NASPGHAN Position Paper: Plant-Based Milks.

Parents and caretakers are increasingly feeding infants and young children plant-based "milk" alternatives to cow milk. The US Food and Drug Administration currently defines "milk" and related milk products by the product source and the inherent nutrients provided by bovine milk. Substitution of a milk that does not provide a similar nutritional profile to cow milk can be deleterious to a child's nutritional status, growth and development. Milk's contribution to the protein intake of young children is especially important. For almond or rice milk, an 8 oz serving provides only about 2% or 8%, respectively, of the protein equivalent found in a serving of cow milk. Adverse effects from the misuse of certain plant-based beverages have been well-documented and include failure to gain weight, decreased stature, kwashiorkor, electrolyte disorders, kidney stones and severe nutrient deficiencies including iron deficiency anemia, rickets and scurvy. Such adverse nutritional outcomes are largely preventable. It is the position of the NASPGHAN Nutrition Committee, on behalf of the society, that only appropriate commercial infant formulas be used as alternatives to human milk in the first year of life. In young children beyond the first year of life requiring a dairy-free diet, commercial formula may be a preferable alternative to cow's milk, when such formula constitutes a substantial source of otherwise absent or reduced nutrients (e.g., protein, calcium, vitamin D) in the child's restricted diet. Consumer education is required to clarify that plant-based milks do not represent an equivalent source of such nutrients. In this position paper we provide specific recommendations for clinical care, labeling and needed research relative to plant-based milks.