Meeting Nutritional Needs for Vegetarian and Vegan Children

It’s possible that children can meet their nutritional needs while eating a vegetarian and vegan diet; this expert guide can explain how kids can get the nutrients they need for good health and development.

In August 2019, parents in Sydney Australia pled guilty to failing to provide for their three-year old daughter, after putting her on a strict vegan diet. The child was found to be severely malnourished; she was underweight, delayed, and failed to reach developmental milestones. Although the parents reportedly believed they were feeding their child healthfully, her diet consisted of mostly oats, potatoes, toast, and rice, and was severely lacking in nutrients (1).

Thanks to well-publicized stories like this one, many misperceptions shroud the viability of a vegetarian or vegan lifestyle for young children. While poorly planned vegetarian diets can be harmful for the development and health of young children, it’s entirely possible to meet the nutritional needs of even the tiniest individuals. However, it takes thorough knowledge of plant-based nutrition to achieve this.

Reed Mangels, PhD, RD, FADA, LDN, nutrition advisor for The Vegetarian Resource Group, a nonprofit educational organization, says, “It’s entirely possible for vegetarian or vegan diets to meet all nutritional needs of infants and children.” Mangels also is an expert in childhood vegetarianism and has developed materials on vegetarianism for children for both the Vegetarian Nutrition Dietetic Practice Group and The Vegetarian Resource Group, published articles on vegan infants and children in the Journal of Academy of Nutrition and Dietetics, contributed to the vegetarian section of the Academy of Nutrition and Dietetics’ (the Academy) Pediatric Nutrition Care Manual, coauthored two Academy position papers on vegetarian diets, served as nutrition editor and columnist for the Vegetarian Journal, and coauthored The Dietitian’s Guide to Vegetarian Diets.

Mangels’ assertion that vegetarian or vegan diets can meet the nutritional needs of infants and children is supported by the review of evidence-based literature appearing in the Academy’s position statement on vegetarian diets published in 2016 (2).

Vegetarians and Vegans: What’s the Difference?

According to the Academy’s position statement, a vegetarian is a person who does not eat meat, poultry, seafood, or products containing these foods (2) . But within this broad definition, there is much variation as to what animal foods people avoid.

Two common plant-based diets are vegetarian and vegan. A vegetarian diet usually is synonymous with a lacto-ovo vegetarian diet, which is devoid of all animal/flesh foods but may include eggs (ovo) and/or dairy (lacto) products. Vegans follow diets devoid of all animal/flesh foods and all egg and dairy products.

It’s important to consider that these categories are broad, and people may describe themselves as vegetarian when they sometimes eat fish or chicken; in this case, they usually are referred to as semivegetarian or flexitarian.

Benefits of a Vegetarian Lifestyle

One goal of living la vida vegetarian is to enjoy the documented health benefits that vegetarians tend to experience. According to the Academy, adult vegetarian diets often are associated with lower blood cholesterol levels and blood pressure levels, and a lower risk of heart disease, hypertension, and type 2 diabetes. Vegetarians also tend to have a lower BMI and overall cancer rates. Vegetarian diets usually are lower in saturated fat and cholesterol, and have higher levels of dietary fiber, magnesium, potassium, vitamins K, C and E, and folate (2).

Who Follows a Vegetarian Lifestyle?

A vegetarian lifestyle has become more popular in the United States, with sales of vegetarian foods and publications on the rise. Although there is no analysis of the incidence of vegetarian or vegan practice among peer-reviewed data, such as the National Health and Nutrition Examination Surveys, polls have been commissioned by vegetarian organizations. A 2019 study based on data collected by The Harris Poll and published by The Vegetarian Resource Group indicated that 4% of US adults follow a vegetarian-based diet. Approximately half of US adult vegetarians were also vegans, and 46% said they always or sometimes eat vegetarian meals when dining out (3).

According to a 2018 Gallop poll 5% of US adults consider themselves a Vegetarian. The poll found that vegetarianism was less prevalent among older adults, with only 2% of Americans age 55 and older self-identified as vegetarian, compared to 8% of 18- to 34-year-olds and 7% of 35- to 54-year-olds (4) .

Although many of the data on vegetarianism deal with adults, another 2014 poll by Harris Interactive asked 1,213 youths aged 8 to 18 how often they ate meat, poultry, seafood, dairy, eggs, and honey. The results showed that 4% of them were vegetarian or vegan (5). 

