Feeding Vegan Kids

by Reed Mangels, Ph.D., R.D.

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Many members of The Vegetarian Resource Group are glowing testimony to the fact that vegan children can be healthy, grow normally, be extremely active, and (we think) smarter than average. Of course it takes time and thought to feed vegan children. 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 of essential nutrients such as calcium and iron are determined.

The earliest food for a vegan baby is ideally breast milk. Many benefits to the infant are conveyed by breast feeding including some enhancement of the immune system, protection against infection, and reduced risk of allergies. In addition, breast milk was designed for baby humans and quite probably contains substances needed by growing infants which are not even known to be essential and are not included in infant formulas.

Many books 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. Be forewarned that the books may discourage vegetarianism. They are wrong. With a little attention to detail, vegetarianism and breast feeding are a good combination. In fact, several reports show that milk of vegetarian women is lower in pesticides than the milk of women eating typical American diets (1,2).

If you choose to breast feed, be sure to see the preceding section on lactation to make sure that your milk is adequate for your child. Be especially careful that you are getting enough vitamin B-12. If your diet does not contain reliable sources of vitamin B-12, your breastfed infants should receive supplements of 0.4-0.5 micrograms of vitamin B-12 daily.

See that your infant receives at least 30 minutes of sunlight exposure per week if wearing only a diaper or 2 hours per week fully clothed without a hat to maintain normal vitamin D levels (3). Dark-skinned infants require greater sunshine exposure. If sunlight exposure is limited, due to factors like a cloudy climate, winter, or being dark-skinned, infants who are solely breastfed should receive vitamin D supplements of at least 10 micrograms (400 IU) per day (4). Vitamin D deficiency leads to rickets (soft, improperly mineralized bones). Human milk contains only very low levels of vitamin D.

The iron content of breast milk is generally low, no matter how good the mother's diet is. 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 or longer. Recommendations call for use of iron supplements (1 mg/kg/day) beginning at 4-6 months to insure adequate iron intake. Breast fed infants may require supplemental fluoride after 6 months if water intake is low and if supplements are prescribed by a dentist or pediatrician.

If for any reason you choose not to breast feed or if you are using formula to supplement breast feeding, there are several soy-based formulas available. These products support normal infant growth and development (5). Soy-based formulas are used by vegan families as the best option when breast feeding is not possible. At this time all soy formulas contain vitamin D derived from lanolin (sheep's wool). Some soy-based formulas (such as Parent's Choice ® and some store brands) may contain animal- derived fats so check the ingredient label. 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 or commercial infant formula during the first year. These foods do not contain the proper ratio of protein, fat, and carbohydrate, nor do they have enough of many vitamins and minerals to be used as a significant part of the diet in the first year.

Supplemental food (food besides breast milk and formula) can be started at different times in different children depending on the child's rate of growth and stage of development 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 sit unsupported, disappearance of the tongue extrusion reflex, increased interest in foods others are eating, and an ability to pick up food and put it in the mouth.

Introduce one 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 a good choice as it is a good source of iron and rice cereal is least likely to cause an allergic response. Cereal can be mixed with expressed breast milk or soy formula so the consistency is fairly thin. Formula or breast milk feedings should continue as usual. Start with one cereal feeding daily and work up to 2 meals daily or 1/3 to 1/2 cup. Oats, barley, corn, and other grains can be ground in a blender and then cooked until very soft and smooth. These cereals can be introduced one at a time. However, they do not contain much iron, so iron supplements should be continued.

When cereals are well accepted, fruit, fruit juice, and vegetables can be introduced. Fruits and vegetables should be well mashed or puréed. Mashed banana is one food that many infants especially enjoy. Other fruits include mashed avocado, applesauce, and puréed canned peaches or pears. Citrus fruits and juices are common allergens and should not be introduced until the first birthday. Mild vegetables such as potatoes, carrots, peas, sweet potatoes, and green beans 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, cooked pasta or rice, soft breads, dry cereals, and crackers can be introduced as the baby becomes more adept at chewing. By age 7-8 months, good sources of protein can be introduced. These include well-mashed cooked dried beans, mashed tofu, and, soy yogurt. Children should progress from mashed or pureed foods to pieces of 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 or crackers or given to babies by the spoonful until after the first birthday.

Many parents choose to use commercially prepared baby foods. There are products available for vegan infants. Careful label reading is recommended. Since commercial products contain limited selections 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 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 10-12 months, most children will be eating at least the amounts of foods shown in Table 16.

Certainly it makes sense for vegans to continue breast feeding for a year or longer, if possible, because breast milk is a rich source of nutrients. Vegan infants should be weaned to a fortified soy milk containing calcium, vitamin B-12, and vitamin D. Low-fat or non-fat soy milks should not be used before age 2. Milks based on rice, oats, hemp, almonds or other nuts, and coconut are not recommended as a primary beverage for infants and toddlers as they are quite low in protein and energy.

