The Vegan Diet for Infants and Children
Reed Mangels, PhD, RD
Sandra Hood, BSc (Hons), SRD
It takes time and thought to feed infants and children, and all parents should think carefully about what their children eat. The years from birth to adolescence are when eating habits are set, when growth rates are high, and to a large extent when the size of stores of essential nutrients such as calcium are determined. This article will examine the health benefits of vegan diets for children, address potential concerns, present information on key nutrients and provide guidelines for feeding vegan infants and children.
The number of vegans in the UK today is estimated at 0.5%(1) but we do not know how many of these are children. In the US, a poll commissioned by the Vegetarian Resource Group in the year 2000 found that about 0.5% of 6 to 17-year-olds were vegan and did not eat meat, fish, poultry, dairy products or eggs (2).
Health Benefits of Vegan Diets
Several studies have examined the nutrient intakes of vegan children. One study of British school-age children found that they had higher intakes of fibre and that intakes of all vitamins and minerals studied (with the exception of calcium) were comparable with those of meat-eating children (3). Vegan pre-schoolers in the US were found to have generous intakes of protein, vitamins, and minerals and their diets exceeded recommended intakes for all nutrients studied with the exception of calcium (4).
The study showing lower calcium intakes by vegan pre-schoolers was conducted before calcium-fortified products were readily available, so calcium intakes of vegan children may be higher now. Calcium is important for bone development. Around 45% of adult bone mass is accrued before 8 years of age, another 45% is added between 8-16 years of age and a further 10% accumulates in the next decade. Given the importance of calcium intake during childhood, all parents should ensure that their children’s diets contain calcium-rich foods and meet current recommendations for calcium for their age group.
Regrettably, there have been few recent studies looking at the long-term effects of a vegan diet*, especially as it is believed that the foundations for many chronic diseases of adulthood have their beginnings in childhood. For instance, processes initiating atherosclerosis and high blood pressure are thought to start very early in life, and blood pressure and cholesterol levels have been shown to track from early childhood and to be related to childhood nutrient intakes (5,6). Body mass also tracks from early childhood, with obese children being at an increased risk of obesity in adulthood (7)
When we look at potential long-term health benefits of vegan diets, we find that vegan children have higher intakes of fruits and vegetables, foods that are important for health. Vegan children have been shown to have lower intakes of fat, saturated fat, and cholesterol than non-vegetarian children (9-10). This may be important in reducing the risk of developing chronic diseases such as heart disease and obesity. Finally, vegan diets may introduce children to a greater variety of whole plant foods, thus establishing healthful lifelong eating habits.
Up to the age of four to six months, the diets of many infants of vegan and of non-vegan parents are identical. The perfect food for the young infant is breast milk and supplementary foods should not be introduced until after four to six months of age. Breast-fed infants of well nourished vegan women tend to grow and develop normally(11). The infant receives many benefits from breast feeding, including some immune system enhancement, protection against infection, and reduced risk of allergies(12). Moreover, as human breast milk is the natural food for baby humans it also probably contains substances needed by growing infants which are not even known to be essential and are not included in infant formulas. Meanwhile, nursing mothers derive benefits such as reduced risk of premenopausal breast cancer, release of stress-relieving hormones and, for some, sheer convenience (12). For all these reasons, we strongly encourage breast feeding.
Vitamin B12 and vitamin D are key nutrients for a young infant being exclusively breast fed by a vegan woman. Mothers whose diets contain little or no vitamin B12 will produce milk with very low levels of vitamin B12 (13). As this vitamin is important for the developing nervous system, it is crucial for the infant to have a reliable source of vitamin B12. Some vegan women opt to use a vitamin B12 supplement while others rely on fortified foods such as some breakfast cereals, fortified yeast extracts, non-dairy milks and some soya products in order to meet both their own and their baby’s need for vitamin B12. If the mother’s diet does not contain a reliable daily source of vitamin B12, the child itself should receive a daily source of vitamin B12.
The vitamin D content of breast milk varies with the mother’s diet and her sun exposure, although vitamin D levels in breast milk are usually quite low. All children below three years of age have a high requirement for vitamin D to enable calcium deposition in bone. The Department of Health therefore recommends that vitamin drops containing vitamins A, C and D be used for all children from 6 months to 5 years of age, whether vegan, vegetarian or omnivore. [Note that Healthy Start vitamin drops for children and Health Start vitamins for women contain vitamin D3 and are not suitable for vegans.]
Readers may also have heard of docosahexaenoic acid or DHA, a fatty acid which appears to be important for eye and brain development and is found primarily in animal foods. However, vegans can make DHA from another fatty acid called alpha-linolenic acid, which will be contained in the breast milk if the mother’s diet includes good sources such as flaxseed oil, ground flaxseed and rapeseed oil. Reducing the use of other oils such as corn oil, sunflower oil, and safflower oil and limiting foods containing hydrogenated fats will also help the breast fed infant to make more DHA. These oils contain linoleic acid and hydrogenated fats contain trans-fatty acids which interfere with DHA production.