There appears to be a slow rise in vegetarianism among children and teens over the past two decades. In 2012, a similar poll was conducted by Harris Interactive in the same age group, finding that the same percentage of 8- to 18-year-olds were vegetarians.  However, Mangels reports that polls by The Vegetarian Resource Group indicate a small increase in the number of vegetarian children and teens since 1995.

Parent Preference

While many parents choose a vegetarian lifestyle for themselves and their children, older children and teens may be attracted to this lifestyle on their own. The reasons for parents choosing a vegetarian lifestyle for their children are numerous and varied, including personal health and wellness, spiritual and religious beliefs, concerns about animal welfare, food safety issues related to meat, and regard for the environmental consequences of a meat-based diet. And the growing popularity of vegetarian lifestyles is certainly influenced by the plethora of celebrities, such as Joaquin Phoenix and Liam Hemsworth, proclaiming the virtues of vegetarianism. There are many reasons to follow a vegetarian or vegan diet, including improving overall health, environmental concerns, wanting to take a natural approach to wellness, food-safety concerns, animal welfare, weight loss, and weight maintenance.

Mangels notes that recent environmental concerns may provide special motivation for parents to consider vegetarianism for their children. She indicates that livestock production causes environmental damage in several ways.

For example, livestock produce seven to nine times more sewage than humans, along with pesticide, antibiotic, and heavy metal discharge into water systems. Animal agriculture is responsible for 5% of global anthropogenic carbon dioxide emissions, represents 44% of methane emissions and 44% of nitrous oxide emissions, and is linked to 75% of deforestation in the Amazon rainforest (6) . Numbers like these inspire many parents to choose a vegetarian diet for their families. Adopting a vegetarian diet early in life lessens one’s lifelong impact on the environment.

With today’s focus on the devastating effects of America’s obesity epidemic that strikes children at ever-younger ages, the vegetarian lifestyle takes on new meaning as a lifelong approach to better health. According to the Centers for Disease Control and Prevention (CDC), 18.5% of children between the ages of 2 and 19 are obese (BMI in the 95th percentile or higher of the CDC growth chart) (7) . According to pediatrician Sara Lappe, MD, at least 60% of overweight or obese adolescents have at least one risk factor for heart disease (8).

A 2019 study entitled “Beyond Meat: A comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents,” looked at the intakes of adolescents aged 12-18 years old from schools near major Adventist universities. The study concluded that the vegetarian individuals were leaner than their non-vegetarian counterparts, and consumed more fruits, vegetables, and nuts/nut butter, as well as significantly less sugar-sweetened beverages (9) . Though this study did not come to conclusions about any long-term effects of a vegetarian diet in youth, higher consumption of these healthy foods and decreased consumption of sweetened beverages is linked with a decreased risk of obesity and other chronic diseases.

Of course, it’s important to consider that while some data suggest that vegetarian children may have a lower risk of obesity than their omnivorous peers, some vegetarian kids are overweight and show signs of diet-related conditions such as type 2 diabetes and high cholesterol. Just like with any child, it’s possible for vegetarian children to be overly dependent on junk foods and high-sugar beverages since “vegetarian” is not synonymous with “healthful.” The bottom line is that modern vegetarian kids can have the same challenges as modern nonvegetarian kids.

Basics of Vegetarianism for Infants and Children

Probably the biggest concern about vegetarianism in early childhood is nutritional adequacy. Yet the Academy’s position on vegetarian diets is that when well planned, such diets are appropriate for individuals during all stages of life, including pregnancy, lactation, infancy, childhood, and adolescence, as well as for athletes (2) .The goals for vegetarian or vegan children are to meet their nutritional needs, help them consume the right amount of calories, and support expected growth patterns (10).

As with any infant, a vegetarian baby’s earliest food ideally is breast milk because it enhances the immune system, protects against infection, reduces the risk of allergies, and provides optimal nutrition. Vegetarian women can successfully breastfeed, and studies have demonstrated that their milk is lower in environmental toxins than the milk of women eating meat (11). 

Breast-feeding women should ensure that their diet is balanced and that they get enough vitamin B12. In order to prevent rickets, the AAP currently recommends that all breast-fed infants receive 400 IU of supplemental vitamin D starting within the first few weeks after birth. Although sunlight is also a source of vitamin D, the AAP recommends keeping infants under 6 months out of direct sunlight to reduce the risk of skin cancer (12). 

