Appropriately planned vegan, lactovegetarian, and lacto-ovo vegetarian diets satisfy nutrient needs of infants, children, and adolescents and promote normal growth.
Meeting the nutrition needs of infants gives them a great start and puts in place a foundation for lifelong health. The years from birth through adolescence are characterized by growth spurts and other physical changes that result in unique physical requirements. Parents also must be prepared with strategies to navigate the challenges that arise as youngsters assume greater degrees of control over their dietary choices. This chapter provides guidelines for designing nutritionally balanced vegan diets that support each stage of the journey toward adulthood.
As noted in chapter 9, the World Health Organization (WHO) and major pediatric associations recommend exclusive breast-feeding during an infant’s first four to six months; continued breast-feeding until the child is 2 years of age or older also is recommended.
Breast milk, iron-fortified soy formula, or both are the only foods that baby requires—when reliable sources of vitamins B12 and D are included—until the baby is about 6 months old. The importance of providing enough vitamin B12 during a baby’s first six months cannot be stressed enough. Vitamin B12 comes through mother’s milk (assuming the mother ensures an excellent B12 status of her own by consuming a reliable source of vitamin B12). To avoid uncertainty and ensure safe levels of intake, the Institute of Medicine (IOM) suggests that vegan infants receive a B12 supplement from birth. A breast-fed or partially breast-fed baby should also get a vitamin D supplement of 10 mcg (400 IU) per day and may be given iron drops, starting at 4 months of age, until enough iron-rich foods are consumed, as recommended by the American Academy of Pediatrics (AAP). Soy formula provides vitamins B12 and D in specific quantities (check the label).2–9 After 12 months of age (but not before), full-fat fortified soy milk is an acceptable alternative.
Breast-feeding through the next six months and up to 2 years of age or longer (with added complementary foods) confers a number of benefits. Continued breast-feeding provides protection against gastrointestinal and respiratory infection in the infant and possibly discourages overweight and obesity later in life. Longer lactation is linked with less risk of breast cancer in the mother and increased sensitivity and bonding between mother and child.
Depending on the amounts of complementary foods introduced to the baby at the same time, during the period between 6 and 8 months of age, mother’s milk typically provides about 80 percent of an infant’s caloric requirements; from 9 months to the first birthday, it can supply about half the calories, and one-third of the calories from age 1 to 2 years. During this stage, soy formula may be given instead of breast milk; there’s abundant evidence that infants also thrive on this food. Soy formula has the approval of the AAP. It accounts for 25 percent of the formula sold in the United States; one infant in three receives soy formula during his or her first year.3,4,10 (For more on formula choices, see Resources on page 449.)
The foods added midway through a baby’s first year provide many important nutrients—iron in particular, which is essential for cognitive development—and also introduce a new world of sensory experiences. At the six-month point (perhaps a month or two earlier for some babies), the supply of iron stored during pregnancy is depleted. Babies indicate their readiness for solid foods when they can sit, hold up their head, clearly indicate an interest in foods that family members are eating, and the extrusion reflex disappears.
Babies younger than 4 months old should not be fed solid foods. One good reason to wait four to six months to introduce solid foods is to minimize the risk of food allergies.6 Before then, the infant’s intestinal lining has not yet perfected its filtering ability. The intestinal lining is a semipermeable membrane that blocks larger molecules and allows small molecules—the products of digestion—to pass through for the body’s use. By acting as an effective barrier for undigested large molecules, the intestinal membrane prevents them from leaking into the bloodstream and triggering allergic reactions. By about 6 months of age, the baby’s intestinal membrane has become an effective filter that can manage a more diverse diet. The function of a baby’s intestinal lining and its connection to the development of allergies is a lively area of research.6,11
Introducing solid foods at the right stage also may help to avoid weight problems in later life. For example, in children who were formula-fed, introducing solid foods before 4 months of age has been linked with six times the likelihood of obesity when the child is 3 years old.12,13
The introduction of solid foods shouldn’t be delayed too long after the baby reaches 6 months of age; this is a normal and optimal stage of learning for babies. If babies don’t experience this period of fascination with new tastes and textures, they may develop into picky eaters and reject new foods.14 The AAP has concluded that there is no convincing evidence that delaying the introduction of solid foods—including common allergens—beyond 6 months of age has a protective effect against the development of allergies.12,15
The sequence and timing for introducing solid foods to babies in vegan families are similar to those in nonvegetarian households. In the past, strict sequences were suggested, but these rules have been modified as the understanding of food allergies and infant nutrition evolved; many variations work well.4,6,11
Foods rich in iron should be the first solid foods a baby consumes. Offer iron-rich foods at least twice a day. Though spinach, Swiss chard, and beet greens contain iron, little of the mineral is available for absorption (see page 181), so these aren’t listed.2,4,16 Instead, suitable iron-rich foods include:
• iron-fortified commercial infant cereals
• cooked and mashed lentils, beans, and tofu
• cooked and puréed or mashed kale, broccoli, and green beans (for example)
• foods listed in table 10.1 (page 312) and table 6.2 (page 214)
Parents can use a variety of iron-fortified infant cereals and grains to start baby on solid food; in fortified cereals, both ferrous fumarate and ferrous sulphate have been shown to effectively deliver iron.17,18 Mixing iron-fortified infant formula with dry infant or family cereals will increase their iron content. Parents who prefer to start with well-cooked, puréed whole grains (mixed with breast milk or formula) can provide additional iron by giving the baby an iron supplement, in amounts advised by a physician.