Unfortunately there is currently no infant formula available which is suitable for vegans. There are soya formulas on the market, but these are not vegan as they are fortified with vitamin D3, which is made from lanolin (a grease produced by sheep’s skin and extracted from their wool). The vegan-suitable formula which was previously available, Heinz Nurture Soya (formerly Farley’s Soya), is no longer manufactured as Heinz no longer produce any infant formulas. On no account should soya milk, nut milk, rice milk, oat milk, pea milk or other home-prepared “formulas” be used as these do not contain the appropriate ratio of nutrients and can lead to potentially life-threatening conditions.
Introduction of Solid Foods
Solid foods should not be introduced before 4 months of age. Try to introduce one new food at a time, waiting 2 to 3 days before trying another. It is then easier to identify which food is responsible if any untoward reaction occurs.
First weaning foods may include rice based dishes, pureed and sieved fruits such as banana, pear and apple, and vegetables such as carrot, potato and spinach. At 6 months of age, wheat and oat based cereals can be introduced. Foods containing generous amounts of protein such as mashed cooked pulses, mashed tofu and soya yogurt are generally introduced at around 7 to 8 months of age. Children should progress from mashed or pureed foods to pieces of soft food. Smooth nut and seed butters spread on bread or crackers can be introduced after the first birthday. In an atopic family, where there is a history of allergies, peanuts and nuts should be avoided until the child is at least 3 years of age (14) to allow the gut to mature and the immune system to develop fully.
As solid foods become a larger part of the diet, consideration should be given to foods which provide concentrated sources of calories and nutrients. These include mashed firm tofu, bean spreads, mashed avocado and cooked dried fruits. Frequent meals and snacks help to ensure adequate energy intakes. The fat intake of healthy infants should not be restricted, and sources such as vegetable oils or soft vegan margarine should be included in the older infant's diet.
To minimize the risk of choking, foods such as whole nuts, crunchy nut butters, vegan hot dogs, large chunks of hard raw fruits and vegetables, whole grapes, hard sweets, and popcorn should not be fed to infants and children younger than 3. However, chopping the nuts, slicing the hot dogs and halving the grapes can reduce the risk and allow such foods to be eaten by toddlers age 1-3 years. Corn syrup and honey (the latter is always avoided by vegans in the UK anyway) should not be given to infants younger than one year because of the risk of botulism, a form of food poisoning.
A note on nuts. The American Academy of Pediatrics does not recommend any sort of nut butters for children under 3 years. In families where there is a history of allergy, eczema or asthma, it is recommended that peanuts and peanut products be delayed until the child is at least 3 years old. Other children may have peanuts and tree nuts of a suitable texture, such as smooth nut butter, from the age of 6 months or when weaned, but not before 4 months. In the UK, it is recommended that peanuts be avoided by pregnant or breastfeeding women if there is a history of allergies. It is suggested that women who are atopic, or where the father or any sibling has atopic disease, may wish to avoid peanuts in their diet to reduce the risk of their children developing peanut allergy, but this is simply precautionary as there has been no conclusive evidence.
Many parents choose to use commercially prepared baby foods and there are some products suitable for vegan infants, though careful label reading is recommended. As there is only a limited selection of commercial products for the older vegan infant, many parents opt to prepare their own baby foods. Foods should be well washed, cooked thoroughly and blended or mashed to an appropriate consistency. Home prepared foods can be kept in the refrigerator for up to 2 days or frozen in small quantities for later use.
By 6 months of age, iron stores in omnivorous, vegetarian and vegan infants will become depleted and it is important that iron-rich foods are included in the diet. Iron-fortified infant cereals are a good way to supply iron to vegan infants Other good sources include whole grains, pulses, green leafy vegetables and dried fruits. To enhance iron absorption, add a source of vitamin C such as green leafy vegetables, citrus fruits, blackcurrants or orange juice to the meal.
For the non-vegan child, cow's milk is typically introduced around age 1 year. Commercial fortified non-dairy milks can be added to the diet of vegan toddlers around the same age provided that the child is growing normally, has an appropriate weight and height for age, and is eating a variety of foods including soya products, pulses, grains, fruits and vegetables. For children with slower growth who have been weaned from breast milk, ensure that the diet is energy dense by adding some healthful oils such as olive or rapeseed oil. Choosing unflavoured varieties of non-dairy milk rather than flavours such as vanilla, cocoa, or carob can help to avoid the development of a preference for very sweet beverages by the young child.
Vegan Toddlers and Preschoolers
Toddlers and preschoolers, whether vegan or not, tend to eat less than most parents think they should. This is generally due to a developing sense of independence and a slowing in growth. While nutrient needs are also relatively lower than during infancy, an adequate diet remains important to promote growth and development. These early years are also important for developing healthy eating patterns that can establish a foundation for a healthful adult diet.
