Download Patient Information – Milk-Free Diet Sheet For Children Department

Department of Dermatology Allergy and Skin Surgery
Patient Information – Milk-Free Diet Sheet For
Children
Milk-free diet
Your child has been advised to follow a milk-free diet because they may have an
allergy or intolerance to cow’s milk proteins. Many children grow out of this as
they get older.
Reading labels
All pre-packaged food bought in the UK is covered by European food labelling
legislation. Manufacturers must list all ingredients and identify any allergens,
including milk, in the ingredient list. Food items that do not have labels or are
sold loose may contain milk or milk products (e.g., bakery, delicatessen items)
and should be avoided. Milk and derivatives are present in many manufactured
foods (see list below). It is essential that all food labels are checked. It must be
stated on the label if the food contains additives derived from milk.
Avoid any foods that contain the following:
Butter
Lactalbumin
Casein & caseinates
Lactoferrin
Cheese, cheese powder
Lactoglobulin
Cream, artificial cream
Lactose
Curds
Margarine
Custard
Milk, milk powder
Dairy product solids
Nisin preparation
Fromage frais
Quark
Galactose
Rennet
Ghee
Sour cream
Ice cream
Whey, whey syrup
E966
Yoghurt
The following do not generally need to be restricted. Lactates, Lactylates,
Lactitol.
E966 may contain some lactose – should be avoided if your child is very
sensitive.
Milk-Free Diet Sheet
Milk substitutes
In infants and young children milk forms a major part of their daily nutritional
intake. Milk and milk products (e.g., cheese and yoghurt) are the main
sources of calcium in the diet. Small amounts of calcium are present in other
foods (e.g., green leafy vegetables, dried fruit, tinned sardines, sesame seeds
and bread).
If milk is excluded from the diet, a substitute will be needed to provide the
nutrition your child needs for healthy growth and development. If your child is
not taking adequate amounts of calcium in their diet, a calcium supplement will
be needed. Calcium supplements are available on prescription or over the
counter. Ensure that they are milk-free. Please see calcium content sheet of
dairy-free foods to ensure your child is taking sufficient.
Alternative milks (e.g., soya, oat, coconut and rice) are available in health food
shops and supermarkets. These may be used in older children as a main
source of milk. They are not supplemented with vitamins and minerals,
frequently have a low calcium content and are not nutritionally complete.
Children with a cow’s milk protein allergy are more likely to be allergic to soya
also (particularly under six months of age), affecting 10-14% of children with
an IgE cow’s milk protein allergy and up to 50% of children with a non-IgE
allergy to cow’s milk (BDA Paediatric Group position statement on the use of
infant formulas based on soya protein for infants, 2010).
Soya formula and soya milk contain phytoestrogens, which when taken in
large quantities (i.e., if sole source of nutrition is soya formula at under six
months) may lead to fertility difficulties in adulthood. For children over 6
months soya milk can be introduced into a mixed weaning diet if you wish.
Please note, with the exception of Alpro 1+, alternative dairy milks should be
not be used under two years as main milk source but can be used to prepare
cereal and family meals.
Rice Milk
Should be avoided in children under 5 years old as it contains trace amounts
of inorganic arsenic. (Department of Health 2010). The volume of rice milk
which would normally be consumed in children over 5 years is not large
enough to cause problems.
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Milk Free Diet Sheet
Goat, sheep, and buffalo milk
Goat, sheep and buffalo milk proteins are very similar to those present in cow’s
milk. As a result the European Food Safety Authority have concluded the use of
this, fresh or formula milk is not recommended as a substitute for cow’s milk in
children with a cow’s milk allergy.
Recipes
Many recipes from ordinary cook books, can be used provided ingredients are
checked and appropriate substitutes used (e.g., milk-free margarine in place of
butter, recommended milk substitute instead of milk).
A few simple recipes are included at the back of this leaflet.
Supermarket lists
The following companies will be able to provide you with lists of their ‘own brand’
foods which are milk-free. It is important you check the ingredients each time
you buy a product.
ASDA – www.asda.co.uk
BOOTS – www.boots.com
CO-OP – www.co-operative.coop/food
HJ HEINZ – www.heinz.co.uk/ourfood
MARKS & SPENCER – www.marksandspencer.com
MORRISONS – www.morrisons.co.uk
SAINSBURY – www.sainsburys.co.uk
TESCO – www.tesco.com
WAITROSE – www.waitrose.com
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Milk-Free Diet Sheet
Foods Allowed and to Avoid - remember to check labels.