Babies can thrive on home-prepared, iron-rich foods, but their digestive system may not be ready for some adult versions. For example, sprouting beans before cooking increases mineral availability; the baby (and the rest of the family) will absorb more iron, zinc, calcium, and magnesium from cooked, sprouted beans. However, the baby shouldn’t be given raw sprouted beans; unwanted components (trypsin inhibitors and hemagglutinins) are present, and these are destroyed in cooking. Due to the potential for food-borne illness, other raw sprouts (alfalfa, clover, radish, and mung bean sprouts) also shouldn’t be given to infants and young children.
Foods that are good iron sources also provide protein and other nutrients. Table 10.1 (page 312) shows the iron, zinc, and protein content of a number of infant foods, both commercially available and prepared at home. In commercial products, the words enriched and fortified indicate that nutrients, such as calcium, iron, or vitamins B12 or D, have been added to products. The label specifies which nutrients have been added.
When vitamin C–rich foods (orange, tangerine, or grapefruit sections; wedges of cantaloupe; raspberries and pieces of kiwifruit, pineapple, and strawberries) are eaten at approximately the same time as iron-fortified cereal or other iron-rich foods, these fruits can boost iron absorption. Fruit is preferable to fruit juice; if juice is given, amounts should be limited to ½ cup (125 ml) per day.2,4,19 Conversely, cow’s milk isn’t a significant dietary source of iron, and it decreases iron absorption; the fact that its use is discouraged in infants up to 12 months old has proved to be a health benefit for babies.
The table below shows examples of foods appropriate for babies. Beans that aren’t listed in table 10.1 have nutrient values in the same general range as those shown. For additional sources of protein, iron, and zinc, see table 3.5 (page 97) and table 6.2 (page 204). Check the labels of prepared foods, because their ingredients may change from time to time and vary in different countries. The infant formulas listed below were selected simply due to availability of data on the US Department of Agriculture (USDA) website; no endorsement is implied.2,20
TABLE 10.1. Iron, zinc, and protein content in selected foods for infants
Some health professionals recommend the use of red meat as a first food for infants in an effort to prevent iron-deficiency anemia in this vulnerable population. However, such a recommendation can set in place lifelong dietary habits linked with increased risk of cardiovascular disease, diabetes, certain types of cancer, dementia, and premature death.22
Foods that contain heme iron need not be viewed as essential iron sources. Recent research shows plant ferritin to be a significant and readily available source of dietary iron.23 Plant ferritin is absorbed independently by the body through a separate transport system, so it doesn’t compete with other dietary iron sources.24 Iron from plant foods has the advantage of being accompanied by abundant protective phytochemicals (see page 260). This form of iron is less irritating to the intestines and doesn’t promote the oxidative stress associated with heme iron. As well, the vitamin C and organic acids present in many plant foods further enhance nonheme iron absorption.
The AAP advises that supplementation of oral iron drops before six months may be needed to support iron stores; this should be done with physician guidance.2 Health Canada also recommends iron supplementation where necessary, for example, where intake of iron-rich foods is insufficient.4,25 For infants who get all their food from formula, the formula chosen should include iron; in that case, supplemental iron isn’t needed.2
Individual recommendations for supplemental iron in preterm infants should be provided by a pediatrician.2,26
Regardless of dietary pattern, iron deficiency is the most common deficiency for infants and has been associated with developmental delays. A Norwegian study found 4 percent of infants had an iron deficiency at 6 months of age and 12 percent at 12 months of age.27 The National Health and Nutrition Examination Survey of toddlers between 1 and 3 years old showed iron deficiency in 6 to 15 percent of these children, depending on ethnicity. The iron fortification of infant cereals, the widespread use of iron-fortified infant formula (among those using formula), and the decline in the use of cow’s milk are given some credit for the reduction in iron-deficiency anemia that has occurred in the decades since 1970.2,25
Babies around the world and throughout human history have proved that they can thrive on an immense variety of adult foods. Getting a baby started on solid foods requires a change in routine. For a successful beginning, it’s best to offer an unfamiliar food at a time when baby is rested, awake, supported to sit up straight, and ready for a new experience. There are two ways to begin. One approach is to give puréed food from a spoon. With a purée, a baby will learn to swallow first and then chew. The other is to offer suitably sized chunks of solid, soft foods, in a method sometimes called “baby-led weaning.” Often, parents use a mix of the two techniques, which are detailed below.
