Dietitians, paediatricians advise parents to exercise caution with plant-based beverages

Public health dietitians are concerned about a rise in parents feeding plant-based beverages (e.g. rice, coconut, almond, hemp, potato) to their infants and young children. Following reports of infants and young children becoming malnourished and one death after being fed plant-based drinks as a main beverage, Dietitians of Canada is joining with the Canadian Paediatric Society to urge parents to select beverages carefully for their children.

“The challenge for parents is conflicting messages. They read that these drinks are considered ‘healthier’ on social media or hear misinformation about cow milk or fortified soy beverage,” says Becky Blair, public health dietitian and spokesperson for Dietitians of Canada. “The reason children can become malnourished is that these beverages contain very little protein and are very low in fat and calories.”

Current recommendations for children two to eight years who are not breastfed are to give 2 cups of cow milk or fortified soy beverage each day to support protein, calcium and vitamin D requirements. In Canada, full fat homogenized (3.25% M.F.) cow milk is recommended until age two.

“What parents often don’t realize is that some plant-based beverages are not fortified with any minerals or vitamins; these drinks are low in all nutrients except carbohydrates, in fact sugar is often the second ingredient after water,” says Catherine Pound, paediatrician and spokesperson for the Canadian Paediatric Society. “In the case of allergies, or other concerns, I recommend parents speak with a dietitian to ensure all nutrient needs, including protein, fat and calories are being met with an age-appropriate diet.”

Fast Facts:

• Breastfeeding - exclusively for the first six months, and continued for up to two years or longer with appropriate complementary feeding - is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.
  • Soy, rice, or other plant-based beverages, whether or not they are fortified, are inappropriate alternatives to cow milk in the first two years.
  • For infants who cannot or should not be fed their mother’s breastmilk, pasteurized human milk from appropriately screened donors and commercial infant formula are suitable alternatives.
  • Commercial infant formula may be the most feasible alternative if it is not possible for an infant to be exclusively fed their mother’s breastmilk. 
  • Cow milk is not recommended before nine to 12 months of age.
• Young children (aged two to eight years) require 13 to 19 grams of protein per day.
  • Two cups of cow milk (16 grams of protein) or two cups of fortified soy beverage (13 grams of protein) pretty well meet their protein needs.
  • Almond, coconut or rice drinks contain little to no protein. To meet their protein needs, children consuming these beverages would need to eat two child-sized servings of meat (30-45 grams) or two servings of lentils (one half cup each).
  • Almond drinks only contain about 4 almonds per cup.
• Drinking too much low-nutrient beverage, other than water, can displace hunger and cause children to eat less food.
• 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 as their main beverage since they are not nutritionally adequate if the child has only small servings of high protein foods.
• Parents wishing to feed their infants and children plant-based beverages as a main beverage should speak with a dietitian to ensure nutrient needs including protein and fat are being met with an age-appropriate diet.

PEN: Practice Based Evidence in Nutrition recently named concerns about plant-based beverages in infants and children a Trending Topic is a piece written by Dr. 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.

About Dietitians of Canada

Dietitians of Canada is the national association for dietitians, representing almost 6,000 members at the local, provincial and national levels.

About the Canadian Paediatric Society

The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,300 paediatricians, paediatric subspecialists and other child health professionals across Canada.