Several studies have been reported showing that the growth of vegan children is slower than that of non-vegans (see 6-8). Studies such as these are often cited as evidence that vegan diets are inherently unhealthy. However, when the studies are examined more closely, we find that they are often based on vegans who have very low calorie or very limited diets (only fruit and nuts for example). In addition, many vegan infants are breast fed. Compared to formula-fed infants, breast-fed infants generally gain weight at about the same rate for the first 2-3 months and then gain weight less rapidly from 3 to 12 months (9). This means by 12 months, breast fed infants will tend to be leaner than formula-fed infants. The newest growth charts are based on the growth of both formula-fed and breast-fed infants and this should be taken into consideration when assessing the growth of exclusively breast-fed infants (9).

An additional question that must be asked is, "What is a normal growth rate?" Growth rate is assessed by comparing changes in a child's height, weight, and head circumference to rates of growth that have been established by measuring large numbers of apparently healthy US children. There is no one ideal rate of growth. Instead, height, weight, and head circumference are reported in percentiles. If your child's height is at the 50th percentile, this means 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 and 75% weigh more.

Table 16: 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.

*Overlap of ages occurs because of varying rate of development.

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While some studies show that vegan children are at a lower percentile of weight and height than are other children of a similar age, a recent study shows that vegan children can have growth rates which do not differ from those of omnivorous children of the same age (10). At this time we cannot say that a child growing at the 25th percentile is any more or less healthy than a child growing at the 75th percentile. What seems to be more important is that the child stays at about the same percentile. For example, a child who is at the 50th percentile for height at age 2 and only at the 25th percentile at age 3 has had a faltering in growth rate. The cause of this faltering should be determined. In addition, children at extremes (5th percentile or lower or 85th percentile or higher) should be individually assessed by their health care provider.

The best way to assure that your children achieve their ideal rate of growth is to make sure that they have adequate calories. Some vegan children have difficulty getting enough calories because of the sheer bulk of their diets. Children have small stomachs and can become full before they have eaten enough food to sustain growth. The judicious use of fats in forms like avocados, nuts, nut butters, seeds, and seed butters will provide a concentrated source of calories needed by many vegan children. Dried fruits are also a concentrated calorie source and are an attractive food for many children. Teeth should be brushed after eating dried fruits to prevent tooth decay.

Are very low fat diets appropriate for children? Some parents wish to reduce their children's risk of developing heart disease later in life and markedly restrict the fat in the children's diets (10 to 15 percent of calories from fat). In some cases, a very low fat diet can compromise a child's growth because the child is not getting enough calories. There is no evidence that a very low fat diet 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 infants less than 2 years. It should be between 30 and 40% of calories for 2 to 3 year olds, and between 25 and 35% of calories for children and teens (11). If you are using a lower fat diet than this, check that the child's growth is normal and that the child is eating enough food to meet nutrient needs.

Diets of young children should not be overly high in fiber since this may limit the amount of food they can eat. The fiber content of a vegan child's diet can be reduced by giving the child some refined grain products, fruit juices, and peeled vegetables.

Sources of protein for vegan children include legumes, grains, tofu, tempeh, soymilk, nuts, peanut butter, tahini, soy hot dogs, soy yogurt, and veggie burgers. Some of these foods should be used daily. Children should get enough calories so that protein can be used for growth in addition to meeting energy needs.

Table 17 shows one diet plan that has been used successfully by vegan children (adapted from 12).

Table 17: 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 or 1/4 to 1/2 cup cooked cereal or grain or pasta or 1/2 to 3/4 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; or 1-1/2 to 3 ounces 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)
CHILDREN (AGE 4-13)
FOOD GROUP	NUMBER OF SERVINGS
GRAINS	8 or more for 4 to 8 yr olds; 10 or more for 9 to 13 yr olds
PROTEIN FOODS	5 or more for 4 to 8 yr olds; 6 or more for 9 to 13 yr olds
VEGETABLES	4 or more
FRUITS	2 or more
FATS	2 or more for 4 to 8 yr olds; 3 or more for 9 to 13 yr olds
OMEGA-3 FATS	1 per day
STARRED FOOD ITEMS	6 or more for 4 to 8 yr olds; 10 or more for 9 to 13 yr olds

 

Adapted from (12).

Notes: Serving sizes vary depending on the child's age.

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The calorie content of the diet can be increased by greater amounts of nut butters, dried fruits, soy products, and other high calorie foods.

A regular source 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 be used.

Adequate exposure to sunlight, 20 to 30 minutes of summer sun on hands and face two to three times a week, is recommended to promote vitamin D synthesis (3, 4). If sunlight exposure is limited, dietary or supplemental vitamin D should be used.

Although today more and more children are vegan from birth, many older children also become vegan. There are many ways to make a transition from a non-vegan to a vegan diet. Some families gradually eliminate dairy products and eggs, while others 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's level. Offer foods that look familiar, at first. Peanut butter sandwiches seem to be universally popular (beware: some kids are allergic to peanut butter) and many children like pasta or tacos. Gradually introduce new foods. Watch your child's weight closely. If weight loss occurs or the child doesn't seem to be growing as rapidly, add more concentrated calories and reduce the fiber in your child's diet.