Bacteria can easily upset a baby’s digestive system; hands and any equipment that touches the food must be absolutely clean. Use an easy-to-clean high chair on a mat; a chair that can be placed in the shower is ideal. In addition, all cooked foods must be cooled before serving.
Salt and sugar shouldn’t be added to baby foods so that babies experience natural flavors. The influence of salt on the body begins early, and excess intakes during the first two years have been linked with hypertension and cardiovascular disease in later life. Immature kidneys aren’t designed to cope with added salt.28 Babies aren’t born with a yen for fast food, though they quickly can develop such preferences; as a result, it’s best that the introduction of added salt and sugar be delayed as long as possible.
• Puréed food from a spoon. A typical beginning is to offer a half-teaspoon of iron-rich food that has the consistency of cream soup one to two times per day. It may take a few weeks for a baby to grasp the concept that the food is supposed to stay inside the mouth and then be swallowed.
Though most commercial baby food is puréed, it isn’t essential that all home-made baby foods be puréed, as was common a few decades ago. Foods with the consistency of mashed potato have value because they encourage the development of chewing skills. Soft fruit can be mashed with a potato masher or fork; a baby-food mill, blender, or food processor can purée peeled vegetables and fruits that have had the skin, string, and seeds removed. Puréed food may be strained, though this step isn’t essential. Sources for making wholesome baby foods from scratch can be found in Resources on page 449.29
For convenience, larger quantities of puréed foods can be prepared and poured into the sections of a clean ice cube tray, covered with waxed paper, and frozen. For example, greens (such as kale or collard greens) can be steamed or boiled, then puréed with a little cooking water, formula, or a mixture of these. The frozen cubes can be transferred to a freezer bag or container, with a label showing the preparation date. Cubes keep for up to one month in the freezer and can be thawed and used as needed.
If not frozen immediately, prepared baby food may be covered and kept refrigerated for two days, then discarded if not used. To prevent bacteria from spoiling uneaten food, any food that the baby or the spoon has touched should be discarded.
• Baby-led weaning. Babies who are fed puréed food from a spoon learn the swallowing technique before learning how to gum soft foods into a liquid that can be swallowed. In contrast, during baby-led weaning, babies first gum and gnaw food—exploring its shape, texture, and taste. They gradually learn to move the food to the back of the mouth and then finally learn to swallow. A distinct advantage of this approach is the sensory experience provided by the new foods, such as a strawberry or slice of avocado. This feeding method is summarized in Baby-Led Weaning by Gill Rapley and Tracey Murkett (Vermilion Publishing, 2008). Though the book is far from vegan, the method is easily adapted to plant-based eating, and some vegan recipes are included. Vegan blogs on the subject are available online.
Babies can choke on soft pieces of food or even on puréed food; to avoid this, make sure the baby is sitting upright, not leaning back or slumping (see the “Cautionary Notes for Infant Feeding” on page 318). Fortunately, a baby’s gag reflex is farther forward in his mouth than in an adult mouth; this reflex effectively moves food forward and out, protecting the baby from choking, though caregivers must be nearby and alert.
Examples of starter foods for baby-led weaning include well-cooked beans or tofu, each offered a few days apart and placed directly on the high chair tray or on a plate. Finger-shaped pieces tend to be easiest to grasp, such as toast fingers with a thin layer of peanut butter. With time, baby can manage smaller pieces and clumps of sticky rice, oatmeal, pasta (such as fusilli or rigatoni), or well-cooked peas. These can be offered between milk feedings.
When beans (such as chickpeas or lima beans) are first given to infants, they should be very well cooked, rather than having the firm consistency of canned beans, so they can be mashed between the fingers (or baby gums). (When offering processed or canned food or food from the family table, make sure it has no added salt.)
In a few months, a baby also will learn to eat from a spoon by imitating adult behavior. At some point, a blunt baby-safe fork may prove easier to use with certain foods. As increasing amounts of food end up inside the baby, he or she will automatically adjust intakes of breast milk or formula. Milk feedings (breast or iron-fortified formula) can continue as a major part of babies’ diets until the age of 2 or more.
