22 Aug

Getting enough calcium on a cow’s milk free diet

Calcium is a mineral found in food that is needed for bone and dental health1.  For most children, cow’s milk and dairy products are usually the main source of calcium in their diet2.  For those children that need to avoid dairy due to cow’s milk allergy (CMA), it is important to find alternate sources of calcium. The amount of calcium your child needs will depend on their age.

 

Age Recommended Dietary Intake (per day) of calcium
0-6 months 210mg (this should be completely provided by breast milk or infant formula)
7-12 months 270mg
1-3 years 500mg
4-8 years 700mg
9-11 years 1000mg
12-18 years 1300mg
Breastfeeding mothers 1000-1300mg

Table adapted from NHMRC Nutrient Reference Values3

 

To ensure children with CMA receive enough calcium, it is important to provide adequate amounts of non-dairy, calcium containing foods. Below is a list of the best non-dairy sources of calcium for both infants and older children. Make sure you take into account other food allergies (like nut or soy allergy) before providing these foods to your child. One serve of calcium is equal to 250mg.

 

To calculate the amount of food needed to provide all of your child’s calcium needs, work out their requirements and then look at the serve sizes below. For example if your child is 2 years old, they require 500mg of calcium per day. This can be obtained by eating 1 cup of soy yoghurt with added calcium (provides 250mg calcium) plus drinking one cup of rice milk with added calcium (provides 250mg calcium).

 

Food Serve size equal to one serve of calcium (250mg calcium)
Breastmilk 700ml
Soy based Infant Formula 400ml
Extensively Hydrolysed Infant Formula (e.g Pepti Junior) 500ml
Amino Acid Based infant formula (e.g. Neocate Gold) 400ml
Amino Acid Based formula for over 12 months (e.g. Neocate Advance) 220ml or 1 cup
Soy milk with added calcium 200ml or 1 cup
Rice, oat or nut milks with added calcium 200ml or 1 cup
Soy yoghurt with added calcium 200ml or 1 tub
Soy cheese 125-400g (calcium content varies- check the label)
Almonds with skin 100g
Brazil nuts4 170g
Tahini 75g
Canned sardines with bones (must eat the bones) 75g
Canned salmon with bones ¼ cup
White sesame seeds 400g
Firm tofu4 75g
Boiled silverbeet4 300g
Broccoli 5 cups
Dried Figs4 125g
Curly parsley4 100g

Table adapted from RCH Cow’s Milk Allergy2 and ASCIA Dietary Avoidance- Cow’s Milk allergy5

 

Note that breast milk or infant formula should be the main drink for children under one year of age. Rice, oat and nut based milks are not suitable for children under 12 months as they contain inadequate amounts of energy, protein, fat and calcium.

 

Calcium supplements

Calcium supplements can be used if your child is finding it difficult to eat enough calcium in their diet5. Your doctor or dietitian can advise on a suitable supplement and dose. Calcium supplements are available over the counter at pharmacies and in some supermarkets.

Soy and other milks small

  1. National Health and Medical Research Council. 2014. Nutrient Reference Values- Calcium. Australian Government. Viewed 15 July 2016. https://www.nrv.gov.au/nutrients/calcium
  2. The Royal Children’s Hospital Melbourne. 2013. Cow’s Milk Allergy. Victorian Health. Viewed 15 July 2016. rch.org.au/uploadedfiles/main/content/allergy/cows_milk_allergy.pdf
  3. National Health and Medical Research Council (NHMRC) 2006, Nutrient Reference Values for Australia and New Zealand.
  4. Healthy Bones Australia. 2012. Calcium Content of Select Foods. Healthy Bones Australia. Viewed 18 July 2016. http://www.healthybonesaustralia.org.au/how/calcium/calcium-content-of-select-foods/
  5. 2015. Dietary Avoidance- Cow’s milk protein (dairy) allergy. Australian Society of Clinical Immunology and Allergy. Viewed 15 July 2016. http://www.allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy