Issues in Vegetarian Dietetics, Summer 1999; Vol. 8(4):1-6
by Carol M. Coughlin, RD
Vegan children may be part of a family following a vegan lifestyle, or may have chosen a vegan diet for themselves. This article will examine vegan diets for children from infancy to adolescence, discuss important nutrients and then give practical meal planning tips for vegan children and their parents.
Diet for infancy
Dietary guidelines for infancy (birth to age 12 months) suggest all children spend most of infancy on a vegetarian if not vegan diet as meat is the last food group to be introduced.
Breastfeeding is the recommended feeding method for infants. The milk produced by vegan mothers is nutritionally adequate (1). Breastfeeding rates among vegetarians are much higher than in the general population; breastfeeding rates above 95% in a vegan population have been reported (2). In the US, only 20% of infants in the general population are still being breastfed at age 6 months (3) while studies examining vegan children showed most were breastfed well into the second year of life (4). Breastfed infants of well-nourished vegetarian mothers grow and develop normally (1).
Breastfed babies do not follow the same growth patterns as formula fed infants (5). If the vegan infant is breastfed, growth should be assessed using tools designed for breastfed infants.
Vegan infants who are not breastfed should receive soy-based infant formula until at least the first birthday. Soy or other "milks" are not a substitute for infant formula. Soy formulas support normal growth in infants (6).
Solid foods should be added to the diet in accordance with accepted infant feeding guidelines which generally suggest starting solids during the middle of the first year of life. Usually iron fortified infant cereal is the first food introduced, followed by vegetables, fruits and then protein foods. Soy, peanuts and strawberries are usually listed as foods Families with a history of food allergy may choose to delay the introduction of foods such as soy, peanut and strawberries until after the first birthday.
Current research indicates that only newly absorbed (as opposed to the stored in the mother's body) vitamin B12 is passed through the breastmilk. A dietary source of B12 for nursing mothers such as a fortified meat analog, nutritional yeast or a supplement must be established and maintained throughout the nursing period (7).
Toddlers (children from age 1 to 5) are notorious for strong food preferences, and vegan toddlers are no exception. Raising a child on a vegetarian diet does not assure that the child will like all plant-foods. Vegan toddlers should be expected to have the same nutritional concerns as omnivore toddlers, namely a dislike of vegetables, "picky" eating habits and food jags (8). Practical information for vegetarian families with picky eaters has been published elsewhere (9).
Young children need more than three meals a day. Nutritious snacks consisting of the same foods that would be served at meals-beans, grains, fruits and vegetables, add significantly to the nutrient intake of the vegan child. Many vegan toddlers are still nursing, which aids in the intake of calcium, protein and other nutrients (4).
A common misconception is that vegan children will have poor growth. Most studies of vegan children in the US have been on children following a macrobiotic diet. One exception is the FARM study. The FARM is a vegan community in Tennessee. A sample of 404 children, vegan from birth, were slightly shorter than controls at age 1 to 3, and were comparable in height at age 10 (2). Studies of British vegan (non-macrobiotic) children showed they were taller than controls, and weighed slightly less (10).
Many school-aged children (ages 5 to 12) have been following a vegan diet from birth. However, it is becoming more common for children as young as 7 or 8 years old to choose this diet for themselves.
School snacks and lunches will probably need to be brought from home as school lunches may have limited vegan choices. However, schools may offer juice, vegetables and fruits, dairy free breads, baked potatoes and even bean burritos on occasion.
While some people express concern that children who are vegan may find the diet socially difficult, that is not necessarily the case. Numerous students avoid food items for religious reasons or due to food allergy, not to mention simply disliking the food.
Many teens (ages 13 to 19) adopt a vegan diet because they view the use of animals for food to be against their moral beliefs. Few data are available on the eating habits of vegan teenagers. Vegan teens are still teens and therefore common teen eating habits are to be expected. Foods with low nutrient density such as french fries and non-dairy desserts may be chosen over green leafy vegetables.
Since vegan diets are more common among teen-agers as are eating disorders, some health professionals have noted that vegetarian diets are somewhat more common among teens with eating disorders than in the general adolescent population. Recent data suggest that adopting a vegetarian diet does not lead to eating disorders (11).
Many of the same dietary concerns apply to both the vegan and omnivorous child. How many fruits and vegetables does the child eat? Is there an excess of empty calorie foods? Is the child getting adequate fiber? Are good sources of vitamin C and vitamin A consumed daily?
Adequate caloric intake is essential to the growth of all children. The diet must have sufficient caloric density so that the child does not feel full before calories needs are met. To reduce bulk some refined grains can replace servings of whole grains; dried and cooked fruits can be substituted for some fresh fruits and vegetables. High fat foods should not be overly restricted. Foods such as seeds, nuts, and nut butters provide a concentrated source of calories as well as necessary minerals and protein. High fat foods such as ground flax seed and various vegetable oils aid in adequate caloric intake as well.
If caloric intake is adequate and the child is not eating an excessive amount of empty calorie foods, protein intake most likely will be adequate. The frequency of meals in a young child's diet greatly assists in providing a variety of amino acids to be available for protein synthesis throughout the day. Legumes, grains, soy products, meat analogues, nut butters, dairy products, and eggs are all concentrated protein sources. Vegetarian children may get a significant amount of their protein requirement from grains and vegetables simply because of the large number of servings eaten per day.
Concern about total dietary fat and saturated fat has led many families to use non-fat or low-fat "milks" and substitute fat free spreads for margarine. Low-fat soy milk and rice milk contain low levels of fat and protein. If these products are used parents must be sure children are getting adequate fat and protein from other dietary sources. Infants get adequate fat and protein from breastmilk or infant formula. Full-fat soy milk is generally recommended for young children. Breastfeeding a child during the second year of life helps assure adequate fat and protein intake as well.
