How can we plan well-balanced plant-based diets for infants and kids?
The Growth and Nutrient Intakes of Children Raised on Plant-Based Diets
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
As I covered in my last video, the American Academy of Nutrition and Dietetics considers plant-based diets suitable for pregnancy—as well as during lactation, infancy, and childhood when they are well-planned. So, what goes into planning a well-balanced plant-based diet for infants and kids?
For infants, breast milk is the basis of nutrition, consisting not only of critical nutrients but also immune-boosting compounds providing both short- and long-term benefits. The World Health Organization recommends breastfeeding exclusively for the first six months of life and continuing with the introduction of complementary foods. What do we know about the breast milk composition of plant-based moms? Vegetarian and vegan mothers provide breast milk with comparable nutritional value, with a couple important caveats. In a direct comparison of breast milk from omnivore and vegetarian or vegan moms, the notable difference was lower DHA, the long chain omega 3, in the milk from plant-based moms, due to their avoiding fish––which is probably a good thing, given how contaminated the aquatic food chain is. Thankfully, ensuring proper supplementation with pollutant-free sources can bridge this gap, just like when there is proper supplementation with vitamin B12. So, provided that women are eating enough to cover their nutritional requirements and supplementing with DHA and vitamin B12, vegan moms can produce nutritionally similar milk.
But what about case reports like this, where an infant on a vegan diet is failing to thrive? Or this report? These case reports highlight the importance of good nutrition during this period of life of extremely rapid growth. By around six months of age, solid foods should be introduced. By that age, breastmilk or formula alone is not sufficient to meet the nutritional needs of infants. In the first case study, the infant was exclusively breastfed for 10 months and then was given a nutritionally insufficient rice-based drink. In the second case report, the infant did not receive vitamin D supplementation, which is recommended for all children in early life.
Breast milk should be continued on demand until the child is at least one year old. Formula is an option for women who cannot breastfeed. The VegPlate Junior, a guide put together to help with dietary planning for plant-based kids, has a helpful visual and a more detailed table for infants who have started consuming complementary foods. And finally, as we’ve highlighted before, raw diets are not appropriate to meet the nutritional needs of infants and children.
So, what about nutrient status and growth in vegan children? First, caution must be applied to some populations defined as vegan but who may follow diets that refuse supplementation. This is where you can get the impression from some experts that vegan diets are deficient and harmful. But the current literature suggests that plant-based diets using supplementation are likely to provide the recommended amounts of critical nutrients to allow normal progression of height and weight in children, and can be beneficial. There is a reason to assume that vegans today may be planning their diets more adequately than vegans in the past, as this way of eating has been adopted in the general population, rather than existing solely in fringe groups. And lucky for us, there is a new set of studies aimed at tackling this very question. What are the associations between the modern practice of vegetarian and vegan diets in children and adolescents and health? Enter the VeChi study, the Vegetarian and Vegan Children Study of German kids.
For the one- to three-year-olds eating plant-based in the VeChi study, how did their growth compare to their omnivorous peers? Overall, vegan, vegetarian, and omnivorous kids did not significantly differ. This is in line with other studies. One- to three-year-old veg kids tend to be slightly smaller and lighter (but within the normal range), or have no differences on average compared to omni kids.
When the researchers assessed micronutrients and fatty acids, they noted special focus should be paid to critical nutrients like vitamin D, iodine, and DHA for all children, regardless of their diet, with extra attention on riboflavin, vitamin B12, calcium, and iron for veg kids.
For a toddler, intake of riboflavin (vitamin B2) should be around 500ug/day. The veg kids were short by about 40-70 ug. Luckily, there are an abundant variety of plant-based sources like nuts, legumes, and fortified plant-based milks. For example, if your toddler drinks a cup (240 ml) of fortified soy milk, they have already met the 500 ug recommended intake. For calcium, great plant sources include dark green vegetables (like kale, bok choy, and broccoli), tofu, almonds, and calcium-fortified non-dairy beverages like soy milk.
What about the older VeChi kids, aged 6-18? Although iron intake was low in the toddler group, it was higher in the older veg children, surpassing the omnivore kids. There was no elevated risk for iron deficiency in the veg kids. The higher intake of iron in the veg group may have helped compensate for the lower bioavailability of iron from plant foods. The kids in this group were also more likely to take supplements. Yet, in another recent study, this one of five to 10-year-old Polish kids with adequate reported iron intakes, about eight percent had mild or moderate hemoglobin deficiency.
Regardless of diet, about three percent of one- to two-year-olds in the United States have iron deficiency anemia, and given its consequences for young children, prevention is a top priority. For adolescent and young adult females, iron deficiency anemia is around six percent, and menstruation increases this risk. It’s worth paying special attention to include iron-rich foods at most meals and to give a little boost of iron absorption, combine them with vitamin C rich foods.