✔
✘
Food
Allowed
Meat
Plain fresh or frozen meats
including, chicken, turkey, beef,
pork, lamb, liver, kidney, bacon.
Burgers, sausages, meat balls,
meat loaf, pies, luncheon meat,
sliced ham, tinned meat, pate
and meat paste. Some brands
may be suitable.
Fish
Plain fresh or frozen fish and
shellfish. Tinned fish.
Fish in batter, breadcrumbs or
sauces. Fish fingers, fish cakes,
fish paste.
Milk
Substitute as recommended.
Milk – cow, goat, sheep and
buffalo. Dried, evaporated and
condensed milk. Cream, coffee
creamers.
Eggs
Boiled, poached, fried.
Yorkshire pudding, quiche.
Cheese
Soya cheese for children and
infants over 6 months - check with
your dietitian.
All cheese – including hard,
cream, cottage, curd, processed
cheeses and cheese spreads.
Paneer.
Rice cheese (contains milk
protein).
Bread
Wholemeal, granary and plain
white bread.
Milk bread, Procea, bagels,
crumpets, muffins, croissants
and chelsea buns. Naan
bread, chapattis made with fat.
Breadsticks and crispbread.
Cereals
Wheat, rye, barley, oats, rice,
maize, corn, sago, tapioca,
semolina, arrowroot, buckwheat.
Original Ready Brek, Cornflakes,
Frosties, Rice Krispies, Weetabix.
Custard powder, arrowroot,
cornflour.
Spaghetti and other plain boiled
pasta.
Milk-free baby cereals
Chocolate flavoured cereals,
Special K, Weetos and muesli
type cereal.
Baby cereals that contain milk.
Tinned spaghetti in sauce –
check labels
Macaroni cheese.
Avoid
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Milk-Free Diet Sheet
Foods Allowed and to Avoid - remember to check labels.
✔
✘
Food
Allowed
Biscuits
and cakes
Biscuits, rusks and crackers.
Checked as milk-free.
Homemade cakes and biscuits
made with milk-free ingredients.
Manufactured cakes and biscuits if
known to be milk-free (eg, Rich Tea,
Party Rings, Ginger Nut) *check
ingredients.
All other biscuits, cakes and
doughnuts.
Fruit and
vegetables
All fresh, frozen, tinned or dried
fruit, vegetables and pulses. Dhal
and lentils.
Baked beans. All plain salad and
vegetables. Mashed potato with
milk-free margarine and milk
substitute.
Some vegetables tinned in
sauce (eg, coleslaw, potato
salad).
Potato croquettes, instant
potato, potato waffles, potato
shapes. Ordinary mashed
potato.
Fruit pie fillings, fruit fools,
fruit mousses.
Fats
Milk-free margarine, supermarket
own brand milk-free margarine,
Tomor, Vitaquell, Granose, Pure,
Vitalite Dairy-Free.
Lard and suet.
Oils (e.g., sunflower oil, corn oil).
Butter, ordinary margarine,
ghee.
Desserts
Homemade puddings (e.g., rice,
semolina, custard made with milk
substitute).
Pies, crumbles, sponges made with
milk-free ingredients.
Fresh fruit, tinned fruit in juice or
syrup. Jelly.
Soya yoghurts, ice cream, soya
desserts if recommended by
dietitian for children and infants over
6 months.
Coconut milk yoghurts and ice
cream. ‘Wot No Dairy’ dairy-free
yogurts
Fromage frais, yoghurt, ice
cream, custard, blancmange.
Milk puddings, pancakes.
Dessert mixes.
Pies, crumbles, sponges,
pastries, unless known to be
milk-free.
Avoid
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Milk Free Diet Sheet
Foods Allowed and to Avoid - remember to check labels.
✔
✘
Food
Allowed
Sugar and
preserves
Jam, marmalade, honey (for
children over 1 year).
Sugar, golden syrup, treacle.
Marmite, Bovril.
Lemon curd.
Sweets and
crisps
Boiled and jelly sweets,
pastilles, lollies.
Plain crisps.
Chocolate, white, milk and
plain. Fudge, toffee, fruit
chews.
Flavoured crisps and
snacks. Low fat crisps.
Butter or toffee popcorn.
Drinks
Water, mineral water, fruit juice,
fruit squash, fizzy drinks.
Tea, coffee and cocoa made
with milk substitute.
‘Milkshake’ made with milk
substitute and fresh fruit or
milkshake syrup.
