From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Q. My 14 month old has a milk intolerance. He has been on a soy formula, because he has diarrhea every time that we tried to give him a cow's milk based formula. He also had diarrhea when we recently tried to introduce regular cow's milk. Does he really need to drink milk?

A. Toddlers don't necessarily need milk, but they do need calcium and Vitamin D, which are readily available from milk and dairy products. Without any milk, it will be difficult to get enough calcium into his diet. There are alternatives to milk, though, and other ways to give your child calcium.

One alternative is to give your child fortified soy milk. However, keep in mind that soy milk is all low fat, and it isn't recommended that you limit a child's fat intake until he is 2-3 years old. Still, you could give soy milk and make up the extra fat with other foods in his diet. Is there a big difference? Not really. Whole milk has 8g of fat per 8oz serving vs. 3.5 or 5g for soy milk. So, based on an average requirement of 16oz of milk per day, whole milk provides 16g of fat vs. 7-10g from soy milk. Giving the extra 6-9g of fat from other sources should ensure that your child is getting enough fat in his diet. (Based on a 1300 calorie diet and with 30% of calories coming from fat, your toddler probably needs about 40g of fat each day).

Another alternative is to give a toddler soy formula, which is milk free and has all of the fat and calcium that a growing toddler needs. Brands of toddler soy formulas include Isomil 2 and Next Step Soy.

How about goat's milk? Although goat's milk is discouraged for children under age 12 months because it lacks iron, folate and Vitamin B12, pasteurized and fortified goat's milk can be given to older children. If your child is allergic to or doesn't tolerate cow's milk, then he is likely to have similar problems with goat's milk, as they share many proteins and both have lactose.

Other foods that are good sources of calcium include calcium fortified orange juice, bread (like Iron Kids Bread), yogurt and cheese, especially some brands of American Cheese that can have up to 350mg of calcium per slice.

It becomes more difficult if your child has a true milk allergy, since he likely wouldn't be able to tolerate yogurt or cheese. On the other hand, children with a simple lactose intolerance, may be able to handle some dairy products. As more foods are fortified with calcium these days, it makes providing your child with a healthy diet easier.

In addition to actually reading the nutrition label, you can also find foods that are good sources of calcium by looking for the following terms on the packaging:

• "High in Calcium, "Rich in Calcium" or "Excellent Source of Calcium," are found on foods that have at least 20% daily value of calcium or 200mg.
• "Contains Calcium," "Provides Calcium" or "Good Source of Calcium," are found on foods that have at least 10-19% daily value of calcium or 100-190mg.
• "Calcium Enriched", "Calcium-Fortified" or have "More Calcium." are found on foods that have more than 10% daily value of calcium as compared to similar foods without as much calcium. So, if you have two type of orange juice and one has 4% calcium and another has 15% daily value of calcium, then the one with more calcium can say the it is calcium enriched or fortified.

So choose food products that are high in calcium to get your child the calcium he needs, but make sure that they don't interfere with his allergies or food intolerances. And compare food labels to choose brands or types of foods that have a higher percentage of the daily value of calcium.

Some good choices, include:

• Golden Grahams cereal - 350mg per 3/4 cup
• calcium fortified soy milk - 300mg per cup
• American Cheese - 50 - 350mg per slice depending on the brand you buy
• Iron Kids bread - 200mg per slice
• yoo-hoo chocolate drink - 250mg per 8 oz serving
• Danimals low fat yogurt - 150mg per cup
• Honey Maid Graham Crackers (look for the ones that say 'Now a good source of calcium) - 150mg in 2 crackers

For children who can eat bread and cheese, a grilled cheese sandwich made with Iron Kids bread (2 slices) and a slice of American cheese, can provide almost a whole days worth of calcium or 750mg (200mg + 350mg + 200mg).

A supplemental vitamin may also be helpful if you don't think your child is getting enough Calcium from his diet. However, vitamins, even those with extra calcium, generally only have about 200mg, or 20% of daily requirements, so you usually also need to supplement these vitamins with foods labeled 'High in Calcium'. See our guide to Buying Vitamins for more information.

Also, according to the AAP, children who don't drink 500ml (about 17 ounces) of milk each day and who do not get regular sunlight exposure should get 200 IU of Vitamin D each day.