A few weeks ago, concerned parents brought their 12-year-old child to the office. For months prior to my meeting him, he was complaining of weakness in his arms and legs, generalized fatigue, and a feeling that he was moving through his daily activities in a fog – finding it difficult to concentrate on tasks at home and at school. Of course, a whole list of differentials came to mind, but on exploring the nutrition history, it was revealed that this patient and his family had been practicing a strict vegan diet for the past three years. While the parents were fueling themselves with a wide variety of plant-based nutrients, my patient turned out to be a bit of a picky eater whose diet consisted mainly of potatoes and little to no greens. After some discussion about my concerns, mom wanted to know whether a vegan diet was OK for children. It’s a question I’ve heard many times before from moms of infants, to parents of student athletes and the short answer is yes – but with some caveats.
The health benefits of vegan diets have been touted widely, but to have a healthy diet of any kind, certain nutrients are essential. In their strictest form, vegan diets are free from dairy and all animal products. They’ve been shown to promote weight loss, reduce risk of heart disease by lowering cholesterol levels, reduce risks of certain cancers like colon cancer, and help reduce the risk of diabetes. While the benefits of a vegan diet are many – protein, vitamin B12, essential fatty acids, vitamin D, and iron tend to be missing from vegan diets if an effort is not made to incorporate them. Throw in the average child’s propensity for picky eating and their risk of being deficient in these nutrients increases ten-fold. That is not to say that children cannot do well on a vegan diet. With proper planning, children can receive the full complement of nutrients required to support growth and development. If considering a vegan diet for your child, there are some important things to keep in mind.
For infants, breastfeeding is encouraged for at least the first six months, as the milk is a rich source of nutrients. Many parents continue breastfeeding until the age of one or beyond. However, breast milk shouldn’t be the sole source of nutrition after six months. If parents decide to stop breastfeeding at six months, a formula fortified with iron, calcium, vitamins B12 and D is recommended. When it comes to formula, soy and oat “milks” are not appropriate for babies less than one year old, as they don’t have the right ratio of carbohydrate, protein and fat. They also lack the vital nutrients for growth and development. Additionally, rice milk should also be avoided for all children under five years, as it is low in protein and fat and these products contain levels of arsenic.
During weaning, an iron-fortified infant cereal is a great option for a first food. The cereal can be mixed with expressed breast milk or plant-based formula for a thin consistency. A variety of foods are to be encouraged when weaning, including vegetables, cereal foods, pulses (peas, beans and lentils), tofu, ground nuts, seeds and fruits.
Vegan diets tend to be less energy dense, so children need to eat larger quantities to get enough energy. Unfortunately, children typically have small appetites, so achieving their daily calorie needs can be a challenge. Adding healthy oils to food, such as soy bean or grapeseed oil are key, as they add more calories to meals and encourage the production of important fatty acids, which are needed for brain development.
Protein is a key nutrient for growth and development and is essential in every child’s diet. There are plenty of protein-rich foods suitable for a vegan diet, and these include a variety of beans and lentils, which will ensure a good mix of amino acids. Grain-like food such as quinoa as well as nuts and nut butters are good sources of protein, provided your child has no allergies. Egg replacers are available in health foods shops and some supermarkets, and can be used in cooking and baking. Aim to include three portions of vegetable protein per day to ensure adequate nutrition.
Calcium is key for maintaining healthy bones, and approximately 45 percent of our bone mass is accrued before the age of eight years. A further 45 percent is laid in the next eight years, with the remaining 10 percent in the following 10 years. It’s therefore essential that calcium requirements are met for children eating a vegan diet. A plant-based milk that’s been fortified with calcium and vitamin D is a good choice. You may wish to include soy yogurts and calcium-rich cereals in your child’s diet, too. Oat and coconut “milks” are another option and are both available in a fortified form with calcium.
Iron is essential for the formation of red blood cells. Good sources of iron, such as beans, lentils and peas, dark green leafy vegetables (like broccoli, okra, watercress or spring greens), whole wheat bread and flour, nuts, whole grains and fortified cereals should regularly be included in their diet. Dried fruits such as apricots, prunes and figs are also good choices. By combining an iron-rich food with a vitamin C-rich one, you will increase your child’s uptake of iron; try orange segments in a fortified breakfast cereal or peppers with lentils in a vegetable casserole.
Vitamin D is required for absorption of calcium to maintain strong bones and teeth. However, it is found in a very limited variety of foods, with the best source being sunlight absorbed by the skin. Dietary sources for vegans are limited, so fortified plant-based milk, spreads and cereals are the best options.
Essential fatty acids are vital for brain development and help keep the brain healthy and functioning optimally. They’re also important for vision and heart health. Plant sources include chia seeds, flaxseeds, hemp and walnuts. However, because plant foods are not the richest source of these essential fats, some vegans, including pregnant and breastfeeding moms, choose to supplement with omega-3 fatty acids derived from microalgae.
Essential for the formation of red blood cells, vitamin B12 is key for brain and nervous system formation. It’s widely recognized that vitamin B12 is only found naturally in animal sources, but fortified breakfast cereals and some low-salt yeast extracts contain B12, as do fortified plant milks and soya products. It’s important that a combination is included in your child’s diet. If not, a B12 supplement may be required. A reliable source of iodine is also important, and a supplement is typically recommended.
High-fiber foods tend to be very filling and can often cause children to become full before they’ve gotten all of the calories and nutrition they need. Choose nutrient-dense foods that also contain fiber, such as avocados, nuts and dried fruits. Remember, it’s good practice to encourage children to brush their teeth after eating dried fruits to minimize the chance of tooth decay.
Vegan diets can be safe for children as long as parents and guardians are well-informed about the key nutrients required for growth and development. Parents of vegan children must take the necessary steps to ensure they’re eating a balanced diet. If you are considering a vegan or other restricted diet for your growing child, be sure to reach out for guidance. Remember, your pediatrician is a valuable resource for helping you raise happy and healthy kids.
• Dr. Tamarra Moss is a pediatrician committed to helping you raise happy and healthy kids. You can find her at Dr. Carlos Thomas & Pediatric Associates in Nassau, Lucayan Medical Center in Grand Bahama, or on Instagram @mykidsdoc242.