• Finger foods. At about 6 to 8 months of age, infants discover their amazing ability to pick up objects with their whole hand and eventually with thumb and forefinger. They often are so excited by this achievement that they’d rather explore this new skill than eat. Messy eating is normal and is a part of learning. Though parents may wonder if any food reaches their stomachs, babies often eat more when they are allowed to feed themselves.
As a precaution, solid foods should only be given to a baby seated in a high chair. The items should be soft enough to be gummed (rather than chewed) or to soften in the mouth. Examples include steamed tofu fingers; well-cooked beans or lentils; florets of boiled broccoli or cauliflower; fingers or cubes of soft-cooked vegetables or fruit; green beans (string removed); slices of raw, soft fruits, such as avocado, banana, kiwifruit, mango, melon, or papaya; chunks of pita bread or tortilla; toast fingers spread with hummus or peanut butter; teething biscuits; different shapes of cooked pasta; unsweetened ready-to-eat dry cereal; pieces of rolls or pancakes; and unsalted crackers.
The baby should be monitored after the first introduction to each individual food, to ensure the food causes no allergic reaction (see page 319). If not, the food can be mixed with other well-accepted foods. Soon the baby can share the family’s tofu stir-fries, lentil curries, chilis, ratatouille, pasta dishes, stews, vegan pizza, risotto, roasted vegetables, and nut or seed “creams.” (For the latter, blend nut butter with soy milk, water, or juice.) The baby’s portion shouldn’t have added salt, sugar, tamari, or Bragg Liquid Aminos.
Tables 10.2 and 10.3 show sample menus suitable for infants who have reached 7 months and 11 months of age, respectively. In some cases, mashing the offered food is optional. Replace breast-feeding by formula feeding where appropriate. A baby also may accept water in a cup. Before the baby reaches 6 months of age or if there’s any concern about safety, the water should be boiled and then cooled.
Healthy babies know how much to eat. Some eat a lot, some a little; variation in appetite from day to day is perfectly normal. If they’re sick or teething, they may not want much food. A baby’s signals, such as reaching out, turning her or his head away, or spitting food out, will indicate when to begin or stop feeding.
One way to tell whether a baby is starting to swallow any solids is to watch for intact pieces appearing in the diaper. Over time, mastication and digestion of these foods will improve. Strained apricots and prunes may cause loose stools; these can be omitted until the baby’s digestive system has matured a little. For infants older than 6 months, strained apricots and prunes or a little prune juice may help in preventing constipation.31 Beets or greens can have obvious, but harmless, color effects on the stool.
TABLE 10.2. Sample menu for a 7-month-old infant
TIME OF DAY |
EXAMPLES OF FOODS TO OFFER |
Early morning |
Breast-feeding |
|
Breast-feeding Iron-fortified infant cereal Mashed soft strawberries or other fruit |
Snack |
Breast-feeding Whole-grain toast cut into small pieces or strips |
Lunch |
Breast-feeding Steamed tofu cubes Cooked and mashed broccoli or other vegetable |
Snack |
Breast-feeding Cooked unsweetened prunes or other fruit |
Supper |
Breast-feeding Iron-fortified infant cereal Well-cooked and mashed lentils Cooked and mashed sweet potato or other vegetable |
Snack |
Breast-feeding |
TABLE 10.3. Sample menu for an 11-month-old infant
Baby’s meals should be viewed as four to six small feedings, given when the child is hungry and interested, rather than scheduled as three meals a day.31 As baby gets older, feeding times are easier when small portions of solid food are put directly on the high chair’s tray; later, food can be placed on a plastic plate or in a bowl with straight sides. When the baby finishes a small portion, more can be offered; amounts can be increased gradually. Do not force solids. If solid food is rejected, due to illness, for example, focus on fluids (breast milk or formula) instead. By 11 months, though breast-feeding may be offered throughout the day (as in table 10.3), some meals or snacks may be limited to solid foods.
• Stay nearby while the baby is eating.
• Don’t let anyone other than the baby put pieces of food into her mouth, including older children who want to be helpful.
• Avoid small pieces that can cause choking, such as nuts, sunflower seeds, pumpkin seeds, peanuts, raw peas, corn kernels, popcorn, whole grapes (these can be halved or quartered), raisins, and hard candies. Avoid chunks of hard, raw fruits and vegetables (carrot can be grated) and vegan “hot dogs” or other cylindrical foods.
• Remove pits from apricots, cherries, peaches, and plums.
• Don’t offer peanut butter on a spoon; spread it on a cracker or piece of toast.
• Teach children how to chew well.
• Avoid giving babies black or green tea, coffee, and foods with added salt, fat, and/or sugar.
• Check labels on baby food jars to ensure the items contain no added sugar.
