Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. 2 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 3 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 4 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 5 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 6 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. 7 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. 8 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 9 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. 10 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. 11 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. www.buckshealthcare.nhs.uk Follow us on Twitter @buckshealthcare 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