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A vegetarian/vegan diet for infants and young children

Infants and young children have higher energy and nutrient requirements than adults, relative to their body weight. When properly followed, a vegetarian or vegan diet is suitable for meeting the requirements of this phase of life.

How to plan a vegan/vegetarian diet for infants and young children

As plant-based diets become more and more popular, the proportion of vegans and vegetarians in society is increasing. This is leading to a consistent increase in vegan and vegetarian families – the Veganz nutrition study of 2020, which evaluated seven European countries, showed that almost 1.9% of people are vegan and 3.1% are vegetarian.1

 The Smart Protein Project data is even more encouraging: according to the survey, 7% of respondents followed a plant-based diet, while 30% followed a flexitarian diet. Almost 46% of people had already reduced their meat consumption, with around 30% stating that they also intended to reduce their dairy consumption.2 These shifts in dietary preferences also mean that there is a greater need for professional guidance on feeding infants and young children who are following vegetarian or vegan diets.

Guidance on plant-based diets for children

2018 saw the publication of the VegPlate Junior (VPJ) food guide, which is specifically aimed at planning vegetarian diets in infancy, childhood, and adolescence. Based on dietary reference intakes (DRIs) from Italy and the US,3 the guide proposed criteria for a well-planned plant-based diet.4 The VPJ is based on six food groups (grains, protein-rich foods, vegetables, fruits, nuts and seeds, and fats) and focusses on the key nutrients that are considered to be critical for vegetarian diets during all life stages: i.e. vitamin B-12 and vitamin D, calcium, and omega-3 fatty acids.5

Similar guidelines from the American Academy of Nutrition and Dietetics and the Canadian Paediatric Society also emphasise the importance of monitoring protein and energy intake, and supplementing when necessary.6 7

A vegetarian/vegan diet for infants (0-12 months)

Breast milk – the best food for infants

Breast milk is the best food for infants during the first months of life. Its nutritional composition is optimally adapted to children’s digestive system, while also containing antibodies that protect the infant against infections and allergies. In addition, the skin and eye contact with the mother that takes place during breastfeeding stimulates emotional and mental development. Lower levels of environmental toxins can be detected in the breast milk of long-time vegetarians and vegans than in those of women on an omnivorous diet.8 A systematic review of the impact of different diets on breast milk composition showed that non-vegetarians, vegetarian, and vegan mothers produce breast milk of comparable nutritional value.9 However, adequate intakes of vitamin B12 by pregnant and lactating people on plant-based diets are crucial

If breastfeeding is not possible, infant formula, which is commercially available in both cow’s-milk and soya-based versions, should be used. Soya formula is a suitable and nutritious replacement for infants with cow milk allergy, lactose intolerance, or those on a vegan diet.10 11 The use of homemade formulas (based on plant-based milks and grains) is strongly discouraged, as it has been associated with nutritional problems in infants.12

Meat-free complementary food from about six months onwards

While breast milk or infant formula should continue to be the primary source of nutrients for the first year of life,13 14 complementary foods should be added to the infant’s diet from around the age of six months,15 since breast milk alone is no longer sufficient to meet the child’s energy and nutrient requirements at this stage of life.

In order to accustom the infant to spoon feeding, plain carrot puree can be given at first. In the case of a vegetarian/vegan diet, a mash of vegetables, potatoes, and cereals is recommended thereafter, with further milk meals being replaced by mash based on plant-based milk, fruit, and cereals. Vegetable proteins such as pureed beans or tofu are used in place of pureed meats.16 From ten months onwards, the mashed meals can gradually shift to the food that the rest of the family eats,17 with a focus on specific nutrients that are of particular importance for children raised on a plant-based diet.18 19 20

Important nutrients in a vegetarian/vegan infant diet

When planning vegetarian diets for infants, special attention should be paid to an adequate supply of iron, zinc, iodine, calcium, and vitamin D, as well as omega-3 fatty acids. In the case of a vegan diet, vitamins B₂ and B₁₂ should also be added to this list.

Iron – important for infants

During the first few months, the infant is mainly dependent on the iron reserves it has built up during gestation, since breast milk contains very little iron. When preparing vegetarian/vegan complementary foods, iron-rich grains and vegetables should be used.21 Later on, cooked legumes and soya-based meat can also serve as additional sources of iron. The regular intake of fortified food such as cereals or plant-based milk, as well as supplements, can also help to increase iron intake.22 23 Iron absorption can be significantly improved by combining it with vegetables, fruits, and fruit juices that are rich in vitamin C.24 Deficiencies of iron and zinc are rarely seen in vegetarian children eating varied diets.25

Vitamin D – important for infants

An undersupply of vitamin D in infants can lead to the development of rickets, i.e. impaired bone development.26 27 Regardless of the breastfeeding mother’s diet and the infant’s own production of vitamin D (with sufficient exposure to sunlight), the recommendation is a daily intake of 10 µg of vitamin D via dietary supplements for the first year of life in order to reduce the risk of rickets.28 Low Vitamin-D levels can also lead to impaired immune functions, higher risk of type 2 diabetes, and an increase in infections, further increasing the need for supplementation.29 The optimal level of vitamin-D supplementation for toddlers, children, and adolescents is not known, but doses of 10-50 μg (micogrammes) a day are safe and may be beneficial.30 31