What else did we learn about the older VeChi kids? BMI did not differ across groups —they were a pretty healthy bunch. The plant-based kids had been veg for four to five years and most vegan kids took supplements, in particular B12, as they absolutely should. Hopefully the 12 percent who weren’t were eating sufficient amounts of B12-fortified foods, as well as vitamin D. One way the groups did differ was that the vegan kids had significantly lower LDL cholesterol compared to the vegetarian and omnivorous kids. And given that atherosclerosis, our #1 killer, starts in childhood and dietary habits track into adulthood, plant-based diets in childhood could ultimately improve the cardiometabolic health of adults, as well as potentially help prevent obesity, which often persists into adulthood.
Please consider volunteering to help out on the site.
- Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-1980.
- Baroni L, Goggi S, Battino M. Planning well-balanced vegetarian diets in infants, children, and adolescents: the vegplate junior. J Acad Nutr Diet. 2019;119(7):1067-1074.
- Karcz K, Królak-Olejnik B. Vegan or vegetarian diet and breast milk composition - a systematic review. Crit Rev Food Sci Nutr. 2021;61(7):1081-1098.
- Ureta-Velasco N, Keller K, Escuder-Vieco D, et al. Human milk composition and nutritional status of omnivore human milk donors compared with vegetarian/vegan lactating mothers. Nutrients. 2023;15(8):1855.
- Farella I, Panza R, Baldassarre ME. The difficult alliance between vegan parents and pediatrician: a case report. Int J Environ Res Public Health. 2020;17(17):6380.
- Lemoine A, Giabicani E, Lockhart V, Grimprel E, Tounian P. Case report of nutritional rickets in an infant following a vegan diet. Arch Pediatr. 2020;27(4):219-222.
- Kostecka M, Kostecka-Jarecka J. Knowledge on the complementary feeding of infants older than six months among mothers following vegetarian and traditional diets. Nutrients. 2021;13(11):3973.
- Johansson U, Öhlund I, Lindberg L, et al. A randomized, controlled trial of a Nordic, protein-reduced complementary diet in infants: effects on body composition, growth, biomarkers, and dietary intake at 12 and 18 months. Am J Clin Nutr. 2023;117(6):1219-1231.
- Menal-Puey S, Martínez-Biarge M, Marques-Lopes I. Developing a food exchange system for meal planning in vegan children and adolescents. Nutrients. 2018;11(1):43.
- Sutter DO, Bender N. Nutrient status and growth in vegan children. Nutr Res. 2021;91:13-25.
- Alexy U, Fischer M, Weder S, et al. Nutrient intake and status of german children and adolescents consuming vegetarian, vegan or omnivore diets: results of the vechi youth study. Nutrients. 2021;13(5):1707.
- Weder S, Hoffmann M, Becker K, Alexy U, Keller M. Energy, macronutrient intake, and anthropometrics of vegetarian, vegan, and omnivorous children (1⁻3 Years) in Germany (Vechi diet study). Nutrients. 2019;11(4):832.
- Weder S, Keller M, Fischer M, Becker K, Alexy U. Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1-3 years) in Germany (Vechi diet study). Eur J Nutr. 2022;61(3):1507-1520.
- Hrubša M, Siatka T, Nejmanová I, et al. Biological properties of vitamins of the b-complex, part 1: vitamins b1, b2, b3, and b5. Nutrients. 2022;14(3):484.
- Vanga SK, Raghavan V. How well do plant based alternatives fare nutritionally compared to cow’s milk? J Food Sci Technol. 2018;55(1):10-20.
- Desmond MA, Sobiecki JG, Jaworski M, et al. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021;113(6):1565-1577.
- Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, anemia, and iron deficiency anemia among young children in the united states. Nutrients. 2016;8(6):330.
- Weyand AC, Chaitoff A, Freed GL, Sholzberg M, Choi SW, McGann PT. Prevalence of iron deficiency and iron-deficiency anemia in us females aged 12-21 years, 2003-2020. JAMA. 2023;329(24):2191-2193.
- Desmond MA, Sobiecki J, Fewtrell M, Wells JCK. Plant-based diets for children as a means of improving adult cardiometabolic health. Nutr Rev. 2018;76(4):260-273.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
As I covered in my last video, the American Academy of Nutrition and Dietetics considers plant-based diets suitable for pregnancy—as well as during lactation, infancy, and childhood when they are well-planned. So, what goes into planning a well-balanced plant-based diet for infants and kids?
