Abstract
Purpose: Milk intolerance in young children is one of the commonest food intolerances seen by paediatricians. In principle, the treatment is simple, but the process of dietary elimination, choosing an appropriate milk substitute and maintaining nutritional adequacy, is no easy task. Design: Market survey and discussion. Method: The history, allergenicity, safety, nutritional adequacy, acceptability, availability and cost of all common milk substitutes used in the UK and the nutritional status of children on milk-free diets are reviewed. Results: There is no ideal milk substitute for the treatment of milk intolerance. Soya infant formulas are cheap and palatable, but there are concerns over their relative allergenicity and phytoestrogen concentration, although the health implications of the latter are still unclear. Extensively hydrolysed formulas have been available for over 40 years and are widely used by paediatricians in the UK as a first-line milk substitute in infancy. However, there are few well-controlled studies supporting their use and there have been a number of case reports of severe reactions to them. There are no known adverse case reports of clinical reactions to amino acid formulas, but choice is limited and they are expensive. The nutritional status of children on milk-free diets is commonly sub-optimal and the use of a milk substitute does not guarantee adequate calcium intake. Conclusions: Milk-free diets are practically difficult and nutritional problems are common. A qualified dietitian should always supervise this diet therapy in children.