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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.
*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).
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.
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.
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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.
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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.