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<如何养育健康聪明的维根宝宝>
http://www.vrg.org/nutshell/kids.htm
Feeding Vegan Kids
by Reed Mangels, Ph.D., R.D.
Manymembers
of The Vegetarian Resource Group are glowing testimony to the fact
thatvegan children can be healthy, grow normally, be extremely active,
and (wethink) smarter than average. Of course it takes time and thought
to feed veganchildren. Shouldn't feeding of any child require time and
thought? After all,the years from birth to adolescence are the years
when eating habits are set,when growth rate is high, and to a large
extent, when the size of stores ofessential nutrients such as calcium
and iron are determined.
Theearliest
food for a vegan baby is ideally breast milk. Many benefits to
theinfant are conveyed by breast feeding including some enhancement of
the immunesystem, protection against infection, and reduced risk of
allergies. Inaddition, breast milk was designed for baby humans and
quite probably containssubstances needed by growing infants which are
not even known to be essentialand are not included in infant formulas.
Manybooks
on infant care have sections on techniques and timing of breast
feeding,and we suggest that you refer to one of these for more
information. Beforewarned that the books may discourage vegetarianism.
They are wrong. With alittle attention to detail, vegetarianism and
breast feeding are a goodcombination. In fact, several reports show that
milk of vegetarian women islower in pesticides than the milk of women
eating typical American diets (1,2).
If
youchoose to breast feed, be sure to see the preceding section on
lactation tomake sure that your milk is adequate for your child. Be
especially careful thatyou are getting enough vitamin B-12. If your diet
does not contain reliablesources of vitamin B-12, your breastfed
infants should receive supplements of0.4-0.5 micrograms of vitamin B-12
daily.
See
thatyour infant receives at least 30 minutes of sunlight exposure per
week ifwearing only a diaper or 2 hours per week fully clothed without a
hat tomaintain normal vitamin D levels (3). Dark-skinned infants
require greatersunshine exposure. If sunlight exposure is limited, due
to factors like acloudy climate, winter, or being dark-skinned, infants
who are solely breastfedshould receive vitamin D supplements of at least
10 micrograms (400 IU) per day(4). Vitamin D deficiency leads to
rickets (soft, improperly mineralizedbones). Human milk contains only
very low levels of vitamin D.
The
ironcontent of breast milk is generally low, no matter how good the
mother's dietis. The iron which is in breast milk is readily absorbed by
the infant,however. The iron in breast milk is adequate for the first 4
to 6 months orlonger. Recommendations call for use of iron supplements
(1 mg/kg/day)beginning at 4-6 months to insure adequate iron intake.
Breast fed infants mayrequire supplemental fluoride after 6 months if
water intake is low and ifsupplements are prescribed by a dentist or
pediatrician.
If
forany reason you choose not to breast feed or if you are using formula
tosupplement breast feeding, there are several soy-based formulas
available.These products support normal infant growth and development
(5). Soy-basedformulas are used by vegan families as the best option
when breast feeding isnot possible. At this time all soy formulas
contain vitamin D derived fromlanolin (sheep's wool). Some soy-based
formulas (such as Parent's Choice ® andsome store brands) may contain
animal- derived fats so check the ingredientlabel. Soy formulas are used
exclusively for the first six months.
Soy
milk,rice milk, and homemade formulas should not be used to replace
breast milk orcommercial infant formula during the first year. These
foods do not contain theproper ratio of protein, fat, and carbohydrate,
nor do they have enough of manyvitamins and minerals to be used as a
significant part of the diet in the firstyear.
Supplementalfood
(food besides breast milk and formula) can be started at different
timesin different children depending on the child's rate of growth and
stage ofdevelopment but are usually begun somewhere in the middle of the
first year.Some signs of the time to start introducing solid foods are:
the ability to situnsupported, disappearance of the tongue extrusion
reflex, increased interestin foods others are eating, and an ability to
pick up food and put it in themouth.
Introduceone
new food at a time so that any source of allergies can be later
identified.Many people use iron-fortified infant rice cereal as the
first food. This is agood choice as it is a good source of iron and rice
cereal is least likely tocause an allergic response. Cereal can be
mixed with expressed breast milk orsoy formula so the consistency is
fairly thin. Formula or breast milk feedingsshould continue as usual.
