Invited review: Maintaining and growing fluid milk consumption by children in school lunch programs in the United States

Abstract

Fluid milk consumption among children has declined for decades. Adequate consumption of milk and dairy products, especially during childhood, has beneficial health outcomes for growth, development, and reduced risk of osteoporosis, hypertension, obesity, and cancer during adulthood. Satisfaction with milk flavor, perceived health benefits derived from milk, and habit are primary drivers of lifelong milk consumption. Child preferences and attitudes for milk may differ from those of adults, and as such, understanding and fulfilling the needs of children is crucial to reverse the decline in milk consumption. School meal programs make fluid milk accessible to millions of children each day; however, regulations and school lunch procurement systems in the United States sometimes make it difficult to provide novel or value-added milk products in these programs. Total consumption of all milk types in US schools declined by 14.2% from 2008 to 2017, and the percentage of children participating in the school lunch program has also declined. This decline has also been driven by declining average daily participation in the school meal program and may also reflect children's dissatisfaction with the sensory characteristics and the form of milk offered in schools. The change in form of milk offered in schools to lower fat and lower added sugar content in the United States has been driven by government-mandated school lunch calorie and fat requirements. This review describes the current milk consumption trends among children; the structure and basic requirements of the school lunch program in total and for milk; and the intrinsic, extrinsic, and environmental factors that influence child perception, preference, and consumption of fluid milk in the US school system.

Parents' implicit perceptions of dairy milk and plant-based milk alternatives

“…Although milk consumption decreases with age, dairy consumption during childhood and adolescence increases the chances of lifetime milk consumption (Lytle et al, 2000;Forshee and Storey, 2003;Huth et al, 2006;McCarthy et al, 2017b). As repeated childhood exposure to foods results in development of preferences for those foods, childhood is a key phase of life for driving dairy loyalty (Wardle et al, 2003;Anzman-Frasca et al, 2012;Ventura and Worobey, 2013;Sipple et al, 2020). However, this loyalty developed during childhood is not necessarily lifelong.…”

“…If parents make the switch from dairy milk to PBA, they may also switch their children's diets, preventing dairy habit formation. These parents may consider PBA healthier despite published statements and guidelines from pediatricians encouraging caution or recommending primarily dairy milk (Lott et al, 2019;Rosen, 2020;Sipple et al, 2020) and other scientific literature that confirms the superior nutrition of dairy foods and sustainability and efficiency progress made by the US dairy industry (Schiano and Drake, 2021b). The American Dietary Guidelines recommend that children consume fat-free or low-fat dairy daily (2.5 cup equivalents/d for children 4-8 yr and 3 cup equivalents/d for children 9-18 yr; USDHHS and USDA, 2015).…”

Children's perceptions of fluid milk with varying levels of milkfat

“…Declines in milk consumption with the substitution of less healthy beverages are associated with children not receiving enough dietary calcium (Johnson et al, 2002;Fayet-Moore, 2016). Even as child fluid milk consumption continues to decline, schools participating in federal meal programs, such as the National School Lunch Program and the National Breakfast Program, are limited to serving skim or low-fat (≤1%) milk (Sipple et al, 2020).…”

“…However, Johnson et al (2002) reported that children who consumed flavored milk during lunch time did not have higher added sugar intakes than other children who were not milk consumers, as nonmilk drinkers were more likely to consume fruit juice or soft drinks. Currently, chocolate milk is the most popular flavored milk for both children and adults in the United States but, as with unflavored white milk, child school meal programs that are eligible for federal compensation are limited to serving fat-free or low-fat (<1%) chocolate milk (Sipple et al, 2020). Federal guidelines limit calories per meal so the fat content, and added sugar in the case of flavored milk, are critical to the calorie count of the entire meal.…”

“…The fact that product liking by children drives preference and desire is clearly demonstrated in the school lunch program. School children like chocolate milk, and this has driven sales of chocolate milk in schools to 60% of the total sales (MilkPEP, 2017;Sipple et al, 2020). Sipple et al (2021) evaluated child perception of school lunch packaging and child perception of the liking of fluid milk packaged in paperboard (laminated tetra bricks), high-density polyethylene (HDPE; opaque and flexible bottles), or polyethylene terephthalate (PET) packaging (clear and glass-like bottle packaging).…”