March 2010 Issue

No Meat, No Problem — Vegetarian Diets Can Support Optimal Health for Infants and Children
By Sharon Palmer, RD
Today’s Dietitian
Vol. 12 No. 3 P. 28

In 2005, a Scottsdale, Ariz., couple was charged with child abuse after their three vegan children were found severely malnourished. The 3-year-old weighed only 12 lbs. What did the police find when they investigated the case? A very tidy home; a refrigerator filled with fresh vegetables and grains; well-educated, home-schooled children; and parents with extensive self-knowledge of homeopathic health and nutrition. Although the parents reportedly believed that they were feeding them a healthy diet, their children’s diet appeared to lack important nutrients.          

Due in part to well-publicized stories like this one, many misperceptions shroud the viability of a vegetarian lifestyle for young children—misperceptions that sometimes even find their way into healthcare professionals’ belief set.

“Unfortunately, there are a lot of myths that seem to have taken hold in the public. And these are largely based on the relatively small handful of tragic cases of child abuse or neglect where the children were fed a very poor diet, a diet that the media or the criminal defense labeled as ‘vegan.’ But the diets weren’t poor because they were vegan; they were poor because they were completely inappropriate,” says Dina Aronson, MS, RD, president of Welltech Solutions, a business that specializes in wellness technology. Regarded as an expert, author, and speaker on vegetarian diets, Aronson has successfully navigated one (going on two) vegan pregnancies and raised her son predominantly vegan.

Reed Mangels, PhD, RD, LDN, FADA, nutrition advisor for the nonprofit educational organization Vegetarian Resource Group, adds, “I occasionally hear statements from both the public and dietitians to the effect that vegetarian or vegan diets are fine for adults but not for infants and children. It’s entirely possible for vegetarian or vegan diets to meet all nutritional needs of infants and children.”

Mangels is a leading expert in vegetarianism during childhood. She has developed children’s materials on vegetarianism for both the Vegetarian Nutrition Dietetic Practice Group and the Vegetarian Resource Group, published articles on vegan infants and children in the Journal of the American Dietetic Association, contributed to the vegetarian section of the American Dietetic Association (ADA) Pediatric Nutrition Care Manual, coauthored two ADA position papers on vegetarian diets, served as nutrition editor and columnist for the Vegetarian Journal, and coauthored the second edition of The Dietitian’s Guide to Vegetarian Diets.

“Dietitians who are unfamiliar with vegetarian diets might say that you cannot raise healthy children on a vegetarian diet,” says Jill Nussinow, MS, RD, a speaker, educator, writer, and consultant specializing in vegetarianism who is also known as the Veggie Queen. “My son was a vegetarian until he was 5 years old and was generally much healthier than his friends who ate meat. Many vegetarian children are well nourished when the parents know what to feed them. As a dietitian, if you only consider meat eating as the norm, then a vegetarian diet might seem like it can’t work—and it might not work for everyone. But if your clients want to do it for themselves or their children, then it’s up to you to learn more about it and counsel them or find someone who can.”

Review of Definitions
According to the ADA’s 2009 position on vegetarian diets, a vegetarian is a person who does not eat meat, fowl, or seafood or products containing these foods. But within vegetarianism, there is much variation as to how far people go to avoid animal products. The two most common ways of defining vegetarian diets are vegan diets, or diets devoid of all flesh foods, and vegetarian diets, or diets devoid of all flesh foods but that include egg (ovo) and/or dairy (lacto) products. It’s important to remember that these categories are broad and that people may describe themselves as vegetarian when they sometimes eat fish or chicken, which is referred to as being semivegetarian.

Plant-Based Eating Gets Popular
Vegetarian lifestyles are becoming popular in the United States, with sales of vegetarian foods and publications on the rise. A 2008 study based on data collected by Harris Interactive and published in the Vegetarian Times indicates that 3.2% of U.S. adults (7.3 million people) follow a vegetarian-based diet. Approximately 0.5% of U.S. adults are vegans and 10% say they follow a largely vegetarian-inclined diet.