For infants, breast milk is the basis of nutrition, consisting not only of critical nutrients but also immune-boosting compounds providing both short- and long-term benefits. The World Health Organization recommends breastfeeding exclusively for the first six months of life and continuing with the introduction of complementary foods. What do we know about the breast milk composition of plant-based moms? Vegetarian and vegan mothers provide breast milk with comparable nutritional value, with a couple important caveats. In a direct comparison of breast milk from omnivore and vegetarian or vegan moms, the notable difference was lower DHA, the long chain omega 3, in the milk from plant-based moms, due to their avoiding fish––which is probably a good thing, given how contaminated the aquatic food chain is. Thankfully, ensuring proper supplementation with pollutant-free sources can bridge this gap, just like when there is proper supplementation with vitamin B12. So, provided that women are eating enough to cover their nutritional requirements and supplementing with DHA and vitamin B12, vegan moms can produce nutritionally similar milk.
But what about case reports like this, where an infant on a vegan diet is failing to thrive? Or this report? These case reports highlight the importance of good nutrition during this period of life of extremely rapid growth. By around six months of age, solid foods should be introduced. By that age, breastmilk or formula alone is not sufficient to meet the nutritional needs of infants. In the first case study, the infant was exclusively breastfed for 10 months and then was given a nutritionally insufficient rice-based drink. In the second case report, the infant did not receive vitamin D supplementation, which is recommended for all children in early life.
Breast milk should be continued on demand until the child is at least one year old. Formula is an option for women who cannot breastfeed. The VegPlate Junior, a guide put together to help with dietary planning for plant-based kids, has a helpful visual and a more detailed table for infants who have started consuming complementary foods. And finally, as we’ve highlighted before, raw diets are not appropriate to meet the nutritional needs of infants and children.
So, what about nutrient status and growth in vegan children? First, caution must be applied to some populations defined as vegan but who may follow diets that refuse supplementation. This is where you can get the impression from some experts that vegan diets are deficient and harmful. But the current literature suggests that plant-based diets using supplementation are likely to provide the recommended amounts of critical nutrients to allow normal progression of height and weight in children, and can be beneficial. There is a reason to assume that vegans today may be planning their diets more adequately than vegans in the past, as this way of eating has been adopted in the general population, rather than existing solely in fringe groups. And lucky for us, there is a new set of studies aimed at tackling this very question. What are the associations between the modern practice of vegetarian and vegan diets in children and adolescents and health? Enter the VeChi study, the Vegetarian and Vegan Children Study of German kids.
For the one- to three-year-olds eating plant-based in the VeChi study, how did their growth compare to their omnivorous peers? Overall, vegan, vegetarian, and omnivorous kids did not significantly differ. This is in line with other studies. One- to three-year-old veg kids tend to be slightly smaller and lighter (but within the normal range), or have no differences on average compared to omni kids.
When the researchers assessed micronutrients and fatty acids, they noted special focus should be paid to critical nutrients like vitamin D, iodine, and DHA for all children, regardless of their diet, with extra attention on riboflavin, vitamin B12, calcium, and iron for veg kids.
For a toddler, intake of riboflavin (vitamin B2) should be around 500ug/day. The veg kids were short by about 40-70 ug. Luckily, there are an abundant variety of plant-based sources like nuts, legumes, and fortified plant-based milks. For example, if your toddler drinks a cup (240 ml) of fortified soy milk, they have already met the 500 ug recommended intake. For calcium, great plant sources include dark green vegetables (like kale, bok choy, and broccoli), tofu, almonds, and calcium-fortified non-dairy beverages like soy milk.
What about the older VeChi kids, aged 6-18? Although iron intake was low in the toddler group, it was higher in the older veg children, surpassing the omnivore kids. There was no elevated risk for iron deficiency in the veg kids. The higher intake of iron in the veg group may have helped compensate for the lower bioavailability of iron from plant foods. The kids in this group were also more likely to take supplements. Yet, in another recent study, this one of five to 10-year-old Polish kids with adequate reported iron intakes, about eight percent had mild or moderate hemoglobin deficiency.
Regardless of diet, about three percent of one- to two-year-olds in the United States have iron deficiency anemia, and given its consequences for young children, prevention is a top priority. For adolescent and young adult females, iron deficiency anemia is around six percent, and menstruation increases this risk. It’s worth paying special attention to include iron-rich foods at most meals and to give a little boost of iron absorption, combine them with vitamin C rich foods.
What else did we learn about the older VeChi kids? BMI did not differ across groups —they were a pretty healthy bunch. The plant-based kids had been veg for four to five years and most vegan kids took supplements, in particular B12, as they absolutely should. Hopefully the 12 percent who weren’t were eating sufficient amounts of B12-fortified foods, as well as vitamin D. One way the groups did differ was that the vegan kids had significantly lower LDL cholesterol compared to the vegetarian and omnivorous kids. And given that atherosclerosis, our #1 killer, starts in childhood and dietary habits track into adulthood, plant-based diets in childhood could ultimately improve the cardiometabolic health of adults, as well as potentially help prevent obesity, which often persists into adulthood.
