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March 2010 Issue No Meat, No Problem — Vegetarian Diets Can Support Optimal Health for Infants and Children 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 Plant-Based Eating Gets Popular 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 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 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 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 “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 • 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
*Overlap of ages occurs because of varying rate of development.
Notes: Serving sizes vary depending on the child’s age. |
     
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