Although much of the data on vegetarianism deal with adults, Mangels reports that the Vegetarian Resource Group has conducted polls indicating a small increase in the number of vegetarian children and teens since 1995. “Certainly, parents are expressing interest in a vegetarian lifestyle. It’s often perceived as a healthier way to eat. Many vegetarian parents were vegetarian before they became parents, and they want to share this lifestyle with their children. There’s also been a proliferation of books, cookbooks, Web sites, and blogs about vegetarian families, and this may have sparked interest as well,” she says.

“More and more caregivers are taking steps to improve their own health by adopting a vegetarian or ‘flexitarian’ [a vegetarian who sometimes eats meat] diet, and they are, of course, feeding their children what they themselves eat. I have also seen an increase in the number of vegan families,” adds Aronson.

Vegetarian for a Reason
Why are parents interested in a vegetarian lifestyle for their children? The list of reasons is long and varied and includes 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 it doesn’t hurt that a plethora of celebrities (eg, Alicia Silverstone, Tobey Maguire) proclaim the virtues of vegetarianism. The 2008 Vegetarian Times study found that more than one half (53%) of current vegetarians eat a vegetarian diet to improve their overall health. Forty-seven percent cited environmental concerns, 39% natural approaches to wellness, 31% food safety concerns, 54% animal welfare, 25% weight loss, and 24% weight maintenance.

Nussinow says in her experience, today’s food safety concerns with animal products are steering parents toward vegetarian eating patterns for their children. Mangels notes that recent environmental concerns may provide special motivation for parents to consider vegetarianism for their children.

“Reports that provide examples of the damage to the environment caused by livestock production—including: the livestock sector is responsible for a greater production of greenhouse gas than automobiles and other forms of transportation; livestock produce almost two thirds of ammonia emissions, a significant contributor to acid rain; and in the U.S., livestock are responsible for 55% of erosion and sediment, 37% of pesticide use, and 50% of antibiotic use—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,” she says.

Nutritional Basics in Early Childhood
Probably the biggest concern with vegetarianism in early childhood is nutritional inadequacy. Yet the ADA’s position on vegetarian diets notes that well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. Mangels reports that many members of the Vegetarian Resource Group are glowing testaments to the fact that vegan children can be healthy, grow normally, and be extremely active. Sure, it takes time and thought to feed vegetarian and vegan children, but all parents should invest energy in nutrition—no matter what diet their children follow—during this critical period of life when eating habits form and growth rates are high. A vegetarian or vegan child’s goals are to meet nutritional needs, get the right amount of calories, and support expected growth patterns.

As with any infant, a vegetarian baby’s earliest food is ideally breast milk because of its many benefits, including immune system enhancement, protection from infection, reduced risk of allergies, and optimal nutritional content. Vegetarian women can successfully breast-feed, and studies published in the European Journal of Clinical Nutrition in 1992 and The New England Journal of Medicine in 1981 demonstrated that their milk is lower in pesticides than the milk of women who follow conventional diets. Breast-feeding women should ensure that their diet is balanced and that they get enough vitamin B12, urges Mangels. The American Academy of Pediatrics now recommends that all infants and children have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The iron in breast milk is adequate for the first four to six months, but recommendations from the American Academy of Family Physicians call for iron supplements (1 mg/kg/day) beginning at 4 to 6 months of age to ensure infants get sufficient iron. Breast-fed infants may require supplemental fluoride after six months if water intake is low or if a physician prescribes supplements.

Soy-based (or cow’s milk-based, for lacto vegetarians) infant formulas that support normal growth and development are available for women who do not breast-feed or who 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 reading the ingredient list is important. Soy milk, rice milk, and homemade formulas should not replace breast milk or commercial infant formula during the first year because they may not contain the proper ratio of protein, fat, and carbohydrate and they do not have enough of the essential vitamins and minerals to be used as a key part of the diet during the first year, says Mangels.

