation for 2 weeks or constipation accompanied by fever, vomiting, blood in stool, swollen abdomen or weight loss you should contact your child’s pediatrician.

Do not use treatments such as mineral oil, stimulant laxatives, or enemas without consulting your child’s pediatrician.

Formula fed babies are encouraged to transition to milk at the 1 year mark, while breastfed babies can continue drinking breastmilk for as long as it’s available. Introduce milk in a cup as opposed to a bottle. Once your child is 1 year old, offer all liquids in a cup and not in a bottle. Begin presenting a cup with water at around 6 months of age to give your baby ample time to practice this new skill before his first birthday.

So which milk or milk alternative is best? Many options exist, and you should weigh the pros and cons of each with your child’s healthcare provider depending on your toddler’s age, weight and any potential food sensitivities. Here are the most common milks and milk alternatives available to families today:

Whole Cow’s Milk – Whole cow’s milk, when included with a variety of foods, can support the growth and development of children over 1 year of age and is recommended as a replacement to formula at this age by the American Academy of Pediatrics. It contains about 150 calories per 8 ounces and is a good source of calcium, protein, fat and Vitamins A and D. Unless your child’s healthcare provider has a specific concern about obesity, choose whole cow’s milk rather than reduced fat cow’s milk (like 1% or 2% milk) until your child is 2 years old.

Breastmilk – The AAP recommends babies continue to breastfeed through their first birthday, while the World Health Organization (WHO) recommends breastfeeding until at least age 2. So if your toddler is still nursing 3-4 times a day, you do not need to add cow’s milk to his diet right at 12 months. After all, breastmilk has a higher fat content than whole cow’s milk (to support brain development), and the nutrients in human milk are significantly more bioavailable than those in cow’s milk (meaning our bodies can better absorb and use those nutrients) because it is species specific. So if you’re still breastfeeding, don’t stress about milk! Your toddler is doing just fine. However, if you are offering breastmilk in a bottle, try offering it in a cup.). If your child is only nursing once or twice per day, then some cow’s milk or other beverage (see below) may be needed. Feel free to discuss this with your toddler’s doctor or a Happy Family Coach!

Toddler Formulas –Toddler or transitional milks are fortified with vitamin D, iron, DHA and other healthy fats, and fiber (in some cases, beneficial prebiotic fibers) and are lower in sugar than cow’s milk. These extra nutrients can be important even for toddlers already eating a balanced diet, and can be a good option in place of cow’s milk for those who are not breastfeeding.

Soy Milk – For those with a sensitivity or intolerance to dairy, soy milk provides adequate calories and protein for the growing toddler. Look for soy milk that is unsweetened and fortified with calcium and Vitamin D.

It is important to note, that approximately 40% of children who are allergic to cow’s milk are also allergic to soy milk so soy milk and soy infant formulas are recommended for children only under specific circumstances.

Rice Milk – Children with allergies to both cow and soy milk or who follow vegetarian or vegan diets often turn to rice milk, but this might not the best choice for your growing toddler as it’s low protein, fat, calorie, vitamin and minerals than other dairy alternatives. . If you choose to use rice milk, opt for unsweetened versions fortified with calcium and Vitamin D and make sure your toddler’s diet includes other sources of protein, healthy fats and vitamin and minerals

Almond Milk – Almond milk, like rice milk, is low in protein and fat when compared to the unique nutrient needs of the younger toddler and therefore might not be the best choice as a milk alternative. If you choose to use almond milk, opt for unsweetened versions fortified with calcium and Vitamin D and make sure your toddler’s diet contains other sources of protein and healthy fats.

Hemp Milk – Unsweetened hemp milk can be a nutritious part of your toddler’s diet only when coupled with a variety of whole, nutrient-rich foods because hemp milk contains many of the same nutrients found in cow’s milk but at lower levels.

Goat’s Milk – While goat milk does contain more calcium, B6, vitamin A and potassium than cow milk, it lacks folate and B12. So if goat milk is your primary choice, it’s important to supplement with folate and B12 or choose fortified goat milk to serve as an adequate cow’s milk alternative.

