Should Milk Drinking by Children Be Discouraged?

Abstract

Although human milk is the optimum form of nourishment for young infants, cows' milk is a valuable substitute and a useful food for older infants and young children. It supplies a large proportion of essential nutrients and calories but it is not an essential component of the diet for anyone whose diet is otherwise adequate. Milk should be eliminated from the diets of children with the rare congenital (hereditary) form of lactase deficiency, those with galactosemia, and those with convincing evidence of milk allergy. Temporary elimination of milk may be beneficial in children with transient lactase deficiency associated with various gastrointestinal disorders. Important racial and age differences in lactase activity are recognized, but our understanding of the etiology and clinical significance of these differences is incomplete. Thus, no firm conclusions can be drawn as yet about the relevance of such differences to the planning of nutritional rehabilitation programs for developing countries and poverty groups, especially in that comparable sources of protein, calories, and other nutrients may not be readily available. The use of skimmed milk is recommended for the approximately one in 150 children born with hereditary hypercholesterolemia as one of the dietary procedures required to lower the blood cholesterol in an attempt to delay the onset and reduce the severity of premature atherosclerosis. Evidence available to date does not support the use of skimmed milk in the child population at large, and such a measure might diminish already inadequate calorie intake in some groups. In infants and young children, the use of skimmed milk may provide an excess of protein and minerals in relation to calories. The amount of milk that should be consumed by healthy older infants and children cannot be stated with convincing accuracy, partly because this will depend to a large extent on economic factors and on the availability of other foods. When a mixed diet is available in adequate quantities, milk consumption should probably not exceed one third of the total daily calorie intake after the latter part of the first year of life (two or three glasses per day). The evidence available at present is insufficient to warrant discouraging programs for increasing the supply and consumption of milk in developing countries where childhood malnutrition is rife, particularly since nutritionally and economically suitable alternatives may not be available in such countries. The distributor of milk under these circumstances should be accompanied by instruction in preparation for feeding to reduce bacterial contamination. If the position stated with regard to some of these issues appears equivocal, it is because the Committee believes that the sum of pertinent, current knowledge does not permit a more dogmatic position. As additional information becomes available, the Committee will review the situation and stands ready to revise its opinions.