Vitamin B₁₂ – important for infants

Severe growth and developmental disorders have been observed in infants of vegan women who do not themselves use vitamin B₁₂-enriched foods or supplements.32 Due to limited body reserves after birth, all breastfed infants of vegans should receive a vitamin B₁₂ supplement (in the form of drops, for example). According to the European Food Safety Authority, 0.4µg is an adequate intake for infants who are younger than four months. The recommended intake for older infants, considering the increase in weight, is 0.8 μg/day for infants aged 4-to-12 months.33

Omega-3 fatty acids – important for infants

Because Omega-3 fatty acids play an important role in brain development, fats should be carefully chosen in order to ensure a good supply. Vegetable oils that are rich in α-linolenic acids (a form of Omega-3 fatty acids mostly found in plants), such as linseed and rapeseed oil, can be an important source and are thus suitable for improving the supply of long-chain omega-3 fatty acids, but alsowalnuts and chia seeds. Another form of Omega-3 fatty acids, mostly found in aquatic animals, is Docosahexaensäure (DHA). While this is especially important for brain development, the body can only convert it from α-linolenic acid to a limited extent. Thus, DHA supplementation can be useful for vegetarian and vegan infants, for example, in the form of microalgae oil.34

High energy and nutrient content – important for infants

When preparing vegetarian/vegan foods to complement the consumption of breast milk, emphasis should be placed on high energy density and nutrient content, as well as a low fibre content.35 Protein and energy intake can be critical due to the high fibre content of plant-based food: because fibre increases satiety while interfering with fat and protein absorption36, it can be useful to provide foods that are as low-fibre and as energy- and nutrient-dense as possible.37 Fibre content must be controlled even during the second year of life, since growth velocity is still high, although, after 12 months, whole plant foods should be part of a child’s daily diet.38 Energy density and protein content can be increased through the consumption of nut  butter, grains, and legumes, and decreased via vegetables and fruits.39

Fats should not be limited in infancy and early childhood, and can provide up to 40% of total energy. However, it’s important to select them carefully in order to achieve an optimal omega-6/omega-3 ratio.40 Energy density should be increased by adding vegetable oils, especially in vegan infant formula, for example, by adding at least one serving of flaxseed oil, which is low in fibre but high in energy and omega-3s.41

Vegetarian/vegan nutrition for young children and preschoolers (1-5 years)

Young children and preschoolers also have high nutrient and energy requirements relative to their body weight. A British study showed that the diets of predominantly vegetarian preschoolers were more favourable overall than those of their meat-eating peers.42 While their vitamin and mineral intake was comparable to that of meat-eaters, the vegetarian children performed better in terms of total fat intake, fat quality, carbohydrate intake, cholesterol intake, and salt intake.

The German VeChi diet study from 2021 shows the differences in the micronutrient and fatty-acid intake of vegetarian, vegan, and omnivorous children (1-3 years). The results indicated that vegan and vegetarian diets can provide most micronutrients in desirable amounts to children, as well as a preferable fat quality, compared to an omnivorous diet. The critical nutrients for all children, regardless of diet, are vitamin D, iodine, and DHA, while vitamin B2, vitamin B12, calcium, and iron are especially critical for vegan and vegetarian children.43

Vegan-fed toddlers are often smaller and lighter than peers of a similar age who also eat meat. However, their nutrient intake is within the recommended range.44 45 46 47 Vegan pregnant and lactating women and vegan parents need to be aware of the dietary sources of critical nutrients and of the food-preparation techniques and cooking practices that enhance their bioavailability. When sun exposure is not sufficient, vitamin-D supplements should be taken in order to maintain an optimal vitamin D status. Vitamin B12 supplementation is a mandatory requirement for all vegans, and even more so for children.48 49

Important nutrients in a vegetarian/vegan infant diet

In general, an adequate supply of calcium, iron, zinc, iodine, vitamin D, and omega-3 fatty acids should be ensured in a vegetarian diet for young children, and, in the case of vegan children, vitamin B₁₂ should also be taken into account. It is recommended that nutrient levels are checked regularly (about once a year) by means of blood tests.

Health benefits of a plant-based diet for infants and young children

Plant-based raised children and adolescents are at lower risk of obesity and being overweight, compared to non-vegetarians.50 Children and adolescents with BMI values in the normal range are more likely to also be within the normal range as adults, resulting in significant disease-risk reduction.51 A high consumption of animal protein, especially in the form of animal-based milk and dairy products, increases the risk of a higher BMI and body-fat percentage at primary-school age.52 53 Vegetarian diets in childhood have been shown to expose children to a wider variety of plant-based foods and therefore a higher consumption of fruits and vegetables.54 Vegan children also seem to have lower intakes of total and saturated fat and cholesterol, compared to non-vegan children.55 A low-fat vegan diet has been effectively used to treat children with obesity and elevated blood pressure.56

Conclusion

  • In the first few months of life, breast milk is the best food for infants. Regardless of what type of diet parents choose for their children, it’s important that they are knowledgeable so they can plan and cook an adequate diet that supports their child’s immediate and future health.
  • A vegetarian or vegan diet can properly cover an infant’s nutritional requirements if the diet is carefully planned. Special attention should be paid to critical nutrients such as iron, zinc, iodine, calcium, vitamins B2 and B12, vitamin D, and omega-3 fatty acids. Ideally, competent nutritional advice should be sought.
  • If it is determined that there is an insufficient supply of certain nutrients, these should be increased via adjustments in diet and, where necessary, food supplements. At the same time, dietary composition should be optimised according to a vegan food pyramid or plate.
  • A varied and favourably composed vegetarian or vegan diet can provide small children with all the nutrients needed for optimal health. In addition, such a diet can contribute to the development of healthy eating behaviours, which are shaped significantly in early childhood.

References

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