No milk today

A dairy allergy is an immune reaction which can be severe and can be similar to a peanut or other serious allergy. Only 1 to 2 per cent of children are believed to have actual food allergies. Possible reactions could be reddening skin, swelling lips, asthma attacks, projectile vomiting, swelling of the breathing tubes, or a serious drop in blood pressure, called an anaphylactic reaction.

Dairy intolerance is often called allergy, so the two become confused.

Intolerances are more common than allergies. Reactions can be uncomfortable or a nuisance, but they do not have the potential to be life threatening.

The main dairy intolerance is a physical inability to digest the milk sugar, lactose. Symptoms are bloating, wind and sometimes diarrhoea.

Seventy per cent of people eventually become lactose-intolerant, particularly those of Asian, African, Jewish and southern European descent.

Other dairy intolerances are less well defined and can involve the immune system, or not. Symptoms may include headaches, asthma, eczema, gut problems or bowel problems (particularly regular constipation).

Children often have dark circles under their eyes.

Balanced nutrition

The two main problems, from the point of view of nursery catering, are:

* In the case of serious allergies, total avoidance of dairy foods. To expose a child with serious allergy could be life-threatening. Parents should also provide the nursery with medication such as the Epipen adrenaline injection kit.

* Providing nutritionally balanced meals that exclude dairy products for any child with an allergy or intolerance, but include sufficient sources of calcium. As for any child, with or without an allergy, food from all the main groups need to be provided: protein, iron and zinc sources (meat, poultry, eggs, vegetarian protein sources such as beans or lentils); carbohydrates (bread, rice, pasta), vegetables and fruit. The only difference is that the fourth group would normally include dairy as a good source of calcium, but alternatives must be found.

Dairy-free catering

Most recipes can easily be adapted with dairy substitutes. Porridges, pancakes, savoury creamy sauces, 'milk' puddings and other desserts all work well with substitutes, so there is no need to depart from a well-balanced menu. While they often taste different straight out of the packet, there is no apparent difference in the final dish. Soya milk tends to be thick in consistency, rice milk fairly thin but sweet, and oat milk is quite rich tasting. A variety of products is available in supermarkets, speciality outlets such as health food shops, or on-line. They include soya cheese, creams, yoghurts and desserts. When catering for children, always use calcium-enriched versions if possible. (Children under the age of one need to have formula milk, and advice should be sought if soya or other formula milks are used).

Children aged one to three need 350mg and aged four to six need 450mg calcium daily. As examples of non-dairy calcium-rich foods, one small can of sardines contains 400mg of calcium, a 75g/3oz serving of broccoli contains 75mg, one large egg contains 25mg, and a slice of wholemeal bread contains 25mg.

Calcium-enriched fruit juices are available, though a bit expensive. A 250ml glass will give a child half of the daily calcium requirement.

What to avoid

In serious allergy, all dairy foods must be avoided - milk, cream, cheese, butter and yoghurt. Also, check packets for any of the following, which could harbour milk proteins: buttermilk, casein/caseinate, creme fraiche, curds, kefir, ghee, lactalbumin, lactic acid, lactobacillus, lactoglobulin, lactos, protein enriched (could mean milk protein), quark, rennet, whey.

What to choose

* Products based on soya, rice or oat milk. Buying organic soya products avoids genetically modified soya.

* Lactose-free milk is available in large supermarkets.

* Hard cheese has little lactose in it.

* Good quality yoghurts which have been fermented for long enough (the plain bio-yoghurts should be fine) will have little lactose, as the bacteria used have pre-digested the milk sugar.

* Butter is usually tolerated, as it is fat (with few stray protein and lactose molecules in it). But it does not count as a dairy portion, as it has no calcium.

* Goat's milk is often better tolerated by those sensitive to cow's milk.

It is available from good supermarkets and health food shops. St Helens Farm produces milk, yoghurt and cheese (01430 861 715, www.sthelensfarm.co.uk).But goat's milk has just as much lactose in it as cow's milk.

This article has been sponsored by the Organix Children's Food Advisory Service, where Suzannah Olivier is the consultant nutritionist. She is the author of What Should I Feed My Baby? and Eating For A Perfect Pregnancy.

Her website is www.HealthyFood4HappyKids.com

Resources

* Children's Food Advisory Service Pack for Nurseries, available on www.

childrensfood.org

* Organic Baby and Toddler Cookbook by Lizzie Vann of Organix. Visit their website www.babyorganix.co.uk