One important consideration for young vegan children is the ability to get enough calories. Young children have small stomachs and too much high fibre food may make them feel full before they get all the calories they need. Foods such as avocados, nut and seed butters, dried fruits, and soya products provide a concentrated source of calories. If necessary, the fibre content of the diet can be reduced by giving some refined grain products, fruit juices and peeled fruits and vegetables. Eating more frequent meals, including nutritious snacks, can also help to ensure adequate energy intakes.
Growth of Vegan Children
If a child’s diet contains enough calories, normal growth and development can be expected and studies of vegan children have shown that their caloric intake is close to recommended levels and similar to intakes of non-vegan children of the same age(16,17).
Vegan children in the UK and the US have been found to be slightly shorter and lighter in weight than average but appeared to be growing at a normal rate(15,16). Children need a lot of energy in relation to their size and although healthy eating should be encouraged it is important that the diet be energy dense. Including foods such as vegetable oils, avocados, seeds, nut butters and pulses can provide both calories and nutrients. Dried fruits are also a concentrated source of energy and are an attractive food for many children. Children from an early age should be encouraged to brush teeth after eating dried fruits and other sweet foods to prevent tooth decay.
Key Nutrients for Vegan Children
Protein needs can be easily met if children eat a variety of plant foods and have an adequate intake of calories. It is unnecessary to plan and complement amino acids precisely within each meal so long as children eat a variety of foods each day. Sources of protein for vegan children include pulses (peas, beans, lentils, soya), grains (wheat, oats, rice, barley, buckwheat, millet, pasta, bread), nuts, meat substitutes and nut butters.
Calcium is an important nutrient for growing bones and teeth. Good sources include fortified non-dairy milks and juices, calcium set tofu, baked beans and dark green leafy vegetables low in oxalic acid such as spring greens and kale. Calcium supplementation may be indicated in cases of inadequate dietary intake.
Children regularly exposed to sunlight under appropriate conditions (two to three times per week for about 20-30 minutes on hands and face) appear to have no dietary requirement for vitamin D. Those children who have limited exposure to sunlight or who are dark skinned and have no dietary source of vitamin D require supplements. Only a few foods naturally contain vitamin D (D3, cholecalciferol) and all of these are animal products. Vitamin D3 is usually obtained from lanolin, which is derived from sheep’s wool and therefore not acceptable to vegans. Foods fortified with a vegan source of vitamin D (D2, ergocalciferol) include margarine, some non-dairy milks and fortified breakfast cereals.
Iron deficiency anemia is the most common childhood nutritional problem and is no more likely to occur in vegan than non-vegan children(8). Good sources of iron include whole or enriched grains and grain products, iron fortified cereals, legumes, green leafy vegetables and dried fruits.
Diets of vegan and non-vegan children often contain similar amounts of zinc, though zinc from plant foods is less well absorbed as they contain phytate, which interferes with zinc absorption. Emphasising foods that are good sources of zinc and protein such as pulses and nuts can increase the amount of zinc in the diet and promote absorption. Use of yeast-leavened bread and fermented soya products such as tempeh and miso can also improve zinc absorption(8). Zinc supplements may be needed for young vegan children whose diet is based on high-phytate cereals and legumes(19). FSC and Seven Seas produce vegan vitamin and mineral supplements suitable for children.
Vegan children should use foods fortified with vitamin B12 or take vitamin B12 supplements. A variety of foods fortified with vitamin B12 are available, including some brands of vegan milk, meat substitutes, yeast extract and some breakfast cereals. Vegan Society trademark holders Quest and Vega Nutritionals produce vegan vitamin B12 supplements.
The Transition to a Vegan Diet
Although today more and more children are vegan from birth, many older children also become vegan. There are many ways to make the transition from a non-vegan to a vegan diet. Some families gradually eliminate dairy products and eggs while others make a more definite change. Regardless of which approach you choose, be sure to explain what is going on and why in a way that the child can understand. Offer foods that look familiar at first. Peanut butter sandwiches seem to be universally popular and many children like pasta or baked beans. Gradually introduce new foods. Watch your child's weight closely. Weight loss is likely at first, but if it continues or the child seems to be growing less rapidly, add more concentrated calories and reduce the amount of fibre in the diet.
What Foods are Popular with Vegan Children?
Many vegan children like:
• Bagels with nut butter or hummous
• Bean burritos or tacos
• Fresh or dried fruit
• Mashed potatoes
• Oven-cooked chips
• Pancakes and waffles
• Pasta with tomato sauce
• Peanut butter and yeast extract sandwiches
• Pizza without cheese, topped with vegetables and pulses, tofu, or fake meat
• Raw vegetables with dips
• Shakes made with soya milk and fruit
• Spaghetti with tomato sauce
• Tofu/vegetarian dogs
• Veggie burgers
Vegan diets planned in accord with current dietary recommendations can meet the nutritional needs of infants and children, give children a better start in life and help to establish lifelong healthy eating patterns.
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