• Honey should not be given to babies under 1 year of age; it can lead to botulism in the immature intestines of young infants. (Also, it’s not a vegan food.)
• For ease in swallowing, thin cashew or almond butters by blending with fortified soy milk, water, or juice.
• Never give a baby unpasteurized juice or sweetened juice. Limit intake of fruit juice to ½ cup (125 ml) per day or less; more can crowd out other important foods. Juice can be mixed with an equal amount of water.
• Choose organic baby food (homemade or commercial) as often as possible.
• Don’t try to persuade the baby to hurry or to eat more than she wants.
• Communicate these cautionary notes to the baby’s caregivers.
Babies as young as 3 months may begin teething, although the usual ages when teeth begin to appear can be anywhere from 6 to 12 months. During teething, babies appreciate cool items to soothe their sore gums, including:
• a clean, cold, wet washcloth
• a plastic teething ring that has been refrigerated
• spoonfuls or chunks of homemade fresh orange sherbet. (To make this, put equal parts of a peeled, chopped, and seeded orange and orange juice in a blender, process until smooth, and then freeze for about an hour until fairly firm.29)
• commercial or homemade vegan teething biscuits (search online for products or recipes)
The early introduction of solid foods—especially at or before 3 months of age—has been linked with the development of food allergies; current recommendations suggest beginning the introduction of solid foods at about 6 months of age. Families with a history of allergies should seek advice from their health care provider; pediatricians and allergy specialists can help individualize the introduction of foods beyond breast milk to minimize the risks for the baby.11,16,32,33 Vegan parents should note that up to 94 percent of skin-prick allergy tests have yielded false-positive results for soybean, meaning that soy can appear to be an allergen when in fact it isn’t.11 True allergies to soy often are outgrown during childhood. Because a child is allergic to one legume (such as soy or peanuts), it doesn’t follow that they’ll be allergic to others in that family.16
Concepts regarding gluten-containing cereals and potentially allergenic foods, such as peanut and nut butters, have changed in recent years.11,16,33 Introducing babies to cereals at 6 months of age and after, while they’re still breast-feeding, is linked with reduced likelihood of reactions to such grains, compared to introduction either before 3 months of age or much later than 6 months. Late exposure to gluten (after 7 months of age and after breast-feeding has been discontinued) may increase risk of celiac disease. Breast-feeding seems to play a protective role in reducing reactions to gluten or to a potential allergen, perhaps by supporting the immune system and the maturation of the intestinal tract.32–34
For any infant, and especially those with a family history of allergies, it’s wise to introduce foods one at a time and wait three or four days to see if there’s any reaction before introducing another new food. (Mixed foods shouldn’t be introduced unless the individual ingredients have been given without reaction.) Signs of food allergy can appear on the skin (redness or itchiness), in the respiratory tract (stuffy nose, wheezing, or runny eyes), or in the gastrointestinal tract (colic that doesn’t go away, frequent spitting up, or diarrhea). Guidelines regarding the ideal time to introduce foods that tend to be allergenic have been changing in recent years; parents should follow the advice of the family physician or dietitian.6,11,12
As a baby’s sole nourishment for the first six months, breast milk or formula generally supplies enough fluid. After that, sips of water may be offered from a cup, or water may be given daily in a bottle. Water intake becomes more important as solid foods replace breast milk or formula and is especially important when the weather is hot or if the baby has a fever. Because iron-fortified infant formula is so nutritious, it’s preferable for babies until age 2, rather than fortified soy milk.31
To avert possible dental damage, a baby shouldn’t be put to bed with a bottle of formula or juice or given a bottle as a daytime pacifier. Instead, a bottle of plain water or a pacifier should be used. Don’t dip pacifiers in sugar, honey, or other sweet substances.31
When breast milk supplies most of a baby’s calories, a lactating woman must ensure that she has an adequate intake of vitamin B12 (see chapter 9) because this vital nutrient is passed to the baby through her milk. Severe B12 deficiency can lead to irreversible brain damage in the infant, thus a reliable source is critical. To avoid uncertainty and be safe, the Institute of Medicine suggests that vegan infants receive a B12 supplement from birth. For entirely formula-fed infants, infant formula is fortified with sufficient vitamin B12.5
After the baby has moved to solid foods, he or she should receive a vitamin B12 supplement or should have B12-fortified foods or formula three times a day. Recommended vitamin B12 intakes are 0.5 mcg at 6 to 12 months of age and 0.9 mcg at 1 to 3 years of age; any excess is excreted in the urine. (See the appendix on pages 446 and 447 for recommended intakes of vitamins and minerals at different ages.)