The iron in breast milk is adequate for the first four to six months, but recommendations call for iron supplements (1 mg/kg/day) for exclusively breast-fed infants beginning at four months to make sure that the infant gets sufficient iron (13). Breast-fed infants may require supplemental fluoride after six months if fluorinated water intake is low or if supplements are prescribed by the physician (14). 

Soy-based infant formulas (or cow’s milk-based for lacto vegetarians), which support normal infant growth and development, are available for women who do not breast-feed or must supplement breast-feeding for the first year of life. While many soy infant formulas are appropriate for vegan diets, some may contain animal fats, so it’s important to read the ingredient list. Soy, rice, and other plant-based milks and homemade formulas should not be used to replace breast milk or commercial infant formula during the first year because they may not contain the proper ratio of protein, fat, and carbohydrates, and they do not have enough of the essential vitamins and minerals needed during the first year (14). 

Since breast milk (or infant formula) is a rich source of important nutrients, vegetarian and vegan infants should breast-feed (or use infant formula) for at least one year or up to 24 months as they transition to solids. Infants should be weaned to fortified soymilk containing calcium and vitamins B12 and D. Low-fat or nonfat soymilks should not be used prior to age 2. Almond, oat, hemp and many other plant-based milks are not recommended as a primary beverage for infants and toddlers because they are low in protein and calories (14). 

Recommended Diet for Infants and Toddlers

As foods are introduced to breast- or formula-fed babies in the middle of their first year, parents should introduce one new food at a time to identify potential allergies. A commercial iron fortified infant cereal based on a single grain mixed with breast milk or formula is an ideal first food, as it is a good source of iron and unlikely to cause an allergic response.

Ground oats, barley, corn, and other grains that are cooked until very soft and smooth can be introduced one at a time, but iron supplements should be continued since these grains are low in this mineral. Mashed or puréed vegetables and fruits as well as fruit juice can be offered to the infant next. Grain foods such as soft, cooked pasta or rice; soft breads; dry cereals; and crackers can be introduced as the baby shows appropriate signs of readiness.

At 6 to 8 months of age, protein sources such as well-mashed, cooked beans; mashed tofu; and soy yogurt can be offered to the infant. Smooth nut and seed butters spread on bread or crackers can be introduced after the baby’s first birthday (14). 

Commercially prepared baby foods also are available for vegetarian and vegan infants, but it’s important to read labels. Many parents of vegetarian infants prepare their own baby foods for better control and variety as well as for cost reasons. These foods and ingredients should be washed well, cooked thoroughly, blended or mashed to the appropriate consistency, and stored safely (14). 

During the vegetarian and vegan toddler years (ages 1 to 3), it’s important to focus on helping the child consume a variety of nutrient-dense foods and ensuring adequate intake of calories, protein, fat, calcium, vitamins B12 and D, iron, and zinc (14). 

What Should Parents Do?

It’s clear that parents and children can benefit from the help of a nutritional professional in planning nutritionally adequate vegetarian or vegan diets for children. With the increasing interest in vegetarianism and veganism, dietitians specializing in plant-based nutrition may be a great asset regarding issues, concerns, and benefits of this lifestyle for infants and children. Look to the Vegetarian Dietetic Practice Group as a resource for nutrition professionals proficient in this area.

Remember that the absence of meat does not necessarily guarantee a healthful diet. Even vegetarian children can overindulge in unhealthful foods such as sugar-coated cereals, macaroni and cheese, veggie hot dogs, pizza, and even fast food, all of which can lead to obesity and other health problems. So, remember to make every meal count—make it rich in vibrant, whole plant foods that contribute to health and flavor for the whole family.

Written by Sharon Palmer, MSFS, RDN

For more information on healthy plant-based eating for the whole family, check out: 

Maximize the Many Benefits of Family Meals
Gather Together for Family Meals and Reap The Benefits

References

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10. Feeding Vegetarian and Vegan Infants and Toddlers. https://www.eatright.org/food/nutrition/vegetarian-and-special-diets/feeding-vegetarian-and-vegan-infants-and-toddlers. Accessed January 29, 2020.
11. “Healthy Milk, Healthy Baby: Chemical Pollution and Mother’s Milk” | NRDC. https://www.nrdc.org/media/2001/010522. Accessed January 29, 2020.
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