Teenage Vegans

Teenage vegans have nutritional needs that are the same as any other teenager. The years between 13 and 19 are times of especially rapid growth and change. Nutritional needs are high during these years. The teenage vegan should follow the same recommendations that are made for all vegans, namely to eat a wide variety of foods, including fruits, vegetables, plenty of leafy greens, whole grain products, nuts, seeds, and legumes. The nutrients teenage vegans should be aware are of protein, calcium, iron, and vitamin B12.

The recommendation for protein is 0.43 grams per pound of weight for 11-13 year olds and 0.4 grams per pound for 14-18 year olds (13). Those exercising strenuously (marathon runners, for example) may need slightly more protein. A 16 year old who weighs 120 pounds, needs about 48 grams of protein daily. In terms of food, 1 cup of cooked dried beans has 12 grams of protein, a cup of soy milk or soy yogurt has 7 grams, 4 ounces of tofu has 9 grams, a tablespoon of peanut butter or peanuts has 4 grams, and 1 slice of bread or 1 cup of grain has about 3 grams.

Fruits, fats, and alcohol do not provide much protein, and so a diet based only on these foods would have a good chance of being too low in protein. Vegans eating varied diets containing vegetables, beans, grains, nuts, and seeds rarely have any difficulty getting enough protein as long as their diet contains enough energy (calories) to support growth. There is no need to take protein supplements. There is no health benefit to eating a very high protein diet and it will not help in muscle building.

During adolescence, calcium is used to build bones. The density of bones is determined in adolescence and young adulthood, and so it is important to include three or more good sources of calcium in a teenager's diet every day.

Cow's milk and dairy products do contain calcium. However, there are other good sources of calcium such as tofu processed with calcium sulfate, green leafy vegetables including collard greens, mustard greens, and kale, as well as tahini (sesame butter), fortified soymilk, and fortified orange juice.

By eating a varied diet, a vegan can meet his or her iron needs, while avoiding the excess fat and cholesterol found in red meats such as beef or pork. To increase the amount of iron absorbed from a meal, eat a food containing vitamin C as part of the meal. Citrus fruits and juices, tomatoes, and broccoli are all good sources of vitamin C. Foods that are high in iron include broccoli, watermelon, spinach, black-eyed peas, blackstrap molasses, chickpeas, and pinto beans.

It is important to consume adequate vitamin B12 during adolescence. Vitamin B12 is not found in plants. Some cereals have vitamin B12 (check the label). Red Star Vegetarian Support Formula nutritional yeast supplies vitamin B12.

Many teenagers are concerned with losing or gaining weight. To lose weight, look at the diet. If it has lots of sweet or fatty foods, replace them with fruits, vegetables, grains, and legumes. If a diet already seems healthy, increased exercise -- walking, running or swimming daily -- can help control weight. To gain weight, more calories are needed. Perhaps eating more often or eating foods somewhat higher in fat and lower in bulk will help. Try to eat three or more times a day whether you are trying to gain weight or lose weight. It is hard to get all of the nutritious foods you need if you only eat one meal a day. If you feel that you cannot control your eating behavior or if you are losing a great deal of weight, you should discuss this with your health care provider.

Often there is just not enough time to eat. Below are some foods that kids can eat on the run. Some of these foods can be found in fast-food restaurants -- check the menu. Ideas for snacks that you can carry from home include:

Apples, oranges, bananas, grapes, peaches, plums, dried fruits, bagels and peanut butter, carrot or celery sticks, popcorn, pretzels, soy cheese pizza, bean tacos or burritos, salad, soy yogurt, soymilk, rice cakes, sandwiches, frozen juice bars.

References

1. Dagnelie PC, van Staveren WA, Roos AH, et al. Nutrients and contaminants in human milk from mothers on macrobiotic and omnivorous diets. Eur J Clin Nutr 1992; 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 serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatrics 1985; 107: 372-376.

4. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets adn vitamin D deficiency in infants, children, and adolescents.Pediatrics.2008;122:1142-52.

5. Committee on Nutrition, American Academy of Pediatrics. Soy protein-based formulas: Recommendations for use in infant feeding. Pediatrics 1998; 101: 148-153.

6. Fulton JR, Hutton CW, Stitt KR: Preschool vegetarian children. J Am Diet Assoc 1980; 76: 360-365.

7. Sanders TAB and Purves R: An anthropometric and dietary assessment of the nutritional 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. Pediatrics 1982; 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: The Farm study. Pediatrics1989; 84: 475-481.

11. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. 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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For more information on breastfeeding, visit:

• La Leche League, an organization that promotes breastfeeding
• Medela. Medela makes breast pumps, and their web site includes lots of information on breastfeeding, plus links to additional sites for more information.