Please consider volunteering to help out on the site.
- Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-1980.
- Baroni L, Goggi S, Battino M. Planning well-balanced vegetarian diets in infants, children, and adolescents: the vegplate junior. J Acad Nutr Diet. 2019;119(7):1067-1074.
- Karcz K, Królak-Olejnik B. Vegan or vegetarian diet and breast milk composition - a systematic review. Crit Rev Food Sci Nutr. 2021;61(7):1081-1098.
- Ureta-Velasco N, Keller K, Escuder-Vieco D, et al. Human milk composition and nutritional status of omnivore human milk donors compared with vegetarian/vegan lactating mothers. Nutrients. 2023;15(8):1855.
- Farella I, Panza R, Baldassarre ME. The difficult alliance between vegan parents and pediatrician: a case report. Int J Environ Res Public Health. 2020;17(17):6380.
- Lemoine A, Giabicani E, Lockhart V, Grimprel E, Tounian P. Case report of nutritional rickets in an infant following a vegan diet. Arch Pediatr. 2020;27(4):219-222.
- Kostecka M, Kostecka-Jarecka J. Knowledge on the complementary feeding of infants older than six months among mothers following vegetarian and traditional diets. Nutrients. 2021;13(11):3973.
- Johansson U, Öhlund I, Lindberg L, et al. A randomized, controlled trial of a Nordic, protein-reduced complementary diet in infants: effects on body composition, growth, biomarkers, and dietary intake at 12 and 18 months. Am J Clin Nutr. 2023;117(6):1219-1231.
- Menal-Puey S, Martínez-Biarge M, Marques-Lopes I. Developing a food exchange system for meal planning in vegan children and adolescents. Nutrients. 2018;11(1):43.
- Sutter DO, Bender N. Nutrient status and growth in vegan children. Nutr Res. 2021;91:13-25.
- Alexy U, Fischer M, Weder S, et al. Nutrient intake and status of german children and adolescents consuming vegetarian, vegan or omnivore diets: results of the vechi youth study. Nutrients. 2021;13(5):1707.
- Weder S, Hoffmann M, Becker K, Alexy U, Keller M. Energy, macronutrient intake, and anthropometrics of vegetarian, vegan, and omnivorous children (1⁻3 Years) in Germany (Vechi diet study). Nutrients. 2019;11(4):832.
- Weder S, Keller M, Fischer M, Becker K, Alexy U. Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1-3 years) in Germany (Vechi diet study). Eur J Nutr. 2022;61(3):1507-1520.
- Hrubša M, Siatka T, Nejmanová I, et al. Biological properties of vitamins of the b-complex, part 1: vitamins b1, b2, b3, and b5. Nutrients. 2022;14(3):484.
- Vanga SK, Raghavan V. How well do plant based alternatives fare nutritionally compared to cow’s milk? J Food Sci Technol. 2018;55(1):10-20.
- Desmond MA, Sobiecki JG, Jaworski M, et al. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021;113(6):1565-1577.
- Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, anemia, and iron deficiency anemia among young children in the united states. Nutrients. 2016;8(6):330.
- Weyand AC, Chaitoff A, Freed GL, Sholzberg M, Choi SW, McGann PT. Prevalence of iron deficiency and iron-deficiency anemia in us females aged 12-21 years, 2003-2020. JAMA. 2023;329(24):2191-2193.
- Desmond MA, Sobiecki J, Fewtrell M, Wells JCK. Plant-based diets for children as a means of improving adult cardiometabolic health. Nutr Rev. 2018;76(4):260-273.
Motion graphics by Avo Media
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The Growth and Nutrient Intakes of Children Raised on Plant-Based Diets
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Content URLDoctor's Note
A note from Dr. Greger:
I am thrilled to introduce Dr. Kristine Dennis, our Senior Research Scientist. Dr. Dennis is an experienced nutrition and public health scientist who joined NutritionFacts to expand our research capacity — diving deep into the research, writing scripts, and now, narrating her own videos! You’ll continue to see videos from both of us interspersed in no particular order. I’m so happy Kristine is with NutritionFacts to help expand our capacity and perspectives.
In case you missed my previous video, check out Preventing Gestational Diabetes During Pregnancy with Diet.
For more on vitamin B12, download our infographic, and for more on vitamin D, calcium, omega-3 fatty acids, iodine, iron, and selenium, see our Optimum Nutrient Recommendations.
These are the videos I mentioned: Avoiding Fish for 5 Years Before Pregnancy and Potential Vitamin and Mineral Deficiency Risks on a Vegan Diet.
For more on nutrition in childhood, see our resources for breastfeeding and early childhood.
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