Barley fruit squashes, malted
milk drinks (e.g., Ovaltine,
Horlicks).
Drinks from vending
machines that contain milk
(e.g., hot chocolate).
Milkshake powders.
Miscellaneou
s
Home made soups, sauces,
tomato ketchup using milk-free
ingredients.
Tomato based pasta sauces,
sweet and sour sauces.
Salt, pepper, herbs, spices,
mustard, baking powder.
Yeast, food essences, food
colourings, gravy mixes, stock
cubes, chutneys.
Tinned or powdered soups,
ready meals, bottled sauces.
Coated nuts, dry roasted
nuts.
Medicines
Remember to check labels
Check all medicines and
tablets are milk-free. Certain
antibiotic syrups contain
lactose.
If in doubt ask your doctor or
pharmacist.
Avoid
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Milk-Free Diet Sheet
Sample meal plans
Weaning
Your baby will normally be ready to begin weaning at about 6 months.
However, all babies are different and you should discuss this with your Health
Visitor or Dietitian. Some babies may need to be weaned earlier, but not before
17 weeks.
Weaning a baby on a cow’s milk-free diet is the same as weaning any other
baby, except you need to avoid any solids containing cow’s milk or cow’s milk
products. As solids are introduced your infant’s appetite for milk will decrease.
To meet your child’s calcium requirements they should have at least 600 mls of
milk substitute daily. This can be given as drinks, used to prepare foods and in
cooking. If your child is breast fed or taking less than 500ml of an infant
formula, they require a daily multivitamin containing vitamins A, C and D until
five years of age.
Tips for successful weaning:
• when first introducing solids start slowly with just 1-2 teaspoonfuls at one
meal a day. Offer before a feed when baby is hungry and finish the meal
with the recommended milk substitute.
• first foods should have a smooth, lump free consistency (eg, pureed
vegetables such as carrots, parsnip, cauliflower, butternut squash, potato).
Pureed fruit (e.g., pears, dessert apples, peaches). Baby rice – milk-free mix
with water or milk substitute.
• DO NOT add sugar or salt to any food.
• do not worry if your baby refuses new foods at first. Try the same food again
at another time.
• gradually increase the variety, quantity offered and the number of times a
day.
• do not give any food containing gluten to babies under 6 months.
• introduce a cup for drinking from 6 months of age.
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Milk-Free Diet Sheet
Sample weaning meal plan
Breakfast:
Milk-free baby rice and fruit puree.
Breast milk or milk substitute.
Lunch & Dinner: Pureed meat, fish or lentils.
Pureed potato or rice.
Pureed vegetables.
Pureed fruit, milk-free custard or milk-free rice pudding.
Breast milk or milk substitute
Bedtime:
Breast milk or milk substitute.
Drinks during the day
Breast milk or milk substitute.
Once weaning has become established offer water in a cup or diluted fruit
juice can be introduced from 6 months.
Water is the best alternative to milk, but if you choose to give juice it should be
diluted 1 in 10 with water and preferably offered with a meal.
Baby Foods
Many commercial baby foods contain milk and milk products. Always check
the labels carefully to see which varieties are suitable for your baby.
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Milk-Free Diet Sheet
Sample meal plan for the older child
Breakfast
Milk-free cereal (e.g., Weetabix, Rice Krispies or Cornflakes with milk
substitute. Add fruit (e.g., sliced banana, strawberries or raisins).
Toast and milk-free margarine, jam or marmalade.
Fruit juice or water.
Mid-morning
Drink - milk substitute, water or juice.
Fresh or dried fruit, milk free biscuit.
Lunch - Ideas
Sandwich of ham, tuna and cucumber.
Spaghetti or baked beans on toast.
Plain pizza base with cheese-free topping.
Baked potato with tuna, sweetcorn, egg or spaghetti hoops.
Selection of salad vegetables – cucumber sticks, carrot sticks, cherry
tomatoes.
Home-made soup with roll.
Omelette cooked in oil – ham, mushroom or sweetcorn.
Milk-free pudding – custard, jelly or fruit
Mid-afternoon Drink - milk substitute, water or juice.
Fresh or dried fruit, milk free biscuit
Evening meal
Meat, chicken, fish, egg or milk-free vegetarian dish
Potatoes, rice, pasta or noodles
Salad or vegetables
Milk-free pudding – baked banana, jelly, meringue nest and fruit, fresh or
tinned fruit
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Milk-Free Diet Sheet
Recipes
Basic White Sauce
30 g (1 oz) milk-free margarine
30 g (1 oz) plain flour
300 ml (10 fl oz) milk substitute
Seasoning to taste.
