Vegan Nutrition in Pregnancy and Childhood

by Reed Mangels, Ph.D., R.D. and
Katie Kavanagh-Prochaska, Dietetic Intern

Summary: A well-planned vegan diet can easily be used during pregnancy, breastfeeding, and childhood.

Basic Needs in Pregnancy

During pregnancy, the body requires extra calories, protein, vitamins, and minerals in order to support the baby's growth and to allow for changes in the mother's body. Important considerations in pregnancy include calories, protein, vitamin B12, iron, calcium, vitamin D, zinc, and folate.

Calories
Pregnant women, in general, need an additional 300 calories per day, beginning in the second trimester. The extra calories allow for the mother's body to change and the baby to grow. Your calorie needs may vary according to your pre-pregnancy weight and the amount of weight which you need to gain. Adding nutritious snacks to your daily routine is one way to get extra calories. A sample meal plan for vegan pregnancy, which includes three snack ideas, can be found inside this brochure.

Protein
Protein recommendations in pregnancy call for an additional 10 grams (for 25-50 year olds) or 14 grams (for 19-24 year olds) of protein. Some examples of protein-rich foods are plain, enriched soymilk; tofu; tempeh; cooked beans; and nuts and nut butters. Eating a wide variety of nutritious foods will help pregnant women get the additional protein they need.

Vitamin B12
Vitamin B12 is used for tissue synthesis and requirements are increased during pregnancy. Some good sources of vitamin B12 are vitamin B12 fortified soymilks and fortified tofu, some fortified ready-to-eat cereals, and Vegetarian Support Formula nutritional yeast. A little more than a tablespoon of Vegetarian Support Formula will provide the recommended amount of vitamin B12. This is a critical nutrient, so if your diet does not include these foods daily, use a vegetarian prenatal vitamin with vitamin B12.

Iron
Iron is needed for increased maternal blood volume and to form the baby's blood. Anemia can be a problem during any pregnancy, regardless of your diet. All pregnant women need to eat foods rich in iron, such as green leafy vegetables, dried beans and legumes, and dried fruits. Eating iron-rich foods with citrus fruits can increase iron absorption. An iron supplement may be necessary if you cannot get enough iron from your diet.

Calcium/Vitamin D
Calcium and vitamin D work together for bone and teeth health and development. Calcium absorption increases in pregnancy and may compensate for increased needs. Pregnant women should eat 4 or more servings of calcium-rich foods daily, including some green leafy vegetables, and calcium-fortified tofu, soymilk, and orange juice. Calcium supplements, on days your appetite is poor, are also an option. Vitamin D is found in fortified soymilk and fortified breakfast cereals.

Zinc
Zinc is necessary for growth and development. The recommended intake for zinc increases during pregnancy. Good sources of zinc include peas, beans, brown rice, spinach, nuts, tofu, and tempeh.

Folate
Folate is important even before you know you are pregnant, so all women of childbearing age should be getting at least 400µg (micrograms) per day. The need for folate increases in pregnancy, to 600µg per day. Dark leafy greens, whole grains, and orange juice are rich sources of folate. Vegan diets are often high in folate.

Basic Needs During Breastfeeding

The best diet for breastfeeding is very similar to the diet recommended for pregnancy. Calorie, protein, and vitamin B12 needs are slightly higher, while the need for iron is reduced. It is a good idea to use a standard prenatal vitamin shortly before, during, and after pregnancy, along with eating a well-balanced diet.

Basic Needs for Infants (0-1 years)

The ideal food for a vegan baby's first year of life is breast milk. Benefits to the breastfed baby include enhancement of the immune system, protection against infection, and reduced risk of allergies. Benefits to the mom include reduced risk of premenopausal breast cancer, release of stress-relieving hormones, and convenience. Breastfeeding may also help you lose weight, though you should not restrict calories when trying to establish milk supply. There may be other benefits we are not aware of yet.

Vitamin D
The most reliable way to get vitamin D is from fortified foods or supplements. Vitamin D is synthesized in our skin with sunlight exposure. This synthesis is greatly reduced by sunscreen use. Since sunscreen should be used with any sunlight exposure, dietary or supplemental vitamin D is needed. Babies under 6 months of age should not be exposed to the sun for long periods of time. After 6 months of age, use a sunscreen formulated specifically for baby's skin. Breastfed infants should be supplemented with 5µg (200IU) of vitamin D daily. Infant formula supplies adequate amounts of vitamin D. Vitamin D deficiency leads to rickets (soft, improperly mineralized bones).

Iron
The breastfed infant should be started on iron supplements or iron-fortified foods (like baby cereal) between 4 and 6 months. Formula fed babies may not need the supplement since infant formula contains iron. Iron-fortified cereals provide additional iron. If you give iron supplements to your baby, ask your pediatrician for the correct dose.

