Vegetarian Diets & Children: The Pluses and Pitfalls

A popular question NET staff receives from childcare providers, parents, teachers, and school nurses concerns the well-being of children on vegetarian diets. "Is it okay?" or "Is it healthy?" are two popular inquiries.

Any diet has the potential to be beneficial or detrimental to health. Vegetarian diets are no exception. The answers to the above questions depend on several factors which influence the nutritional adequacy of a vegetarian diet, including the type of vegetarian diet the child follows and the variety of foods they consume. In general, the greater the variety of foods included in the child's diet, the more likely they are to be well-nourished.

Plant foods alone can provide adequate amounts of protein and nutrients if calorie intake is sufficient to meet energy needs and food choices are reasonably varied. However, health experts agree that care is needed in planning vegetarian diets for infants and children who have increased nutritional needs.

A vegetarian is a person who consumes a diet made up mainly of plant foods such as fruits, vegetables, grains, seeds, and nuts. Eggs, or milk and milk products may be consumed, as well. Semi-vegetarians may even consume poultry or fish in addition to these foods. Generally vegetarian diets are classified as follows:

• Vegan - a total vegetarian diet devoid of meat, fish, fowl, eggs, and dairy products.
• Lacto-vegetarian - vegetarian diet that includes fruits, vegetables, grains, dairy food and their products.
• Lacto-ovo vegetarian - a lacto-vegetarian diet that includes eggs. Most vegetarians in the United States fall into this category.

 Vegetarians choose their diets for many different reasons, including health, environmental, ethical, economic, and religious beliefs. All of these reasons are valid and should be recognized as such.

It may be easier for some people to eat meals consistent with the Dietary Guidelines using a vegetarian diet. This is because vegetarian diets tend to be lower in calories, total fat, saturated fat and cholesterol, and higher in carbohydrates than non-vegetarian diets.

Vegetarian diets have also been associated with lower rates of heart disease, high blood pressure, some forms of cancer, adult-onset diabetes and obesity. This is encouraging news to health conscious people. Keep in mind that these health benefits may not be due to diet alone, however. Vegetarians are also more likely to exercise, avoid tobacco, alcohol and other harmful substances, and are typically leaner than non-vegetarians.

 While vegetarian diets can be healthful, many types of non-vegetarian diets can be too. Non-vegetarians need not feel guilty as they can also plan meals that meet the Dietary Guidelines and reduce their risk of chronic diseases.

The American Dietetic Association states that infants, children, and adolescents who consume well-planned vegetarian diets can generally meet all of the nutritional requirements for growth. This is particularly true of children who include dairy products and eggs in their diet.

Children on a vegan diet with a very limited variety of foods are at greatest nutritional risk and more care should be taken in planning their meals. These children need to be sure to include a reliable source of vitamin B12 and vitamin D in their diet. Calcium, iron and zinc intakes may also need special attention, although intakes are generally adequate when reasonable variety and adequate energy is consumed. See the chart below for the best sources of potential problem nutrients.

*Consumption of vitamin C-rich foods (citrus fruits or juices, broccoli, tomatoes, peppers) at the same meal helps the body absorb iron from plant sources.

Children need adequate amounts of protein to grow and develop normally. Although protein intakes of vegetarians are slightly lower than the general population, they are usually more than adequate. Whole grains, legumes, vegetables, seeds and nuts all contain the building blocks of protein. Vegetarians don't even have to worry about combining complementary proteins, as once believed, to make complete proteins. The body will make its own complete protein given a variety of foods and adequate calories.

In most vegetarian diets the danger lies not in getting enough protein, but in consuming enough calories. Vegetarian diets typically contain less calories since most plant foods are low in fat and calories. Adequacy of calories is of particular concern for young children, whose small stomach capacity limits how many calories they can eat at one sitting. Young children who have difficulty meeting energy needs should eat three meals plus several snacks daily. Snacks like nuts, peanut butter, cheese, yogurt, breads and crackers can boost calorie intake.

It is particularly important for children on vegetarian diets to limit the use of low-nutrient foods such as sweets and high-fat foods. Small amounts of such foods are okay, but consumption of too many low-nutrient foods can crowd out nutrient-dense food choices. Parents can consult a registered dietitian to assist them in planning a nutritious vegetarian diet for their child.

When it comes to vegetarian diets, the Food Guide Pyramid with a few adaptations is still a good framework for menu planning. The main concern is in getting enough calories, particularly if dairy products and eggs are not used. To get adequate calories, more servings of grains, vegetables and fruits should be consumed. Legumes, tofu, nuts, peanut butter, and seeds can be substituted for meat, poultry, fish and eggs. Fats, oils and sweets - food with little nutritional value - should still be used sparingly.

Here are some tips from the American Dietetic Association on planning a healthful vegetarian diet:

• Eat a variety of foods.
• Consume enough calories to meet energy needs.
• Minimize use of low nutrient-density foods.
• Explore the variety of meat substitute products available now. Many are made with soy protein, whose nutritional quality is equivalent to that to animal protein.
• Use a variety of fruits and vegetables, including a good source of vitamin C to enhance iron absorption.
• If milk and milk products are consumed, choose low-fat or nonfat varieties.
• Limit egg intake to 3 to 4 egg yolks per week.
• Vegans should consume a reliable source of vitamin B₁₂ such as fortified commercial cereals or soy beverages.
• A vitamin D supplement may be needed for those who don't drink fortified milk and have limited exposure to sunlight.