For breast-fed babies up to 1 year old, the recommended intake is 10 mcg (400 IU) given as a supplement; this amount is supplied by infant formula, so a supplement isn’t necessary for formula-fed babies. Newborns and infants up to 6 months old shouldn’t be given more than 25 mcg (1,000 IU) of supplementary vitamin D per day.35 Current practices advise that infants younger than 1 year of age avoid direct sunlight, due to the risk of skin cancer.
For children from 1 to 3 years of age, the recommended vitamin D intake is 15 mcg (600 IU).35 In addition to its requirement for bone mineralization, vitamin D is believed to be important for prevention of development of type 1 diabetes as well as other chronic diseases later in life.36
Although there’s no Recommended Dietary Allowance for essential fatty acids, Adequate Intakes (AI) (see page 182) have been set at 0.5 grams of alpha-linolenic acid (ALA) for babies from 6 to 12 months old and 0.7 grams for children from 1 to 3 years old; higher amounts may be advisable for vegan children.
Sufficient omega-3 fatty acids can be obtained from breast milk or DHA-fortified infant formula. Additional steps can be taken to maximize long-chain omega-3 fatty acid DHA, which may be preferable.
• If a breast-feeding mother consumes a supplemental source of DHA, her intake should be at least 200 to 300 mg of DHA per day.
• If infant formula is used, one with added DHA should be selected.
• If no direct DHA sources are provided double the AI for ALA. ALA sources include ground flaxseeds, chia seeds, hempseeds, and walnuts (walnuts could be ground and added to cereals, spreads, cookies, or other foods). Quality oils that provide a 1:1 or 2:1 ratio of omega-6 to omega-3 fatty acids are available; some provide DHA in addition to ALA. Read the label to determine appropriate serving sizes. The source of ALA can be an oil blend that provides a mixture of omega-3, -6, and -9 fatty acids.
• If breast-feeding stops between 1 and 3 years of age and the child gets full-fat fortified soy milk rather than formula, then he or she should either obtain 0.7 grams of ALA from the foods listed above plus 70 mg of supplemental DHA or receive double the ALA, meaning 1.4 grams per day.37–39 (For more on omega-3 fatty acids, see table 4.5 on page 129 and other sections in chapter 4.)
When young children leave breast or bottle behind (at least some of the time), their nutrient needs change again. They move from a reliance on breast milk or formula to family foods, and expand their exploration of textures, tastes, and their ability to feed themselves. They can be nutritionally vulnerable during this time of change, of growth spurts, and of discovering the power of saying “No!” The key to a successful transition to healthy vegan foods is to be flexible, adjusting for the child’s individual preferences, while following a balanced diet plan. This can be averaged over time.
The recommended intake is 0.9 mcg per day. From a larger dose, a smaller fraction is absorbed. Children should receive B12 from one of the three sources below:
• a daily supplement that provides 10 to 40 mcg of vitamin B12
• a twice-a-week supplement of 375 mcg of vitamin B12
• a food fortified with at least 0.3 mcg of vitamin B12 (or 5 percent of the DV) three times a day. (This could include some combination of infant formula, fortified soy milk, fortified cereals, and nutritional yeast; check labels. Because the amounts of vitamins in fortified foods can vary, some experts suggest also giving a daily or weekly supplement that provides B12.)
The recommended intake is 15 mcg (600 IU) per day. Parents should select one of the following options daily to provide adequate vitamin D:
• a daily supplement that provides 15 mcg (600 IU) of vitamin D
• foods fortified with 1.7 mcg (70 IU) of vitamin D three times a day (such as 6 ounces or 180 ml of infant formula or fortified soy milk) plus a daily supplement that provides 10 mcg (400 IU) of vitamin D
• sun exposure on face and forearms between 10 a.m. and 3 p.m.; ten to fifteen minutes for light-skinned children and twenty minutes for those with darker skin
A combination of sun exposure, fortified foods, and supplements can work well. Because adequate sun exposure isn’t an option in winter months at latitudes above 37 degrees N (see page 224), children living in these locations should receive vitamin D using supplements and/or fortified foods. Excess sun exposure and vitamin D intakes above 63 mcg (2,520 IU) per day should be avoided (see pages 222 to 230).35,40
FIGURE 10.1. Typical daily vegan food guide for 1- to 3-year-old children
Include a wide variety of foods. Offer water from a cup between meals. |
|
Milks and formula: Total 20 to 24 oz (600 to 700 ml) |
|
Five servings of breast milk, commercial infant formula, full-fat fortified soy milk, or a combination of these. |
|
Breads and cereals: 4 or more toddler-sized servings |
|
1 toddler-sized serving = |
|
¼ c (60 ml) cooked cereal, grain, or pasta ½ c (125 ml) ready-to-eat cereal |