DHA
DHA is a fatty acid which appears to be important for eye and brain development. It is found primarily in animal derived foods. However, babies can make DHA from another fatty acid called linolenic acid which is found in breast milk if the mother's diet includes good sources of linolenic acid (flaxseed oil, ground flaxseed, canola oil, soy oil).

Soy Formula
There are several soy-based formulas available. Vegan families should choose these if breastfeeding is not an option. Some soy-based formulas may contain animal–derived fats, so check the ingredient label. Unfortunately, at the time of this writing, in the US the food industry does not offer ANY soy-based formulas that do not include vitamin D derived from lanolin, which comes from sheep's wool. There are no other acceptable options for formula-fed vegan infants. Only consumer outcry is likely to change this situation.

It is important to note that soymilk, 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 right amounts of nutrients for babies.

Basic Needs for Infants (0-1 years)

Introducing Solid Foods
Solid foods should be introduced between 4 and 6 months of age. Try to introduce one food at a time, waiting 2 to 3 days before trying another food, to see if the baby has a reaction to the food. If an allergic reaction occurs, the offending food is more easily identified.

Iron-fortified infant rice cereal is a good first food. It is an excellent source of iron, and rice cereal is least likely to cause an allergic response. Once the baby eats this cereal well, begin introducing other cereals such as oats, barley, and corn. Vegetables may be introduced next, again, one at a time to check for allergies. Vegetables must be well-mashed or puréed. Well-mashed potatoes, carrots, peas, sweet potatoes, and green beans are good first vegetables.

Fruits are usually introduced after vegetables, theoretically in order to allow acceptance of vegetables before the sweet taste of fruits is experienced. Good first fruits are well-mashed bananas, pears, or peaches.

Protein foods are generally introduced around 7 to 8 months. Some good sources of protein include mashed, cooked dried beans; mashed tofu; and soy yogurt. Smooth nut and seed butters spread on bread or crackers can be introduced after the first birthday.

Some parents choose to use commercial baby foods. There are products made for vegetarian babies, but careful label reading is recommended. Many parents wish to make their own baby foods. These should be prepared without added sugar, salt, or spices. Foods should be well cooked, mashed or puréed, and handled under clean conditions.

Babies under age 2 need more calories and fat than at any other time in their lives. Fat is important in brain development. Some foods used to increase fat in the diet are mashed avocado, vegetable oil, and nut and seed butters spread on crackers (in children older than 1 year).

If a breast-feeding mother is not using a reliable source of vitamin B12, the baby needs a vitamin B12 supplement.

For a more detailed discussion of vegan pregnancy, you can purchase Simply Vegan, by Debra Wasserman and Reed Mangels, Ph.D., R.D. This book is available from The Vegetarian Resource Group. Healthcare practitioners may wish to consult the "Nutrition Management of the Vegetarian Child" chapter from the Pediatric Manual of Clinical Dietetics, from The American Dietetic Association.

Children, especially toddlers and preschoolers, often tend to eat less than most parents think they should. This is generally due to a developing sense of independence and a slow down in growth. All parents should schedule regular check-ups with their child's pediatrician, in order to monitor growth, development, and health. All parents need to make sure that what their child does eat, gives the child the nutrients he or she needs. The preschool years are an important time for developing healthy eating patterns, which can set the stage for a healthful adult diet.

Calories and Fat
Young children have small stomachs and eating a lot of high fiber foods may not give them enough calories. A diet rich in fresh fruits, vegetables, and whole grains is also usually high in fiber. The fiber content of a vegan child's diet can be reduced by offering him or her some refined grain products, fruit juices, and peeled fruits and vegetables. Foods like avocado, nut and seed butters, dried fruits, and soy products can pack a lot of calories into small quantities, which is great for the growing child. To promote synthesis of DHA, an important fat, include source of linolenic acid like canola oil, flaxseed oil, and soy products in your child's diet.

Protein
A child will meet protein needs if a variety of plant foods are eaten and calorie intake is adequate. It is unnecessary to precisely plan and complement amino acids within each meal as was once thought, as long as children eat several meals and snacks a day. Variety is the key to a healthy diet. Sources of protein include legumes, grains, soy products, meat analogs, and nut butters.

Calcium
Calcium is very important for growing bones and teeth. Good sources of calcium include fortified soymilks, fortified rice milks, and calcium-fortified orange juice, tofu made with calcium, blackstrap molasses, vegetarian baked beans, and textured vegetable protein (TVP). Because of the small size of a child's stomach and the amount needed, leafy greens are not a major source of calcium. However, the older child may be able to consume enough kale, collard greens, turnip, and mustard greens, along with other good sources of calcium, to meet needs.

