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My kids have dairy allergies. Are they getting enough calcium?

The question: Both our children, 5 and 2, suffer from an anaphylactic allergy to dairy products. They get milk substitutes in the form of soy and almond milk but otherwise have a fairly normal, balanced diet (including fruit, vegetables and meat proteins). Should my wife and I be concerned about a lack of calcium in their diet in these formative years? Are the milk substitutes enough? Should we also be giving them a calcium supplement?

The answer: It must be very challenging to have not one, but two children with severe milk allergies. I follow many children in my practice who must avoid milk products for a variety of reasons, a task not easily accomplished with our dairy-rich North American diet.

Although you have likely done this already, it is important to verify the anaphylactic nature of the allergy with a pediatrician or pediatric allergist. The more common scenario is for a young child to be intolerant (but not necessarily anaphylactic) to dairy products. Happily, milk intolerance is very commonly outgrown in the first few years of life. By contrast, those who have anaphylactic reactions to milk protein are often afflicted in the long term and need to strictly avoid all dairy products, wear MedicAlert identification and carry an epinephrine pen with them at all times.

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Preschool children require 700 mg of calcium a day, and the total increases to 1,000 mg when they hit school age. This need could very well be met with soy and almond milk provided they have been fortified with calcium and vitamin D. Drinking two to three cups of milk or fortified soy beverage daily is one way to achieve this goal. Other calcium-rich foods include spinach, turnips, salmon, tofu and calcium-enriched orange juice. Check the label of your milk substitutes to make sure they also contain other important nutrients such as vitamins A and D, vitamin B-12 and riboflavin. If in doubt, ask your physician for a referral to a registered dietitian to do a more formal analysis of your children's needs.

Send pediatrician Michael Dickinson your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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