½ slice bread or a similar-sized piece of tortilla, pita bread, or roll |
Vegetables: 2 or more toddler-sized servings |
|
1 toddler-sized serving = |
|
¼ c (60 ml) cooked vegetables ⅓ c (85 ml) vegetable juice |
½ c (125 ml) salad or other raw vegetable pieces |
Fruits: 2 or more toddler-sized servings |
|
1 toddler-sized serving = |
|
½ to 1 fresh fruit ¼ cup (60 ml) cooked fruit |
¼ cup (60 ml) fruit juice (limit to ½ cup total per day) |
Beans and alternatives: 2 or more toddler-sized servings |
|
1 toddler-sized serving = |
|
¼ cup (60 ml) cooked beans, peas, or lentils 2 oz (60 g) tofu or tempeh ½ to 1 oz (15 to 30 g) meat substitute |
2 oz (30 ml) soy yogurt 1 to 2 T (15 to 30 ml) peanut butter |
Nuts and seeds: 1 or more toddler-sized servings |
|
1 toddler-sized serving = |
|
1 to 2 T (15 to 30 ml) nut or seed butter |
2 T (30 ml) nuts or seeds |
The AI for essential fatty acids has been set at 0.7 grams of ALA. Many experts suggest that this should be doubled to 1.4 grams of ALA for vegan toddlers to support conversion of ALA to DHA, or that additional DHA may be beneficial. Options for getting these essential fats are:
• breast milk (see page 305 for a mother’s DHA sources)
• infant formula that includes DHA
• nuts, seeds, or oils in quantities that provide 0.7 grams of ALA (see table 4.5 on page 129) plus a supplement that provides 70 mg of DHA (vegan DHA sources are available online)
• nuts, seeds, or oils in quantities that provide 1.4 grams of ALA, such as ½ teaspoon (2 ml) of flaxseed oil, 1 teaspoon (5 ml) of an oil that contains a blend of omega-3, -6, and -9 fatty acids, 2 teaspoons (10 ml) of chia seeds, 2 tablespoons (30 ml) of hempseeds, or 3 tablespoons (45 ml) of walnuts (see table 4.5 on page 129).
Oils rich in omega-3 fatty acids are unstable and have a low smoke point, so they shouldn’t be used for cooking. Meanwhile, chia seeds can be added to cooked cereal; hempseeds; to smoothies and cereals; and walnuts to cereals, loaves, patties, and other foods, such as vegan pesto and other spreads.
The recommended intake is 90 mcg, which can be obtained from ⅓ teaspoon (2 g) of iodized table salt. However, this amount of iodized table salt also delivers 388 mg of sodium—or more than one-third of a child’s recommended intake for the day (1,000 mg sodium).
Another reliable way to provide the recommended amount of iodine is in supplement form or by a using a combination of supplement (which may provide only 50 mcg of iodine) plus a little iodized salt. Kelp is an option only if the amounts of iodine are listed on the label; otherwise, the kelp’s iodine content may vary greatly and be insufficient or excessive.
Toddlers can be given a vegan multivitamin-mineral supplement that includes vitamins B12 and D and iodine, as well as calcium, iron, and zinc, to top up their intakes of these nutrients from foods, especially during a stage when meals seem unbalanced or insufficient.41–43 Vegan supplements can be found in local natural foods stores or sourced online. All supplements should be safely stored away from children.
At weaning, little ones are nutritionally vulnerable. It’s hard to beat human milk and infant formula, which are so well suited to the first years of life. Toddlers are switching from these easily digested fluids—which are tailored to infant needs and in which approximately half the calories come from high-quality fat—to an assortment of foods that can be more challenging to eat.
Children have small stomachs and may need meals or nutritious snacks every two to three hours. Youngsters thrive on healthier high-fat plant foods, such as tofu, nut and seed butters, avocado, soy yogurt, soy formula, and fortified full-fat soy milk. In contrast, bulky foods (such as salads) can fill a child’s small stomach while providing few calories. For good nutrition, foods from three to five of the food groups listed in figure 10.1 on page 323 should be included at each meal; at least two food groups should be represented at snack time. Any of the foods can be served any time of day. For example, in some parts of the world, lentils are regularly served at breakfast. Though whole grains are excellent choices, vegan parents may be surprised to learn that refined breads, cereals, crackers, and pastas, which are lower in fiber and bulk, also can be healthful parts of a toddler’s diet. Iron-rich foods, such as iron-fortified dry cereals and other items listed in tables 10.1 (page 312) and 6.2 (page 204), should be provided often.44
It’s best to offer meals at regular times. Children shouldn’t eat while running or playing; avoid or keep to a minimum other distractions (such as television or tablets). To prevent choking, seat children at the table with an adult nearby. It’s natural for children to take time to finish their meals, and adults may want to match their children’s pace at the table instead of hurrying them along. Leisurely mealtimes are viewed as one of the health benefits of the Mediterranean diet.