Start with one cereal feeding daily and work up to 2meals daily or 1/3
to 1/2 cup. Oats, barley, corn, and other grains can beground in a
blender and then cooked until very soft and smooth. These cerealscan be
introduced one at a time. However, they do not contain much iron, soiron
supplements should be continued.
Whencereals
are well accepted, fruit, fruit juice, and vegetables can beintroduced.
Fruits and vegetables should be well mashed or puréed. Mashedbanana is
one food that many infants especially enjoy. Other fruits includemashed
avocado, applesauce, and puréed canned peaches or pears. Citrus
fruitsand juices are common allergens and should not be introduced until
the first birthday.Mild vegetables such as potatoes, carrots, peas,
sweet potatoes, and greenbeans should be cooked well and mashed. There
is no need to add spices, sugar,or salt to cereals, fruits, and
vegetables. Grain foods such as soft, cookedpasta or rice, soft breads,
dry cereals, and crackers can be introduced as thebaby becomes more
adept at chewing. By age 7-8 months, good sources of proteincan be
introduced. These include well-mashed cooked dried beans, mashed
tofu,and, soy yogurt. Children should progress from mashed or pureed
foods to piecesof soft food. Smooth nut and seed butters can be used to
make sauces or dips.To avoid choking, nut and seed butters should not be
spread on bread orcrackers or given to babies by the spoonful until
after the first birthday.
Manyparents
choose to use commercially prepared baby foods. There are
productsavailable for vegan infants. Careful label reading is
recommended. Sincecommercial products contain limited selections for the
older vegan infant, manyparents opt to prepare their own baby foods.
Foods should be well washed,cooked thoroughly, and blended or mashed to
appropriate consistency.Home-prepared foods can be kept in the
refrigerator for up to 2 days or frozenin small quantities for later
use.
By 10-12months, most children will be eating at least the amounts of foods shown inTable 16.
Certainlyit
makes sense for vegans to continue breast feeding for a year or longer,
ifpossible, because breast milk is a rich source of nutrients. Vegan
infants shouldbe weaned to a fortified soy milk containing calcium,
vitamin B-12, and vitaminD. Low-fat or non-fat soy milks should not be
used before age 2. Milks based onrice, oats, hemp, almonds or other
nuts, and coconut are not recommended as aprimary beverage for infants
and toddlers as they are quite low in protein andenergy.
Severalstudies
have been reported showing that the growth of vegan children is
slowerthan that of non-vegans (see 6-8). Studies such as these are often
cited asevidence that vegan diets are inherently unhealthy. However,
when the studiesare examined more closely, we find that they are often
based on vegans who havevery low calorie or very limited diets (only
fruit and nuts for example). Inaddition, many vegan infants are breast
fed. Compared to formula-fed infants,breast-fed infants generally gain
weight at about the same rate for the first2-3 months and then gain
weight less rapidly from 3 to 12 months (9). Thismeans by 12 months,
breast fed infants will tend to be leaner than formula-fedinfants. The
newest growth charts are based on the growth of both formula-fedand
breast-fed infants and this should be taken into consideration
whenassessing the growth of exclusively breast-fed infants (9).
Anadditional
question that must be asked is, "What is a normal growthrate?" Growth
rate is assessed by comparing changes in a child's height,weight, and
head circumference to rates of growth that have been established
bymeasuring large numbers of apparently healthy US children. There is no
oneideal rate of growth. Instead, height, weight, and head
circumference arereported in percentiles. If your child's height is at
the 50th percentile, thismeans that 50% of children of that age are
taller and 50% are shorter.Similarly, a weight at the 25th percentile
means 25% of children weigh less and75% weigh more.
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Table 16: Feeding Schedule For Vegan Babies Ages 6-12 Months
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6 mos
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6-8 mos*
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7-10 mos
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10-12 mos
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MILK
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Breast milk or soy formula.
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Breast milk or soy formula.
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Breast milk or soy formula.
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Breast milk or soy formula (24-32 ounces).
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CEREAL & BREAD
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Begin iron-fortified baby cereal mixed with milk.
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Continue baby cereal. Begin other breads and cereals.
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Baby cereal. Other breads and cereals.
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Baby cereal until 18 mos. Total of 4 svgs (1 svg=1/4 slice bread or 2-4 TB cereal).