It should not be assumed that all vegan diets are low fat. Vegan diets can be low fat; however, the fat intake of vegan adults averages about 30% of calories from fat (1). Vegan foods such as some baked goods, some non-dairy desserts, nuts, oils and french fries are high in fat. Heart-healthy dietary guidelines of limiting total fat to less than 30% of calories and saturated fat to no more than 10% of calories still apply.
Osteoporosis prevention appears to be enhanced by achieving maximum bone mass in the first years of life. Dietary intake data from the National Health and Nutrition Examination Survey III (NHANESIII) show that most children are far from meeting the DRIs for calcium (12). Vegan sources of calcium for children include breastmilk, calcium-fortified juices and cereals; calcium-fortified soy and rice beverages; low oxalate vegetables like collard greens and bok choy; and blackstrap molasses. In addition, baked goods made with fortified vegetable milks can contribute significant amounts of calcium to the diet of children. For children with a low dietary intake of calcium, a supplement may be desired. Liquid and chewable supplements flavored to appeal to children are available. Daily weight bearing exercise will enhance the benefit of calcium intake on bone health.
In the southern US, sunshine can be an adequate source of vitamin D year-round. In northern states there is not adequate sunshine in the winter to allow the body to produce vitamin D. Vitamin D synthesis is poorer in people with dark skin and can be blocked by sunscreen, therefore a dietary source is recommended for all children. Fortified soy or rice milk, fortified breakfast cereals, or a vitamin supplement can be used to augment vitamin D intake.
Iron deficiency anemia is the most common childhood nutritional problem. While meat contains heme iron that is better absorbed than the non-heme iron found in plant foods, iron deficiency anemia is no more likely to occur in vegetarian than non-vegetarian children (1). Good iron sources include whole or enriched grains and grain products, iron-fortified cereals, legumes, and green leafy vegetables. Consuming foods rich in vitamin C at the same meal enhances non-heme iron absorption.
Vegans consume no animal products so they must consume vitamin B12 fortified foods or supplements. There are several foods popular with children that are fortified with a vegetarian (non-animal derived) vitamin B12 such as breakfast cereals (Total, Nutri-Grain), Red Star Brand Vegetarian Support Formula nutritional yeast, meat analogs, and some soymilks. Most children's multivitamins contain vitamin B12.
Most reports of dietary B12 deficiency in the literature are in people following a macrobiotic diet (1). Some foods commonly included in a macrobiotic diet such as tempeh (a cultured whole soybean product), sea vegetables (kelp, kombu, arame), miso (a fermented soybean paste), algae, and spirulina had been previously reported to contain vitamin B12. Current thinking is that much of this was actually B12 analogs and may interfere with active vitamin B12 absorption (13). Since a deficiency risks permanent neurological damage it is critical to assure a reliable source of this vitamin.
There is little available information on the zinc content of diets of vegetarian children (1). Zinc from breastmilk is better absorbed than zinc found in infant formula, probably due the presence of zinc-binding proteins in human milk (14).
While whole grains contain oxalate that lowers the absorption of minerals such as zinc, refined foods generally contain lower amounts of zinc, so total absorption may be greater from the whole grain. For example, almost 40% of the zinc in white bread is absorbed, while only 17% is absorbed from whole-grain bread. However, the total amount of zinc absorbed from a serving of whole-grain bread is almost 50% more than from white bread because whole-grain bread contains more than three times as much zinc (15).
Vegetarian children should include a variety of zinc-rich foods in their diets, such as whole grain pasta, wheat germ, fortified cereals, legumes, and peanut butter.
Meal planning for new vegans
The vast majority of food in every healthful diet is vegan: grains, legumes, fruits, and vegetables. Peanut butter sandwiches, pasta with vegetables, bean burritos, lentil soup, pizza, vegetables, salads, hot cereal, and breads are all vegan. Familiar looking main dishes can be made from soy or wheat gluten based meat analogs.
Soy and rice milk may be used cup for cup like cow's milk in recipes. It is generally recommended that vegan children use brands fortified with calcium and vitamin D. Eggs can be replaced with commercial starch-based egg replacers, ground flax seeds, mashed bananas, applesauce, or prune puree depending on the recipe.
It may be easier to find vegan dishes at ethnic restaurants when eating out. Many ethnic dishes are not meat based. Stir fry vegetables with tofu, Indian lentil dishes (dal), and hummus are but a few examples. Juice box sized soy milk is handy for traveling or eating away from home, as soy milk is not commonly available from commercial foodservice. However, most restaurants serve fruit juice.
Omnivore families with one vegan child may find it helpful to serve meals that each person assembles themselves such as a chef salad served salad bar style, tacos, etc. When a meat containing entree is served, it may be possible to create a vegan version at the same time. A small non-meat, no cheese lasagna can be made while making a meat containing one. Chili, pizza, bean soup, and pasta sauce can all be made without meat or using meat analogs. Another meal planing strategy is to serve a side dish for the omnivores such as vegetable and grain casseroles function as the entree for the vegan. The entire family can enjoy a few meatless dinners each week.
Vegan diets can easily meet the nutritional needs of the growing child. Most of the nutritional concerns and issues vegetarian families have are exactly the same as for all other families. The scientific literature shows a positive relationship between vegetarian diets and reduced risk for several chronic diseases and conditions, including obesity, coronary artery disease, hypertension, diabetes mellitus, and some types of cancer (16).
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- Committee on Nutrition, Academy of Pediatrics. Soy protein formulas: Recommendations for use in infant feeding. Pediatrics. 1983;359-363.
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