Zinc
There is little available information on the zinc content of diets of vegan children. Zinc sources include legumes, whole grain pasta, wheat germ, fortified cereals, tofu, nut butters, and miso.

Vitamin D
Dietary sources of vitamin D include some brands of fortified soymilk, fortified rice milk, and some dry cereals. Vitamin D supplements are needed for children who have no dietary source of vitamin D. Sun exposure has traditionally been recommended for vitamin D production. Current recommendations call for the use of sunscreen, which greatly reduces vitamin D production by the skin, so sun exposure should not be relied on for vitamin D adequacy. Remember that children always need to wear sunscreen outdoors.

Vitamin B12
Vegan children should use foods fortified with vitamin B12 or vitamin B12 supplements. A variety of foods fortified with vitamin B12 are available, including some brands of soymilk, meat analogs, fortified nutritional yeast, and some breakfast cereals.

Iron
Iron deficiency anemia is a common childhood nutritional problem, no matter what the diet. Good iron sources include whole or enriched grains and grain products, iron-fortified cereals, legumes, green leafy vegetables, and dried fruits. Vitamin C helps the body absorb iron, so offer citrus fruits with iron-rich foods.

A diet plan for vegan toddlers and children is included below.

Special Tips for Feeding Preschoolers

• Offer choices of foods. Letting the child make some decisions can increase acceptance of foods.
• Offer a variety of foods, repeatedly. Children's food preferences often change. The food they refuse today may become tomorrow's favorite.
• Keep mealtime a pleasant time. Do not force a child to eat or use food as a reward. Try to remain low-key about food refusals. Studies show that a new food can be offered up to 15 times before the child will try it.
• Make food fun. Try pancakes in different shapes, offer vegetables and dips, and hide small pieces of soft fruit in soy yogurt.
• Set a good example. Let the child see you eating healthy foods.
• Foods that are not a particular favorite may be added to foods the child likes, for example, chopped or puréed vegetables can be added to pasta sauce or soup. Tofu can be blended into a fruit shake. Fruit purées can be added to baked goods.
• Involve the child in food preparation. Even young toddlers can tear lettuce and help put cut-up vegetables into a pot.
• Some children may prefer eating single foods in separate bowls rather than a mixture of foods such as a casserole.

• Nuts, except when finely ground.
• Nut butters by the spoonful.
• Vegetarian hot dogs, unless sliced into tiny pieces the size of a pea.
• Cherry tomatoes, unless halved or quartered.
• Grapes, unless cut in half. Peeling may be needed for young toddlers.
• Raw cherries, unless pitted and sliced.
• Raw celery and whole raw carrots.
• Popcorn.

Meal Planning Ideas
Popular foods with vegan children include:

• Pizza, without cheese, and topped with vegetables, tofu, or meat analogs.
• Pasta with marinara sauce.
• Oven-baked French fries.
• Soy yogurt.
• Macaroni and soy cheese.
• Milkshakes made with calcium-fortified soymilk and fruit.
• Peanut butter and jelly sandwiches.
• Fresh or dried fruit.
• Pancakes and waffles.
• Noodles with peanut butter sauce.
• Raw vegetables with dip.
• Muffins.
• Mashed potatoes.
• Veggie burgers.
• Tofu dogs.
• Bagels with nut butter or hummus.

Interested in teen nutrition? Check out our Vegetarian Nutrition Guide for Teenagers for more information, or call (410) 366-8343 for a paper copy.

• Use an iron skillet when preparing acidic foods, such as tomato sauce. This helps "unlock" the iron.
• Be sure your non-dairy milk alternative is fortified with vitamins D and B12, as well as calcium.
• Good sources of zinc are peas, beans, brown rice, nuts, spinach, tofu, wheat germ, fortified breakfast cereals, and tempeh.
• Introduce one new food at a time to your baby in order to identify possible allergens.
• Do not restrict fat in your baby's diet before 2 years of age. Babies need fat for brain development. Some sources of fat are avocados, olive oil, and nut butters.

Sample Meal Plan for Vegan Pregnancy, Infancy, and Childhood

Sample Meal Plan for Vegan Pregnancy

This sample meal plan provides approximately 2500 calories, 94 gm protein, 70 gm fat (24% of calories), and 396 gm carbohydrate. This sample meal plan meets the RDA for iron, calcium, zinc, vitamin B12, folate, vitamin D, thiamin, riboflavin, and niacin.

All charts reprinted from Simply Vegan, by Debra Wasserman and Reed Mangels, PhD, RD

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

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