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FRUITS & VEGETABLES
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None
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Begin juice from cup: 2-4 oz vit C source. Begin mashed vegetables & fruits.
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4 oz juice. Pieces of soft/cooked fruits & vegetables.
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Table-food diet. Allow 4 svgs per day (1 svg=2-4 TB fruit & vegetable, 4 oz juice).
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LEGUMES & NUT BUTTERS
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None
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None
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Gradually introduce tofu. Begin casseroles, pureed legumes, soy cheese, & soy yogurt.
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2 svgs daily each about 1/2 oz.
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*Overlapof ages occurs because of varying rate of development.
Whilesome
studies show that vegan children are at a lower percentile of weight
andheight than are other children of a similar age, a recent study shows
thatvegan children can have growth rates which do not differ from those
ofomnivorous children of the same age (10). At this time we cannot say
that achild growing at the 25th percentile is any more or less healthy
than a childgrowing at the 75th percentile. What seems to be more
important is that thechild stays at about the same percentile. For
example, a child who is at the50th percentile for height at age 2 and
only at the 25th percentile at age 3has had a faltering in growth rate.
The cause of this faltering should bedetermined. In addition, children
at extremes (5th percentile or lower or 85thpercentile or higher) should
be individually assessed by their health careprovider.
The
bestway to assure that your children achieve their ideal rate of growth
is to makesure that they have adequate calories. Some vegan children
have difficultygetting enough calories because of the sheer bulk of
their diets. Children havesmall stomachs and can become full before they
have eaten enough food tosustain growth. The judicious use of fats in
forms like avocados, nuts, nutbutters, seeds, and seed butters will
provide a concentrated source of caloriesneeded by many vegan children.
Dried fruits are also a concentrated caloriesource and are an attractive
food for many children. Teeth should be brushedafter eating dried
fruits to prevent tooth decay.
Are
verylow fat diets appropriate for children? Some parents wish to reduce
theirchildren's risk of developing heart disease later in life and
markedly restrictthe fat in the children's diets (10 to 15 percent of
calories from fat). Insome cases, a very low fat diet can compromise a
child's growth because thechild is not getting enough calories. There is
no evidence that a very low fatdiet is any healthier for a vegan child
than a diet which has somewhat more fat(25 to 35 percent of calories
from fat). Fat should not be limited for infantsless than 2 years. It
should be between 30 and 40% of calories for 2 to 3 yearolds, and
between 25 and 35% of calories for children and teens (11). If youare
using a lower fat diet than this, check that the child's growth is
normaland that the child is eating enough food to meet nutrient needs.
Diets
ofyoung children should not be overly high in fiber since this may
limit theamount of food they can eat. The fiber content of a vegan
child's diet can bereduced by giving the child some refined grain products, fruit juices,and peeled vegetables.
Sourcesof
protein for vegan children include legumes, grains, tofu, tempeh,
soymilk,nuts, peanut butter, tahini, soy hot dogs, soy yogurt, and
veggie burgers. Someof these foods should be used daily. Children should
get enough calories sothat protein can be used for growth in addition
to meeting energy needs.
Table 17shows one diet plan that has been used successfully by vegan children (adaptedfrom 12).
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Table 17: Diet Plans for Vegan Children
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TODDLERS AND PRESCHOOLERS (AGE 1-3)
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FOOD GROUP
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NUMBER OF SERVINGS
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GRAINS
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6
or more (a serving is 1/2 to 1 slice of bread or 1/4 to 1/2 cup cooked
cereal or grain or pasta or 1/2 to 3/4 cup ready-to-eat cereal)
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LEGUMES, NUTS, SEEDS
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2
or more (a serving is 1/4 to 1/2 cup cooked beans, tofu, tempeh or
TVP; or 1-1/2 to 3 ounces of meat analogue; or 1 to 2 Tbsp. nuts,
seeds, nut or seed butter
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FORTIFIED SOYMILK, ETC
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3 (a serving is 1 cup fortified soymilk, infant formula, or breast milk)
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VEGETABLES
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2 or more (a serving is 1/4 to 1/2 cup cooked or 1/2 to 1 cup raw vegetables)
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FRUITS
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3 or more (a serving is 1/4 to 1/2 cup canned fruit or 1/2 cup juice, or 1 medium fruit)
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FATS
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3 (1 tsp. margarine or oil) (use 1/2 tsp. flaxseed oil or 2 tsp. canola oil daily to supply omega-3 fatty acids)
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CHILDREN (AGE 4-13)
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FOOD GROUP
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NUMBER OF SERVINGS
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GRAINS
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8 or more for 4 to 8 yr olds; 10 or more for 9 to 13 yr olds
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PROTEIN FOODS
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5 or more for 4 to 8 yr olds; 6 or more for 9 to 13 yr olds
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VEGETABLES
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4 or more
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FRUITS
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2 or more
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FATS
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2 or more for 4 to 8 yr olds; 3 or more for 9 to 13 yr olds
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OMEGA-3 FATS
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1 per day
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STARRED FOOD ITEMS
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6 or more for 4 to 8 yr olds; 10 or more for 9 to 13 yr olds
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Adaptedfrom (12).
