Replacing breastmilk or infant formula with a nondairy drink in infants exposes them to severe nutritional complications

Replacing breastmilk or infant formula with a nondairy drink in children under one year of age is of increasing concern in all industrialised countries, as their composition does not meet the standards for infant nutrition by European or North American legislation. We sent an electronic questionnaire to 310 French paediatricians, and this identified 34 children (53% boys) who suffered medical complications between January 2005 and December 2015 when they consumed nondairy drinks before the age of one year. Qualitative variables were studied in terms of absolute frequencies, and the quantitative variables were studied in terms of means and standard deviations. We used logistic regression analysis to investigate whether early and/or prolonged consumption of nondairy drinks was associated with the risk of hospitalisation. The mean age of the cases at diagnosis was 8.8 3.8 months, the average age at the onset of administration was 5.2 3.3 months, and the average duration of consumption was 3.7 2.5 months. The main reasons why infants were changed from breastfeeding or formula to a nondairy drink was: suspected cows’ milk intolerance (n = 15) and minor digestive (n = 11) or skin symptoms (n = 8). The main influences on the parents were the media (44%) and alternative medical professionals (38%). The beverages that were consumed were mainly based on almonds (n = 15), chestnuts (n = 4), rice (n = 4) and soya (n = 1). In 29% of cases, nondairy drinks were sometimes mixed with nonbovine dairy drinks, such as goats or mares milk. In addition, 59% of these children had not received any childhood immunisations. The use of nondairy drinks was found during systematic questioning by paediatricians when they were consulted about a child with fatigue or a height and weight deficit. The symptoms were much more significant for the 10/34 children with status epilepticus, two with deep hypocalcaemia, five with malaise with a haemoglobin below 60 g/L and one case each of respiratory distress with metabolic alkalosis, impaired consciousness with severe hyponatraemia and spontaneous bone fracture of the lower limb with bone demineralisation. The clinical signs at diagnosis were a height and weight impairment in 28 cases, asthenia in 22, erythema with desquamation skin lesions in 14 and oedema in six. An anthropometric diagnosis was available for 32/34 children (Table 1) and a blood assessment for 20/34. The blood assessment showed that 12/20 children had anaemia, with a haemoglobulin level of less than 100 g/L (mean 71 g/ L 30.2), and 11 had hypoalbuminaemia, with less than 35 g/L (mean 23.4 7.9). Hyponatraemia was observed in eight blood tests, with a mean value of 126 mmol/L (range 96–134 mmol/L). Two patients developed hypocalcaemia, with seizures, and six patients had their vitamin D levels measured, and these were lower than 7 lg/mL. We found that 19/34 (56%) children were hospitalised for complications from consuming nondairy drinks. Early consumption before the age of four months was significantly associated with hospitalisation, with an odds ratio of 14.36 (95% confidence interval 1.57–71.89) (p = 0.008). There was one death as a direct result of nutritional complications due to the exclusive consumption of a chestnut drink, with hyponatraemia of 96 mmol/L. We assessed 30 children at least once after providing nutritional advice on drinks, and they had positive outcomes after they resumed a normal infant diet. In one-third of cases, the parents were not happy about the new diet, including four families who were warned about particularly worrying consequences. Consuming nondairy drinks under the age of one exposed infants to severe nutritional complications, which resulted in hospitalisation in more than half of the cases. Serious case reports have also been reported (1). To our knowledge, this study included the largest series of patients to date. The main negative consequence of nondairy drinks was that growth stopped or slowed down in more than 80% of children, but weight loss was sometimes underestimated because of oedema. Lacking adequate nutrition may have harmful effects on child development and growth at this age. A third of our cohort had malnutrition (2) due to the insufficient protein and energy in nondairy drinks. A report by the French national food Table 1 Nutritional parameters of 32 children who consumed nondairy drinks