Feeding Vegan Kids

by Reed Mangels, PhD, RD

From Simply Vegan 5th Edition, updated September, 2019

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 sizes 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 or veganism. They are wrong. With a little attention to detail, vegetarianism/veganism 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 B12. If your diet does not contain reliable sources of vitamin B12, your breastfed infants should receive supplements of 0.4-0.5 micrograms of vitamin B12 daily.

Vitamin D is produced by our bodies after sunlight exposure. However, to reduce the risk of skin cancer from sun exposure, the American Academy of Pediatrics recommends keeping infants younger than 6 months out of direct sunlight and protecting them with clothing and hats. So, for infants, the most reliable way to get vitamin D is from supplements and fortified foods. Infants who are solely breast-fed or who get less than a quart of day of infant formula should receive a daily vitamin D supplement of 10 micrograms (400 IU) (3). Infant formula is fortified with vitamin D so infants who are getting a quart or more a day of infant formula do not need a vitamin D supplement. 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. Recommendations call for use of iron supplements (1 mg/kg/day) beginning at 4 months to insure adequate iron intake (4). 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 may contain animal-derived fats so check the ingredient label. Soy formulas are used exclusively for the first 6 months.

Soy milk, rice milk, other plant milks, 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.

Infants should ideally be given only breast milk for the first six months. If exclusive breastfeeding is not possible, commercial infant formula or a combination of infant formula and breast milk should be used. Breastfeeding or formula feeding should continue until at least the infant's first birthday. Supplemental food (food besides breast milk and formula) are started near age 6 months. 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 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, fruits 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. 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 6-8 months, good sources of protein can be introduced. These include pureed cooked dried beans, mashed tofu, and soy yogurt. Children should progress from puréed foods to mashed 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 until after the first birthday and even then, supervise the child.

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. Certainly it makes sense for vegans to continue breast-feeding beyond a year, if possible, because breast milk is a rich source of nutrients. After the first year (or later) vegan infants who are growing normally and eating a variety of foods can be transitioned to a fortified soy milk or pea protein-based milk fortified with calcium, vitamin B12, 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.

The growth of vegan infants and children should be similar to that of non-vegans. Growth charts from the World Health Organization (WHO) are based on the growth of healthy breastfed infants (6). These growth charts, which show what normal growth should look like, are called the WHO growth charts and should be used to assess growth of children less than 2 years of age. Older children are monitored with growth charts from the Centers for Disease Control (CDC) (6).

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 children. Once your child's height and weight are measured, the measurements are compared to growth curves — graphs that show growth patterns of children by age. There is no single perfect growth rate. Instead, growth charts are set up using percentiles. If your child's height is at the 50th percentile, that 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 at the same age.

A wide range of growth percentiles are considered "normal." A child at the 10th percentile for weight or the 95th percentile for height is still considered to be within the healthy range. You don't get extra points for higher or lower percentiles. However, if your baby or young child (under age 2) is below the 2nd percentile for length or for weight for length or above the 98th percentile for weight for length, your health care provider will try to find out why this is and if intervention is needed. In addition, children don't usually make large jumps — like from the 75th to the 25th percentile — so if this happens, the reason for this faltering is investigated. Older children (age 2 and older) are assessed using slightly different standards. Older children's' body mass index (BMI) is calculated using their weight and height. If BMI for age or weight for height is above the 95th percentile, the child is evaluated as being obese. If BMI for age is between the 85th and 95th percentile, the child is classified as overweight. If BMI for age is below the 5th percentile, the child is considered underweight and further evaluation may be needed (6).

Of course, when any child is evaluated, factors such as the size of the parents and whether or not the child was born prematurely or if there are health issues are taken into consideration.

Table 16: Feeding Schedule For Vegan Babies Ages 6-12 Months

6 mos 6-8 mos 9-10 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 servings (1 serving = 1/4 slice of bread or 2-4 Tbsp of cereal).
FRUITS & VEGETABLES None. Begin strained vegetables and fruits. Soft or cooked fruits, soft mashed vegetables. Table-food diet. Allow 4 servings per day (1 serving = 2-4 Tbsp of fruit and vegetable).
LEGUMES & NUT BUTTERS None. Begin tofu, pureed legimes and soy yogurt. Continue to introduce tofu, pureed legumes, soy yogurt. 2 servings daily each about 1/2 oz.

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 their 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 that 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 1 to 3 year olds, and between 25 and 35% of calories for 2 to 3 year olds, and between 25 and 35% of calories for children and teens (7). 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. For more information see Nutrition Hotline: www.vrg.org/journal/vj2016issue1/2016_issue1_nutrition_hotline.php.

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, 100% fruit juices, and peeled vegetables. Sources of protein for vegan children include legumes, grains, tofu, tempeh, soy milk, 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 inaddition to meeting energy needs.

Table 17 shows one diet plan that has been used successfully by vegan children (adapted from 13).

Table 17: Diet Plans For Vegan Children

TODDLERS AND PRESCHOOLERS, 1-3 YEARS
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 1 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 ounce of meat analogue; or 1 to 2 Tbsp nuts, seeds, or nut butters or seed butters. Include at least 1 serving of nuts, seeds, or a full-fat soy product.
FORTIFIED SOY MILK, ETC. 3 (a serving is 1 cup fortified soy or pea protein-based milk, 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 100% fruit juice, or 1 medium fruit) Limit 100% fruit juice to no more than 1/2 cup per day.
FATS 3-4 (1 tsp. margarine or oil) (use 1/4 tsp. flaxseed oil or 1 tsp. canola oil daily to supply omega-3 fatty acids)
CHILDREN, 4-13 YEARS
(Note: See the Vegan Food Guide for information on serving sizes and the starred food items.)
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 2 per day A serving is 1/4 tsp flaxseed oil, 1 tsp of canola oil, 1 tsp ground flaxseed, 3 halves of English walnuts
STARRED FOOD ITEMS 6 or more for 4 to 8 yr olds; 8 or more for 9 to 13 yr olds

Adapted from (8).

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

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 B12 like Vegetarian Support Formula nutritional yeast, vitamin B12 fortified soy milk or pea protein-based milk, vitamin B12 fortified breakfast cereal, vitamin B12 fortified meat analogues, or vitamin B12 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 of are 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 of weight for 14-18 year olds (7). 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 about 15 grams of protein, a cup of soy milk has 7 grams, 4 ounces of tofu has 10-12 grams, a Tablespoon of peanut butter or peanuts has 4 grams, and 1 slice of bread or 1 cup of grain has about 4 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 good sources of calcium in a teen-ager'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 soy milk and other plant milks, 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, whole 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 as snacks 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, soy milk, 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. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-52.

4. Baker RD, Greer FR, the Committee on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010;126:1040-1050.

5. Bhatia J, Greer F; American Academy of Pediatrics Committee on Nutrition. Use of soy protein-based formulas in infant feeding. Pediatrics. 2008;121:1062-1068.

6. Centers for Disease Control and Prevention. National Center for Health Statistics. Growth Charts. https://www.cdc.gov/growthcharts/. Accessed August 21, 2018.

7. 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.

8. Mangels R, Messina V, Messina M. The Dietitian's Guide to Vegetarian Diets, 3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2011.