Notes:Serving sizes vary depending on the child's age.
Thecalorie
content of the diet can be increased by greater amounts of nut
butters,dried fruits, soy products, and other high calorie foods.
A
regularsource of vitamin B-12 like Vegetarian Support Formula
nutritional yeast,vitamin B-12-fortified soymilk, vitamin B-12-fortified
breakfast cereal,vitamin B-12-fortifed meat analogue, or vitamin B-12
supplements should beused.
Adequateexposure
to sunlight, 20 to 30 minutes of summer sun on hands and face two
tothree times a week, is recommended to promote vitamin D synthesis (3,
4). Ifsunlight exposure is limited, dietary or supplemental vitamin D
should be used.
Althoughtoday
more and more children are vegan from birth, many older children
alsobecome vegan. There are many ways to make a transition from a
non-vegan to avegan diet. Some families gradually eliminate dairy
products and eggs, whileothers make a more abrupt transition. Regardless
of which approach you choose,be sure to explain to your child what is
going on and why, at your child'slevel. Offer foods that look familiar,
at first. Peanut butter sandwiches seemto be universally popular
(beware: some kids are allergic to peanut butter) andmany children like
pasta or tacos. Gradually introduce new foods. Watch yourchild's weight
closely. If weight loss occurs or the child doesn't seem to begrowing as
rapidly, add more concentrated calories and reduce the fiber in
yourchild's diet.
Teenage Vegans
Teenagevegans
have nutritional needs that are the same as any other teenager.
Theyears between 13 and 19 are times of especially rapid growth and
change.Nutritional needs are high during these years. The teenage vegan
should followthe same recommendations that are made for all vegans,
namely to eat a widevariety of foods, including fruits, vegetables,
plenty of leafy greens, wholegrain products, nuts, seeds, and legumes.
The nutrients teenage vegans shouldbe aware are of protein, calcium,
iron, and vitamin B12.
Therecommendation
for protein is 0.43 grams per pound of weight for 11-13 yearolds and
0.4 grams per pound for 14-18 year olds (13). Those
exercisingstrenuously (marathon runners, for example) may need slightly
moreprotein. A 16 year old who weighs 120 pounds, needs about 48 grams
of proteindaily. In terms of food, 1 cup of cooked dried beans has 12
grams of protein, acup of soy milk or soy yogurt has 7 grams, 4 ounces
of tofu has 9 grams, atablespoon of peanut butter or peanuts has 4
grams, and 1 slice of bread or 1cup of grain has about 3 grams.
Fruits,fats,
and alcohol do not provide much protein, and so a diet based only
onthese foods would have a good chance of being too low in protein.
Vegans eatingvaried diets containing vegetables, beans, grains, nuts,
and seeds rarely haveany difficulty getting enough protein as long as
their diet contains enoughenergy (calories) to support growth. There is
no need to take proteinsupplements. There is no health benefit to eating
a very high protein diet andit will not help in muscle building.
Duringadolescence,
calcium is used to build bones. The density of bones is determinedin
adolescence and young adulthood, and so it is important to include three
ormore good sources of calcium in a teenager's diet every day.
Cow'smilk
and dairy products do contain calcium. However, there are other
goodsources of calcium such as tofu processed with calcium sulfate,
green leafyvegetables including collard greens, mustard greens, and
kale, as well astahini (sesame butter), fortified soymilk, and fortified
orange juice.