According to the ADA’s recommendations, as they add foods to the breast-feeding or infant formula regimen in the middle of the first year, parents should introduce one new food at a time to identify potential allergies. Iron-fortified infant rice cereal mixed with expressed breast milk or formula is an ideal first food; it is a good source of iron, and rice cereal is unlikely to cause an allergic response. Parents can introduce ground oats, barley, corn, and other grains that are cooked until they are very soft and smooth one at a time, but they should continue iron supplements since these grains are low in iron. They can offer the infant mashed or puréed vegetables and fruits and fruit juice next in the progression of foods. As the baby becomes more interested in chewing, parents can add grain foods such as soft, cooked pasta or rice, soft breads, dry cereals, and crackers. At 7 to 8 months, infants can try protein sources such as well-mashed, cooked beans, mashed tofu, and soy yogurt. Parents can add smooth nut and seed butters spread on bread or crackers after the baby’s first birthday.

Commercially prepared baby foods are also available for vegetarian and vegan infants, but parents should read labels to identify ingredients. Many parents of vegetarian infants prepare their own baby foods for better control and variety. They should wash these foods and ingredients well, cook them thoroughly, blend or mash to the appropriate consistency, and store safely. Since breast milk is a rich source of important nutrients, vegetarian and vegan infants should breast-feed (or use infant formula) for at least one year—up to 24 months is even more desirable—as children transition to solids. The infant should be weaned to fortified soy milk containing calcium, vitamin B12, and vitamin D. Low-fat or nonfat soy milks should not be used prior to the age of 2. Rice milks are not recommended as a primary beverage for infants and toddlers because they are low in protein and calories. During the vegetarian and vegan toddler years (ages 1 to 3), it’s important to focus on a variety of nutrient-dense foods and ensure adequate intake of calories, protein, fat, calcium, vitamin D, iron, vitamin B12, and zinc.

Kids Can Reap the Benefits
A big bonus for living la vida vegetarian is enjoying all of the documented health benefits that vegetarians tend to experience. According to the ADA position statement, vegetarian diets are often associated with a number of health advantages in adults, including lower blood cholesterol levels, lower risk of heart disease, lower blood pressure levels, and lower risk of hypertension and type 2 diabetes. Vegetarians also tend to have a lower body mass index (BMI) and lower overall cancer rates. Vegetarian diets are usually lower in saturated fat and cholesterol and have higher levels of dietary fiber, magnesium, potassium, vitamins C and E, folate, carotenoids, flavonoids, and other phytochemicals.

With today’s focus on the devastating impact of obesity, which is affecting children at even younger ages, the vegetarian lifestyle is taking on new meaning as a lifelong approach to better health. Aronson stresses that 90% of overweight kids already have at least one avoidable risk factor for heart disease (eg, high cholesterol, hypertension) and that the process of atherosclerosis begins in childhood, with significant damage observed by the age of 2.

“There are not a lot of recent studies of vegetarian children, so it’s difficult to generalize about their weight status. We do know that vegetarian adults have mean BMIs that are lower than nonvegetarian adults. This could suggest that if a child continues to be vegetarian throughout life, he or she will typically have a lower risk of overweight and obesity. A recent study in Taiwan did find that vegetarian children were at lower risk for excess weight than their nonvegetarian peers,” reports Mangels.

While some data suggest that vegetarian children (as well as adults) tend to have lower obesity rates than their omnivorous peers, as noted in the ADA position statement on vegetarian diets, it’s important to consider that some vegetarian kids are overweight and show signs of diet-related risk factors such as diabetes and high cholesterol. It’s possible for vegetarian children to be overdependent on junk foods and sugary beverages. The bottom line is that modern vegetarian kids can have the same challenges as modern nonvegetarian kids.

“There is no question that a balanced vegetarian diet throughout the life span offers significant health benefits over the standard American diet,” says Aronson. “However, one need not go 100% vegetarian to reap these benefits; moving more towards a whole, plant-based diet is key. Including multiple daily servings of vegetables, fruits, whole grains, beans, nuts, and seeds in age-appropriate forms is what protects us against illness and disease.”

Offer Parents Knowledge and Support
With an increasing interest in vegetarianism on the horizon, dietitians may benefit from becoming well versed on the issues, concerns, and benefits of this lifestyle for children.

