How much milk is too much for toddlers? What Wichita pediatricians say they’re seeing

Pediatricians at Ascension Via Christi St. Francis are advising Wichitans to keep a better eye on how much milk their toddlers are drinking.

This comes after the doctors saw a surge in iron deficiency anemia in young children as a result of either too much calcium or too little iron in their diets, with several cases resulting in hospitalization.

Dr. Amy Seery, a pediatrician with Ascension since 2011, said that although anemia isn’t uncommon among children, the severity she and her colleagues have observed over the past few months is cause for concern.

“This is a common issue that happens for a handful of kiddos, but to have so many all at once that were severe enough to require hospitalization with dangerously low levels, like, that’s the abnormal blip,” Seery said.

What is anemia, and how is it caused?

Iron-deficiency anemia is a common medical condition that happens when, because of an iron deficiency, the body does not produce enough healthy red blood cells or hemoglobin to carry oxygen throughout the body. Iron-deficiency anemia, the most common type, often occurs when toddlers transition from a milk-only diet to a diet including solid foods.

Sometimes, Seery said, parents assume the best primary calories for young children should come from a liquid form like milk, which can lead to over-consumption.

“So if families are kind of overdoing it on milk consumption, so really kind of above 24 ounces per day, now they’re no longer getting just the benefits, but now they’re potentially crossing over into some of the negative side effects of having just too much calcium in our bodies,” Seery said.

Too much calcium, Seery said, overpowers the body’s ability to deliver iron, leading to the decreased production in red blood cells that can cause anemia.

Additionally, kids that drink too much milk often experience a reduced appetite, which means toddlers eat less and, as a result, consume less iron altogether.

“So if they’re either, one, not eating enough iron or two, eating enough but the calcium is out-competing it, the iron doesn’t get absorbed into their body fully. And iron is important because it’s how we make our red blood cells,” Seery said. “So if you don’t have iron, that’s how you end up anemic.”

What are pediatricians at Ascension seeing?

So far, Seery said, the increase and severity of anemia in toddlers related to milk over-consumption appears to be hyper-local to Wichita. Over the last two to four months, Ascension has diagnosed and provided “aggressive intervention” — either hospitalization or outpatient iron transfusions — to five toddlers with iron deficiency anemia. According to Ascension External Communications Manager Bill Kueser, pediatricians typically see this many cases over the span of a year, not in a few months.

While the excessive consumption of cow’s milk is the leading cause of anemia in toddlers, according to Nationwide Children’s Hospital, less than 10% of toddlers develop an iron deficiency and less than half of that percentage are hospitalized for it.

Wesley Healthcare’s Market Director of Communications & Community Engagement Dave Stewart said that Pediatric Medical Director Dr. Stephanie Kuhlmann did not notice any out-of-the-ordinary increases in toddler anemia cases.

“She said that that (anemia in toddlers) is a fairly common diagnosis that we see throughout the year, but she did not feel that we’ve seen any particular increase recently,” Stewart said. “But it is a fairly common thing for kids to get admitted for.”

Health care providers at Ascension said they are still unsure exactly how the trend they are seeing started. Seery said some colleagues have speculated that the increase could be “a kind of pendulum swing behavior” from families who were affected by formula shortages several years ago who are now overcompensating with milk, while others think a gap in education may be responsible.

“We’re not certain,” Seery said. “So most importantly, again, we’re trying to get on top of this. We’re trying to get information out so families, all caregivers, have information to use for good, informed decision making. But yes, I wish I had a direct answers to why we seem to be having this clustering of behavior.”

Through an examination of the dietary history and lab work of toddlers with anemia symptoms, pediatricians at Ascension were able to determine the anemia was a result of excessive milk consumption.

In response, they issued a press release recently to alert the community.

“It just caught us off guard,” Seery said. “We’re like, ‘Why are there so many coming in all at once?’ I am curious to keep seeing like, does the trend continue? But rather than just wait and see, hence, we wanted to put out the press release and be like, well, can we kind of get on top of it?”

What can parents do?

The American Academy of Pediatrics recommends that children between the ages of 1 and 3 shouldn’t drink more than 24 ounces — three cups — per day in milk. The optimal amount is between 16 and 24 ounces, according to the press release.

Incorporating more iron-rich foods, such as lean meats, beans and dark leafy greens, can also help prevent anemia in toddlers. Seery said when children turn 1, parents should aim to give them three meals a day, plus two snacks, to get the best calories from these “good, high quality, variable foods.”

“The more color on the plate, the better,” Seery said.

Parents should also watch for key symptoms of anemia, like tiredness, paleness, an accelerated heart rate, poor appetite and excessive chewing outside of age-appropriate behavior.

Seery recommends that parents review their child’s diet and consider visiting their doctor if there seems to be a valid reason for concern.

And, if nothing else, Seery said, instilling healthier food habits can go a long way.

“As Americans, our dietary trends have not been getting better over the generations,” Seery said. “So if everyone can work harder on a balanced diet with lots of fiber, and be maybe a little bit less obsessed about protein, I think a lot of us would be a lot healthier for it.”