By
eatinga varied diet, a vegan can meet his or her iron needs, while
avoiding theexcess fat and cholesterol found in red meats such as beef
or pork. To increasethe amount of iron absorbed from a meal, eat a food
containing vitamin C aspart of the meal. Citrus fruits and juices,
tomatoes, and broccoli are all goodsources of vitamin C. Foods that are
high in iron include broccoli, watermelon,spinach, black-eyed peas,
blackstrap molasses, chickpeas, and pinto beans.
It
isimportant to consume adequate vitamin B12 during adolescence. Vitamin
B12 isnot found in plants. Some cereals have vitamin B12 (check the
label). Red StarVegetarian Support Formula nutritional yeast supplies
vitamin B12.
Manyteenagers
are concerned with losing or gaining weight. To lose weight, look atthe
diet. If it has lots of sweet or fatty foods, replace them with
fruits,vegetables, grains, and legumes. If a diet already seems healthy,
increasedexercise -- walking, running or swimming daily -- can help
control weight. Togain weight, more calories are needed. Perhaps eating
more often or eatingfoods somewhat higher in fat and lower in bulk will
help. Try to eat three ormore times a day whether you are trying to gain
weight or lose weight. It ishard to get all of the nutritious foods you
need if you only eat one meal aday. If you feel that you cannot control
your eating behavior or if you arelosing a great deal of weight, you
should discuss this with your health careprovider.
Oftenthere
is just not enough time to eat. Below are some foods that kids can eat
onthe run. Some of these foods can be found in fast-food restaurants --
check themenu. Ideas for snacks that you can carry from home include:
Apples,oranges,
bananas, grapes, peaches, plums, dried fruits, bagels and peanutbutter,
carrot or celery sticks, popcorn, pretzels, soy cheese pizza, beantacos
or burritos, salad, soy yogurt, soymilk, rice cakes, sandwiches,
frozenjuice bars.
References
1.Dagnelie
PC, van Staveren WA, Roos AH, et al. Nutrients and contaminants inhuman
milk from mothers on macrobiotic and omnivorous diets. Eur J Clin Nutr1992; 46: 355-366.
2.Hergenrather J, Hlady G, Wallace B, et al. Pollutants in breast milk of vegetarians.N Engl J Med. 1981; 304: 792 (letter).
3.Specker
BL, Valanis B, Hertzberg V, et al. Sunshine exposure and
serum25-hydroxyvitamin D concentrations in exclusively breast-fed
infants. JPediatrics 1985; 107: 372-376.
4.
WagnerCL, Greer FR; American Academy of Pediatrics Section on
Breastfeeding; AmericanAcademy of Pediatrics Committee on Nutrition.
Prevention of rickets adn vitaminD deficiency in infants, children, and
adolescents.Pediatrics.2008;122:1142-52.
5.Committee on Nutrition, American Academy of Pediatrics. Soy protein-basedformulas: Recommendations for use in infant feeding. Pediatrics 1998;101: 148-153.
6. FultonJR, Hutton CW, Stitt KR: Preschool vegetarian children. J Am Diet Assoc1980; 76: 360-365.
7.Sanders TAB and Purves R: An anthropometric and dietary assessment of thenutritional status of vegan pre-school children. J Hum Nutr 1981; 35:349-357.
8.Shinwell ED and Gorodischer R: Totally vegetarian diets and infant nutrition. Pediatrics1982; 70: 582-586.
9.Centers for Deisease Control. Growth Charts, 2000.http://www.cdc.gov/growthcharts/ Accessed October 3, 2005.
10.O'Connell JM, Dibley MJ, Sierra J et al: Growth of vegetarian children: TheFarm study. Pediatrics1989; 84: 475-481.
11. Foodand Nutrition Board, Institute of Medicine. Dietary Reference Intakes forEnergy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and AminoAcids. Washington, DC: National Academy Press, 2002.
12.Mangels R, Messina V, Messina M.The Dietitian's Guide to Vegetarian Diets,3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2011.
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This chapter appears in the fourth edition of Simply Vegan by Debra Wasserman. Nutrition section by Reed Mangels Ph.D., R.D.
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