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Plant-based Beverages – Are They Healthier For Young Children? (Updated)

Posted: 2023-09-27
Plant-based Beverages – Are They Healthier For Young Children? (Updated)

What’s Happening?

Plant-based drinks (e.g. rice, coconut, almond, oat, hemp, potato) may not be able to support good health for infants and young children when used as the main beverage. Infants and young children have become malnourished after being fed plant-based drinks as their main beverage (1-8). 

What is the nutrient composition of plant-based drinks compared to milk?

While some plant-based drinks may be fortified with added calcium, vitamin D and other vitamins, they are low in protein; fortified soy beverage is the exception (9). Only milk and fortified soy beverages are included as protein foods in Canada’s Food Guide (10). Children’s diets that are low in milk are often low in important nutrients, including protein, vitamin A, calcium, iodine and zinc (11).
 
The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) noted about some plant-based drinks, “Substitution of a milk that does not provide a similar nutritional profile to CM [cow’s 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 CM. 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” (8).

A diagram of a diagram of a line of milk Description automatically generated with medium confidence
 *Grain-based drinks include oat, quinoa, spelt and teff.
 
Young children (aged two to eight years) require 13 to 19 grams of protein per day (12). Two cups of cow’s milk (16 grams of protein) or two cups of fortified soy beverage (15 grams of protein) (13) help to meet their protein needs. If young children drink low protein almond, coconut or rice drinks to meet their protein needs, they need either two child-sized servings of meat (30-45 grams (14,15)) or two servings (one half cup each) of lentils (13). 

Given the low protein content of plant-based beverages other than soy, it can be difficult for young children to obtain enough dietary protein to support their growth and health when their main beverage is a plant-based drink. A guideline for choosing a plant-based beverage with suitable protein content is to select one with 6 or more grams of protein per cup (2.5 grams per 100 mL) (16).
 
Also of concern is that some of these drinks are very low in fat and calories (9), which could also limit growth of young children if they drink these drinks as their main beverage. In addition, plant-based drinks often have sugar as the main ingredient after water, thus meeting the definition of a sugar-sweetened beverage.
 
It is important to promote reading the labels and nutrient profiles on drink containers. Health Canada requires manufacturers of plant-based drinks to add the statement "Not a source of protein" directly on drink containers due to their low protein content (16).

The Bottom Line
Worldwide, most food guides continue to recommend milk and dairy consumption, while encouraging an increased intake of plant-based foods, an increased fruit and vegetable intake and a reduced animal-sourced food intake, especially processed meats (11). Regarding environmental impact, milk as well as eggs and chicken can have similar carbon footprints to certain plant-sourced foods, including rice and almonds.
 
Other than soy-fortified beverages, plant-based drinks, whether available in the dairy section of the store refrigerator or in shelf-stable containers, are not appropriate choices for young children (aged two years and older) as their main beverages if the child has only small servings of high protein foods. For recommendations specific to infants and additional information, see: What are the recommendations for the use of plant-based beverages (e.g. soy, rice, almond, coconut and oat milk/beverage) during the complementary feeding period in infants?

For allergies or any other concerns, a dietitian should be consulted to ensure all nutrient needs (including protein, fat, calories, vitamins and minerals) are being met with an age-appropriate diet. For older children who consume low protein plant-based drinks as a main beverage, it is advisable to consult with a dietitian to ensure appropriate nutrient intakes.

Additional Content
At what age should cow's milk (non-formula) and other dairy products be consumed as a complementary food in healthy term infants?
At what age is it appropriate to introduce lower fat milk to children?
 
Current Contributors
Written by Tanis Fenton, PhD, RD, FDC and reviewed by Jane Bellman, MEd, RD

Past Contributors
Written by Tanis Fenton, PhD, RD, FDC and reviewed by Becky Blair MSc, RD, Gerry Kasten, MSc, RD, FDC, Dawna Royall MSc, RD. FDC and Kerri Staden, BSc, RD

Original Publication Date: 2017-08-29; Updated 2023-09-27

References

  1. Lemale J, Salaun JF, Assathiany R, Garcette K, Peretti N, Tounian P. Replacing breastmilk or infant formula with a nondairy drink in infants exposes them to severe nutritional complications. Acta Paediatr. 2018 Jun 20. doi: 10.1111/apa.14437. [Epub ahead of print]. Citation available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=29923219.
  2. Katz KA, Mahlberg BA, Honig PJ, Yan AC. Rice nightmare: kwashiorkor in 2 Philadelphia-area infants fed Rice Dream beverage. J Am Acad Dermatol. 2005 May;52(5 Suppl 1):S69-72. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/15858513 
  3. Carvalho NF, Kenney RD, Carrington PH, Hall DE. Severe nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics. 2001 Apr:107(4):e46. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/11335767 
  4. Keller MD, Shuker M, Heimall J, Cianferoni A. Severe malnutrition resulting from use of rice milk in food elimination diets for atopic dermatitis. Isr Med Assoc J. 2012 Jan;14(1):40-2. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/22624441 
  5. Fourreau D, Peretti N, Hengy B, Gillet Y, Courtil-Teyssedre S, Hess L, et al. [Pediatric nutrition: severe deficiency complications by using vegetable beverages, four cases report]. Presse Med. 2013 Feb;42(2):e37-43. [French]. Abstract available
    from: https://www.ncbi.nlm.nih.gov/pubmed/23021957 
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    Michigan: case report and review of the literature. Int J Dermatol. 2010 May;49(5):500-6. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/20534082 
  7. Liu T, Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, et al. Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol. 2001 May;137(5):630-6. Abstract available
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  8. Merritt RJ, Fleet SE, Fifi A, Jump C, Schwartz S, Sentongo T, Duro D, Rudolph J, Turner J; NASPGHAN Committee on Nutrition. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper: plant-based milks. J Pediatr Gastroenterol Nutr. 2020 Aug;71(2):276-281 PMID: 32732790. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/32732790/ 
  9. Dietitians of Canada. What are recommendations for the use of plant-based beverages (e.g. soy, rice, almond, coconut and oat milk/beverage) during the complementary feeding period in infants? In: Practice-based Evidence in Nutrition [PEN]. 2022-12-16. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=2503&pqcatid=146&pqid=19553. Access only by subscription.
  10. Government of Canada. Canada’s food guide. Eat protein foods. 2022 May 3. Available from:  https://food-guide.canada.ca/en/healthy-eating-recommendations/make-it-a-habit-to-eat-vegetables-fruit-whole-grains-and-protein-foods/eat-protein-foods/ 
  11. Comerford KB, Miller GD, Reinhardt Kapsak W, Brown KA. The complementary roles for plant-source and animal-source foods in sustainable healthy diets. Nutrients. 2021 Sep 29;13(10):3469. PMID: 34684469. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538100/ 
  12. Panel on Macronutrients, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. National Academy Press. Washington DC; 2005. Available from: https://nap.nationalacademies.org/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids 
  13. Government of Canada. Canadian Nutrient File. 2015. Available from:  https://food-nutrition.canada.ca/cnf-fce/newNutrientSearch 
  14.  More JA, Emmett PM. Evidenced-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet. J Hum Nutr Diet. 2015 Apr;28(2):135-54. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/24654561 
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  16. Health Canada. Interim Policy on the Use of Expired Interim Marketing Authorizations Related to Food Fortification. 2022 Sept. Available from: https://www.canada.ca/en/health-canada/services/food-nutrition/legislation-guidelines/policies/interim-policy-on-use-expired-interim-marketing-authorizations-related-food-fortification.html 
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