What to Do

If offering cow’s milk, stick to whole milk from 1 to 2 years of age

Whole milk provides the full milk fat needed for your toddler’s developing brain. Skim milk or nonfat milk provides too high a concentration of protein and minerals and should not be given to infants or toddlers under age 2 unless directed by your child’s healthcare provider.

Introduce milk in a cup, not in a bottle

Once your child is 1 year old, offer all liquids in a cup and not in a bottle. Begin presenting a cup with water at around 6 months of age to give your baby ample time to practice this new skill before his first birthday.

For more information on introducing cups, see The pros and cons of cups, sippy cups, and straws for babies and toddlers.

Experiment with milk temperature

If your baby is used to drinking warmed formula or room temperature breastmilk, then the switch to ice cold milk might be a tough transition. Begin with warmed milk and slowly transition to cooler milk until your little one is happy drinking it right out of the fridge.

Try mixing milk with formula or breastmilk

If the flavor change to milk is too drastic for your toddler, try adding a few ounces of breastmilk or formula to an ounce or two of whole cow’s milk or the milk alternative of your choosing. As your toddler becomes more comfortable, slowly decrease the percentage of formula or breastmilk until you are offering only milk (or milk alternative).

Ease the transition as necessary by working milk into foods your child likes

If your little one isn’t taking to milk, try incorporating it into fresh fruit smoothies, hot whole grain cereals (use milk instead of water for cooking), beat into scrambled eggs and omelets and mash with sweet or regular potatoes.

Continue offering other foods rich in calcium and vitamin D

Offer plenty of cheese, plain yogurt, cottage cheese, beans, seafood and enriched breads and cereals. While calcium and vitamin D fortified orange juice is available in stores, limit your toddler’s juice intake to no more than 4-6 ounces per day, if at all.

Limit your toddler to no more than 24 ounces of whole milk a day

Research shows that toddlers who drink more than 24 ounces of cow’s milk a day have higher rates of iron deficiency because cow’s milk can interfere with the absorption of iron. Plus with too much milk, your toddler’s little belly will be too full to eat all the other healthy foods you’re now providing during the day.

While the milk fat is essential to brain development, toddlers gain a lot of calories from foods, like proteins, grains, vegetables and fruits that also provide all kinds of other vitamins and minerals. So 2-3 small glasses of milk a day is all he needs, as opposed to the 3-4 bottles of breastmilk or formula he used to drink.

Consult with your toddler’s healthcare provider

Speak with your child’s healthcare provider if your child is overweight or you have a family history of obesity, high blood pressure or heart disease. If your child’s growth is above the 95 percentile, switching to 2% milk at his first birthday may be the best choice.

If your baby has a dairy or soy sensitivity, speak to your healthcare provider about which type of milk to introduce first. And don’t worry – many infants outgrow a milk or soy protein intolerance by their first birthday. You and your child’s pediatrician can form a plan of which soy and dairy products to re-introduce and the pros and cons of each type of milk.

If your family doesn’t eat dairy or your child won’t or can’t adapt to cow’s milk

Cow’s milk is an easy delivery system for calcium, protein, fat, and, when fortified, vitamin D but it may not be for your child (or you). If it’s not, it will be especially important for your child to eat nutritious foods that are high in these nutrients, notably fish (sardines with the bones and salmon, in particular), lean meats, eggs, legumes (beans), dark green leafy vegetables, and, if tolerated and acceptable, yogurt, cottage cheese, and cheese.

When choosing milk alternatives, opt for unsweetened varieties

Sugar is often added to soy, rice, hemp and almond milks. While it increases the caloric intake (for better or for worse), it provides no nutritional benefit and increased exposure to sugar can affect your child’s affinity for sweetness. As flavor preferences are developing at this time (and no child needs help liking sweets!), it’s best to limit added sugar whenever possible. Beware of “Original” flavors as these often have sugar added; look specifically for “Unsweetened” claims instead.

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