Place ingredients in a pan.
Heat, whisking continuously until sauce thickens and is cooked. Season.
Fruit Smoothie
(1 serving)
½ banana or 60 g (2 oz) fruit (eg, strawberries, raspberries, apricots) or
milkshake syrup
200 mls (7 fl oz) milk substitute
Blend ingredients together in liquidiser until smooth.
Pour into glass.
Milk-Free Rice Pudding (2 servings)
3 rounded tablespoons or 30 g (1 oz) flaked rice
300 mls (10 fl oz) milk substitute (sweet so no sugar needed)
Place all ingredients in a pan and bring to boil.
Simmer for 10 minutes. Stir occasionally. Allow to thicken.
Milk-Free Custard
(2 servings)
2 rounded teaspoons custard powder
200 ml (7 fl oz) milk substitute (sweet so no sugar needed)
Mix the custard powder with a few teaspoons of milk substitute to a smooth
paste.
Add the milk substitute.
Place into a pan and heat whisking all the time until the custard thickens and just
comes to the boil.
Chocolate Custard - As above but add ½ level teaspoon cocoa powder and 1
level teaspoon sugar to the custard mix.
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Milk-Free Diet Sheet
Recipes
Jelly Mousse
(4-6 servings)
1 strawberry or raspberry jelly
300 mls (½ pint) boiling water
300 mls (½ pint) milk substitute
Gently heat the milk substitute in a pan to boiling point, use to dissolve half the jelly.
Dissolve the other half of the jelly in boiling water.
Pour each jelly into separate bowls until cool. Refrigerate.
When the jellies are nearly set, take the milk substitute jelly mix and whisk well for 2
minutes.
Place whisked milk substitute jelly on top of the other jelly and return to the fridge
until completely cold.
Frequently asked questions
My child refuses to drink the milk substitute - what should I do?
Try and use in cooking (e.g., custards, milk puddings) or use on suitable milkfree breakfast cereals. If your child continues to take less than 300 ml (1/2 pint)
of the substitute per day a calcium supplement should be given. You can also
flavour the milk with a milk-free milkshake powder or syrup, or a few drops of
vanilla extract.
Can I use any milk substitute?
The simple answer is NO. The milk substitute that is recommended for your
child is nutritionally adequate. It is fortified with vitamins and minerals in the
proportions that are necessary for your child. If your child is allowed soya, then
Alpro 1+ can be used as a main milk source from one year but the other
alternatives should not be used as a main milk source until over two years as
they do not contain adequate calories, fat or fat soluble vitamins.
Will my child grow out of a milk allergy?
Many children grow out of milk allergy and intolerance as they get older. Please
follow the guide provided at the group for how to do this.
Will my child be able to stay for school or nursery dinner?
This should be no problem but please liaise with the nursery or school providing
you give them plenty of information about the diet beforehand. Alternatively your
child could take a packed lunch.
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Milk-Free Diet Sheet
Will my child grow without milk in the diet?
Provided they are taking the recommended milk substitute and eating a
good variety of other foods (e.g., meat, fish, eggs, cereals, fruit and
vegetables) they will grow normally.
How much Calcium should my child be having a day?
Recommended Nutrient Intake – Calcium (Department of Health 1991)
Age
0-1 year
1-3 years
4-6 years
7-10 years
11-18 years
(girls)
(boys)
mg/day
524 mg
352 mg
452 mg
552 mg
800 mg
1000 mg
Does my child require any other supplements?
All children under five years old who drink less than 500ml of formula milk
require a vitamin ‘drop’ containing vitamins A,D and C. These are available
to buy over the counter.
How can I help reduce healthcare associated infections?
Infection control is important to the well-being of our patients and for that
reason we have infection control procedures in place. Keeping your
hands clean is an effective way of preventing the spread of infections.
We ask that you, and anyone visiting you, use the hand sanitiser
available at the main entrance of the hospital and at the entrance to
every clinical area before coming in to and after leaving the clinical area
or hospital. In some situations hands may need to be washed at the sink
using soap and water rather than using the hand sanitiser. Staff will let
you know if this is the case.
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If you require a translation of this leaflet please call 01494 734604.
Author: Marianne Tomlin
Issue date: June 2015
Review date: June 2018
Leaflet code: DERM-024
Version: v1