“We must help our clients realize that the absence of meat alone does not ensure a health-supporting diet,” stresses Aronson. “It is possible to design a very poor meatless diet that offers no benefit over the accepted diet of so many of today’s children, such as a diet limited to a few staples like cereal, chicken nuggets, pizza, and macaroni and cheese. This is an example of a very poor diet, but this seems to be the standard among many American youths. We can do better.”

“The point is that it’s not only about what the diet excludes; it’s more about what the diet includes,” she continues. “Vegetarian to some implies exclusion. And while some people do completely exclude animal products from their diets, others have discovered that basing the diet on fresh plants and using animal products more as a condiment than a base is a very satisfying and healthful approach towards optimal health.”

While the path to vegetarianism can veer off in many directions, one thing’s for sure: Who can better guide parents along that path than a dietitian?

— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and freelance food and nutrition writer in southern California.

 

Vegetarian Resources
• 2009 Position of the American Dietetic Association: Vegetarian Diets, www.eatright.org/about/content.aspx?id=8357

• A Dietitian’s Guide to Vegetarian Diets, www.vegnutrition.com

• Raising Vegetarian Children by Joanne Stepaniak, MSEd, and Vesanto Melina, MS, RD

• Vegetarian Nutrition Dietetic Practice Group, www.vegetariannutrition.net

• The Vegetarian Resource Group, www.vrg.org

• Vegetarian Times, www.vegetariantimes.com

• VegFamily Magazine, www.vegfamily.com

• The Veggie Queen, www.theveggiequeen.com

 

Feeding Schedule for Vegan Babies Ages 6-12 Months
	6 mos	6-8 mos*	7-10 mos	10-12 mos
MILK	Breast milk or soy formula.	Breast milk or soy formula.	Breast milk or soy formula.	Breast milk or soy formula (24-32 ounces).
CEREAL & BREAD	Begin iron-fortified baby cereal mixed with milk.	Continue baby cereal. Begin other breads and cereals.	Baby cereal. Other breads and cereals	Baby cereal until 18 mos. Total of 4 svgs (1 svg=1/4 slice bread or 2-4 TB cereal).
FRUITS & VEGETABLES	None	Begin juice from cup: 2-4 oz vit C source. Begin mashed vegetables & fruits.	4 oz juice. Pieces of soft/cooked fruits & vegetables.	Table-food diet. Allow 4 svgs per day (1 svg = 2-4 TB fruit & vegetable, 4 oz juice).
LEGUMES & NUT BUTTERS	None	None	Gradually introduce tofu. Begin casseroles, pureed legumes, soy cheese, & soy yogurt.	2 svgs daily each about 1/2 oz. Nut butters should not be started before 1 year.

*Overlap of ages occurs because of varying rate of development.
— Table used with permission from Reed Mangels, PhD, RD, LDN, FADA, Vegetarian Resource Group

Diet Plans for Vegan Children
TODDLERS AND PRESCHOOLERS (AGE 1-3)
FOOD GROUP	NUMBER OF SERVINGS
GRAINS	6 or more (a serving is 1/2 to 1 slice of bread, 1/4 to 1/2 cup cooked cereal or grain or pasta, or 1/2 to 1 cup ready-to-eat cereal)
LEGUMES, NUTS, SEEDS	2 or more (a serving is 1/4 to 1/2 cup cooked beans, tofu, tempeh, or TVP; 1-1/2 to 3 ounce of meat analogue; or 1 to 2 Tbsp. nuts, seeds, nut or seed butter)
FORTIFIED SOYMILK, ETC	3 (a serving is 1 cup fortified soymilk, infant formula, or breast milk)
VEGETABLES	2 or more (a serving is 1/4 to 1/2 cup cooked or 1/2 to 1 cup raw vegetables)
FRUITS	3 or more (a serving is 1/4 to 1/2 cup canned fruit, or 1/2 cup juice, or 1 medium fruit)
FATS	3 (1 tsp. margarine or oil) (use 1/2 tsp. flaxseed oil or 2 tsp. canola oil daily to supply omega-3 fatty acids)

Notes: Serving sizes vary depending on the child’s age.
— Table used with permission from Reed Mangels, PhD, RD, LDN, FADA, Vegetarian Resource Group