Unpasteurized foods and young children

What pasteurization does

Pasteurization heats milk or juice to a set temperature for a set time to kill germs that cause illness (CDC, FDA). The FDA says it doesn’t reduce milk’s nutritional value, and the CDC notes that pasteurized milk has the same nutrition benefits without the risks of raw milk.

“Unpasteurized” and “raw” mean the same thing: the food hasn’t been heat-treated. That includes milk from cows, goats, sheep or any other animal (FDA).

Why it matters more for young children

The CDC says children under 5 are more likely to get sick from germs in food, because their immune systems are still developing, and food poisoning can quickly lead to diarrhea and dehydration. Children under 5 are three times more likely to be hospitalized if they get a Salmonella infection (CDC).

Raw milk and products made from it can carry Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella and Salmonella (CDC). The CDC lists children under 5 among those at higher risk of serious illness. Some infections lead to hemolytic uremic syndrome (HUS), which can cause kidney failure (CDC). The FDA describes several US outbreaks where the children who drank raw milk were the ones who became most seriously ill.

The FDA also addresses common claims: raw milk doesn’t prevent allergies or asthma, doesn’t treat lactose intolerance, and doesn’t contain helpful “probiotic” bacteria. Children with a milk allergy react to raw and pasteurized milk alike.

Milk

• Use pasteurized milk. Before 12 months, milk as a drink means breast milk or formula. From 12 months, pasteurized whole cow’s milk can be a main drink: see cow’s milk at 12 months and cow’s milk.
• The NHS says young children should not be given unpasteurized milk, because of the higher risk of food poisoning. Raw goat’s milk and sheep’s milk carry the same germs (FDA).
• Read the label. The FDA says safe milk has the word “pasteurized” on it. If it doesn’t, it may be raw.
• Be careful at farmers’ markets and roadside stands. The FDA says not to buy milk or milk products there unless you can confirm they’re pasteurized.
• Raw milk sold for pets is not safe for people (FDA).

Cheese, yogurt and other dairy

The CDC’s safer choices for children under 5:

• Hard cheese such as cheddar, Parmesan, Swiss or Gruyère
• Cottage cheese, cream cheese, string cheese and feta
• Processed cheese
• Soft cheese clearly labeled “made from pasteurized milk”

The CDC lists soft cheese made from raw milk, such as some queso fresco, brie, camembert and blue-veined cheese, as a riskier choice. Raw-milk yogurt and ice cream carry the same risk, so choose versions made from pasteurized milk (CDC, FDA).

The NHS says babies can have pasteurized full-fat cheese from 6 months, including mild cheddar, cottage cheese and cream cheese. It is stricter on some soft cheeses (see the US and UK section). Many cheeses are made from unpasteurized milk, so check the label (NHS). Cooking kills listeria, so these cheeses are fine baked into a hot dish (NHS).

Cheese is also a choking hazard in chunks, and string cheese in particular: grate cheese or cut it into short, thin strips, and never give a whole stick of string cheese. See cheese, string cheese, feta, goat cheese and yogurt.

Juice and cider

Juice isn’t recommended before 12 months at all, and the NHS says to avoid it up to age 4 because of its sugar: see juice for babies. If you do offer juice, make it pasteurized.

• Fresh-squeezed and raw-pressed juice can pick up bacteria from the fruit. Unless it’s pasteurized or otherwise treated, it could be contaminated (FDA). That includes juice you squeeze at home.
• In the US, untreated juice sold in packages must carry a warning label, but juice or cider sold by the glass, at orchards, juice bars, farmers’ markets and some restaurants, doesn’t need one (FDA). Ask if you’re not sure.
• Untreated juice is most likely to be found in the refrigerated section of a store (FDA).
• The CDC says unpasteurized juice or cider for a child under 5 should be brought to a rolling boil for at least 1 minute first.

Sprouts

Raw or undercooked sprouts, such as alfalfa and bean sprouts, are on the CDC’s list of riskier foods for children under 5. Cook them until steaming hot. See bean sprouts.

Eggs

Raw eggs aren’t a pasteurization question in the same way, but the idea is similar. For foods that won’t be cooked, like homemade dressings, the CDC suggests pasteurized eggs. US and UK advice on eggs differs: see egg.

Honey is a different risk

Honey carries a separate risk: infant botulism. The NHS says not to give your child honey of any kind until they’re over 1 year old. Honey and botulism explains why cooking or baking it into food doesn’t make it safe for a baby.

If your child has had raw milk or cheese

Watch for diarrhea, vomiting or tummy cramps (CDC). The FDA says food poisoning usually starts within 1 to 3 days, but can start anywhere from 20 minutes to 6 weeks later. It also says anyone who becomes ill after consuming raw milk or products made from it should see a healthcare professional straight away, so call your pediatrician or GP if symptoms start, and say what your child had. Call the same day if there is blood in the diarrhea or bleeding from the bottom (NHS). For caring for a child with diarrhea or vomiting, see food poisoning in babies.

Call 911 or go to the emergency room if your child:Call 999 or go to A&E if your child:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your child:

• has fainted, is difficult to wake or can’t be woken (NHS)
• is breathing very fast or having difficulty breathing (NHS)
• has blue, gray, pale or blotchy skin, lips or tongue (NHS)
• hasn’t had a pee in the past 12 hours (NHS)
• is having a seizure (fit) (NHS)
• has a rash that doesn’t fade when you press it (NHS)

Where US and UK advice differs

• Soft cheese. The CDC says soft cheese clearly labeled “made from pasteurized milk” is a safer choice for young children. The NHS says babies and young children shouldn’t have mould-ripened soft cheeses like brie or camembert, ripened goats’ milk cheese like chèvre, or soft blue cheese like roquefort, even if pasteurized, unless they’re cooked.
• Raw milk. In the UK, the Food Standards Agency says infants and small children should not have raw drinking milk or raw cream. Raw cow’s milk can only be sold directly to consumers, mainly by registered farms, in England, Wales and Northern Ireland, and its sale is banned in Scotland. US agencies (CDC, FDA) give the same health advice: choose pasteurized.
• Juice. The CDC gives a boiling step for unpasteurized juice. The NHS foods-to-avoid page says to avoid fruit juice up to age 4 because of its sugar, and its Best Start in Life page advises against juice before 12 months and, if you do offer it, diluting it 1 part juice to 10 parts water with a meal. The AAP allows a small amount of 100% juice from age 1: see juice for babies. All of them point to whole fruit instead.