It is widely appreciated that health food beverages are not appropriate for infants. Because of continued growth, children beyond infancy remain susceptible to nutritional disorders. This study reports on 2 cases of severe nutritional deficiency caused by consumption of health food beverages.

Because of a history of chronic eczema and perceived milk intolerance, one child was started on a rice beverage after weaning. The fluid was referred to as "rice milk," and was extremely low in protein content and the child developed kwashiorkor (protein calorie malnutrition).

Children in industrialized countries have developed kwashiorkor resulting from the use of a nondairy creamer as a milk alternative, but this is the first report of kwashiorkor caused by a health food milk alternative.

Another report is of a 17-month-old black male child who was diagnosed with rickets. He was full-term at birth and was breastfed until 10 months of age, when he was weaned to a soy health food beverage, which was not fortified with vitamin D or calcium. Intake of solid foods was good, but included no animal products.

Dietary vitamin D intake was essentially absent because of the lack of vitamin D-fortified milk. The patient lived in a sunny, warm climate, but because of parental career demands, he had limited sun exposure. His dark complexion further reduced ultraviolet light-induced endogenous skin synthesis of vitamin D.

Pediatrics Vol. 107 No. 4 April 2001, E46

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