What to drink - Milk, Juice or Water?

Being a kid is thirsty work but, as nutritionist Leanne Cooper explains, you need to be careful about what you give your child to drink. 

You have done your homework, had the solids talk from your Plunket nurse, compared notes with friends and feel you have the subject under your belt. And I am sure you do, but did you know that most babies need to start water when they start solids? And there are a few extra questions that might rear their heads, for instance: Why is water important for babies? How much should they drink? When is a little juice okay? And how much cows' milk should they have as toddlers?

Milk in infancy
There are concerns about the use of cows' milk in infancy and possibly also in early childhood. Indeed, many paediatric agencies recommend against giving cows' milk to infants under one year. Other children avoid cows' milk for cultural reasons or simply reasons of taste - cows' milk isn't for everyone. Life without cows' milk isn't necessarily a problem, as many cultures attest. For example, many Asian cultures have done fine on a diet rich in other calcium-containing foods. Milk alternatives (opt for calcium-enriched varieties) include:

• Soy milk (many varieties are now fortified with calcium).
• Nut milks such as almond milk (high in essential fats and calcium; not recommended if an allergy is present).
• Oat "milk" (notably low-glycaemic index and reputed to be good for the nervous system).
• Rice milk (can be quite sweet). 

The problem with milk
Have you got a fussy eater? Read on, the answer may lie in the amount of milk he's drinking.

While milk is a wonderful source of calcium and many other nutrients, the key is moderation. Excessive dairy milk can cause an imbalance in two ways: firstly, it is high in energy (calories) and secondly, it contains a lot of calcium.

Just small amounts of energy-dense milk can fill a little tummy quickly. Feeling full, your little one might turn away from other foods and meals, thereby causing them to become deficient in other nutrients. For example, toddlers and young children require between 1200 and 1500 calories a day. If a two year old drinks just 300ml of milk, they've consumed 20% of all their calories for that day - from just one food source.

Too much milk can also lead to too much calcium which can interfere with iron absorption, which in turn has been linked to fussy eating.

If you opt to give your child milk, make sure you offer it in a cup and only after meals and snacks. It should form just one part of a varied diet and your child should meet their calcium needs from a variety of sources. Nature's harvest affords us many benefits. By eating a wide range of foods, we broaden the spread of nutrients and health-giving compounds and ensure we're consuming a balanced diet.

How much milk?
"But I've been told my child should drink 600ml of milk a day. Is this true?" I hear you ask. My answer is this: when your little one is eating a healthy and balanced diet made up of a variety of foods, she will generally easily reach her nutrient requirements over the course of the day. I detect a few raised eyebrows. Well, let's take a closer look at the facts and figures.

While guidelines suggest 600ml of milk per day for children between four and eight years of age (less if they are younger), it's important to realise that this doesn't refer to the amount of calcium a child needs in order to reach their recommended daily allowance (RDI). This is a rather misleading message, so it's easy to see how people can get confused. Hands up if you assumed this was the amount of milk children needed to drink in order to stay healthy!

Let's look at this closer…

• The RDI of calcium for children between one and three years is 500mg.
• One cup of full-fat milk (250mg) has 295mg of calcium.
• So, two cups of milk (500ml) has 590mg of calcium, slightly exceeding the RDI for children aged between one and three.
• A total of 600ml of milk provides 708mg of calcium, vastly exceeding the requirement for this age group.
• Children aged four to eight years require 700mg per day of calcium; hence 600ml of cows' milk will completely fulfil this age range's calcium needs.
• If a child drinks this amount of milk and still has room for other calcium-rich foods, such as cheese or yoghurt, she may start to over-reach her calcium needs.
• So, in fact, some milk (or calcium-enriched drinks) along with other calcium-rich food makes for a far more balanced diet. Are you still with me?

Reduced-fat or fat-free?
Reduced-fat or low-fat milks (which contain just 1% fat) should not be given to children under two years. Likewise fat-free milk and skim milk (which have 0.1% fat) aren't suitable for children under five. These types of milks, which were first produced for adults to keep their fat intake in check, don't contain the right amount of protein or types of healthy fat that children need to grow at the rate they do. Healthy fats are essential for brain and eye development, for making important substances in the body and for absorbing and using fat-soluble vitamins.

Other calcium sources
The following are examples of other calcium-rich foods that children might consume over a day:

• Half a cup of baked beans has 40mg of calcium.
• 50g of tinned salmon (in water, drained and bones crushed) has 155mg.
• 30g of cheddar cheese gives 255mg.
• 200g of plain yoghurt has 342mg.
• 100ml of a calcium-enriched soy beverage has up to 300mg of calcium.
  

The trouble with apple juice
Each time my son and I visit our local supermarket, I gasp at the popularity of apple juice for children's drinks. So many of us are led to believe that apple juice is ideal for children, it seems so harmless. In fact, the opposite is true. Apple juice is one of the two fruit juices known to cause childhood diarrhoea, which in turn can be a reason why a child may fail to thrive.

So many of us believe that giving our children a little fruit juice will ensure they get vital nutrients such as vitamin C. While fruit-based drinks and even milk alternatives such as soy, oat and rice milks can be added (in appropriate amounts), they can present problems. One of the big issues is that juices (and as discussed earlier, too much milk) can displace food, which can lead to nutrient imbalances.

One major concern with young children drinking too much fruit juice is diarrhoea. The main sugar in fruit is fructose (fruit sugar), along with lesser amounts of glucose and sorbitol. I won't bore you with the chemistry but essentially fruit juice, such as apple and pear juice, tends to cause malabsorption in the intestinal canal, which causes diarrohea and a loss of fluid and nutrients from recently eaten food.

What to drink?
Recommendations vary, but when looking for a safe juice for your child, choose citrus, strawberry, raspberry, blackberry or white grape juice as they do not contain sorbitol. This is particularly important when your little one already has a tummy upset. Orange juice is especially good as it has equal parts of glucose and fructose and no sorbitol.

While there is no firm consensus on the amount of juice a child can drink - each child reacts differently - I recommend erring on the side of caution. For infants over six months, small amounts of diluted fruit juice (one quarter juice to water and no more than a glass a day) are fine. It's worth remembering though, that your child will not be disadvantaged if you decide not to give her fruit juice at all, provided she has a diet rich in fresh fruit. It takes four pieces of fruit to make one glass of juice.

Water, water, water
Babies need more water than adults to digest their food because babies' kidneys are not fully developed and therefore not as adept at handling the waste products from the digestion and metabolism of food. Infants' kidneys use more water than adults to dilute and remove waste products.

So when the big day arrives and baby is ready for solids select a nice age-appropriate sipper cup and fill with cooled boiled water. As solids increase in volume, it becomes more important to monitor the amount of water your child is drinking.

Water doesn't contain any calories so it won't fill up tiny tummies. If your little one gives water the thumbs down at first don't be tempted to sweeten it.  Just keep offering as often as you can without forcing the issue. Every little drop gets you closer to a sip which edges closer to a guzzle. Ensure drink bottles and cups are placed in easy-to-see and reachable positions for children and check the levels throughout the day.

Other drinks
Try to avoid (except in tiny quantities) soda water because of the sodium bicarbonate in it which is linked to de-mineralisation of the teeth. But do consider cooled-down non-caffeinated herbal teas as an alternative to water.

Leanne Cooper is a mum of two and nutrition adviser to OHbaby! and Huggies Baby Club (Australasia), and is director of Cadence Health and Sneakys. Living life on Sydney's Northern beaches with her husband, two boys and mad dog is the icing on Leanne's (very healthy) cake.