Healthy snack ideas include muffins (made with nutritious ingredients and kept handy in the freezer), soy yogurt, a tray of cut-up veggies with an avocado or bean dip, or a smoothie with hempseeds.
If a child isn’t hungry, he or she shouldn’t be forced to eat. Although regular meals are important for children, it’s acceptable if they miss a meal occasionally. By deciding when and how much to eat, a child learns self-confidence and independent thinking.
Meal and snack times provide an arena in which children and parents work out issues of independence (feeding oneself) and dependence (being fed). A creative approach can have better results than efforts to force feeding. For example, when one small girl stubbornly refused to be fed with a spoon, her parent gave her the spoon and let her feed the adult instead. As food dribbled down the adult’s chin, the pair dissolved in laughter, harmony was restored, and the meal proceeded.
Children shouldn’t be punished for not eating; such actions can override their natural cues regarding hunger and fullness. Parents who try to force a child to eat will likely fail—and possibly steer the child toward eating problems. Instead, parents and caregivers can decide which foods to serve and allow the child to choose whether and how much to eat. Offering a selection within a food group (such as bananas, blueberries, or papaya; or bread, tortillas, or noodles) provides choice, as well as motivation to eat something. A child may reject a food on one or many occasions yet accept and enjoy it in the future.
On the other hand, parents needn’t cater to every wish. Nor should dessert be used as a bribe; this raises the status of sweets so they seem more desirable. Instead, it’s best to remove uneaten food without comment. This portion or another nutritious choice can be offered again at snack time.
By 12 months of age, children can become independent eaters and feed themselves. Parents encourage autonomy and avoid conflict by providing nutritious finger foods and allowing children to accept or refuse what they wish. Though the “Vegan Food Guide for 1- to 3-Year-Old Children” (see figure 10.1 on page 323) is helpful, a child’s diet won’t always follow the guide’s recommendations. Adults can model good eating habits and be confident that their example will be followed.
It may seem that five foods favored by children can’t possibly sustain a child’s life. Yet over the course of a day, if a child that weighs 25 to 33 pounds (11 to 15 kg) consumes 3 cups (750 ml) of fortified soy milk, two peanut butter sandwiches, two sliced bananas, and ½ cup (125 ml) of peas, he or she receives enough calories and triple the recommended intake for protein. These foods provide more than enough B vitamins, vitamins A, C, E, and K, calcium, iron, magnesium, phosphorus, selenium, and zinc, plus 85 percent of the potassium and more than half the recommended intake for vitamin D. Even though this “picky eater” firmly rejects every other food in the house, these simple choices are packed with nutrition.
Though children may appear to be fussy eaters, examining their food intake, energy, and growth often proves they’re managing well and even thriving. They may reject much on their plate at meals, while between-meal snacks disappear easily. That makes snack choices important.
Parents can employ other strategies to pique a child’s appetite, such as inviting them to participate in simple food preparation. One vegan father overcame concerns about his daughter’s lack of interest in food by inventing a concoction he called Sneaky Dad’s Pudding. He helped his daughter to climb up on a stool by his side to add nutritious ingredients to a blender. These included strawberries, a banana, cocoa or carob powder, hempseeds, nut butter, a wedge of avocado, a little orange juice, and fortified soy milk to thin the mixture to the desired consistency. He then allowed her to push the button to start the blender. As cocreator of this tasty combination, she enjoyed sharing it with her dad, while the father could rest assured that she wasn’t developing a deficiency.
Creativity can ensure that children consume vegetables, even if they’ve put a ban on them; children do outgrow such temporary distastes. Meanwhile, muffins can be prepared with grated carrots, cooked squash, or pumpkin as an ingredient. Children often will add avocado, tomato, or sprouts to a veggie burger or taco, at the same time that they might shun cooked spinach. Parents can set out platters of cut vegetables for snacking.
To encourage picky eaters, one of the best tools is perseverance. Mealtimes can be made pleasant and include at least one favorite food. The child can be encouraged to try something different, and his or her success in trying new foods celebrated. Table 10.4 suggests solutions to a few of the common challenges.
Although most parents didn’t learn how to prepare wholesome and delicious vegan food as children, this may be the ideal time to develop this skill.45 If they’re good role models, parents and caregivers can inspire their children to develop healthy diets. Research associated with 1,254 people from 61 to 90 years old whose diets and health had been tracked since childhood showed that good habits, such as vegetable consumption, were set in place early in life.46
TABLE 10.4. Food challenges and solutions
Adults who spend time with youngsters in shared food preparation can reap a rich harvest in good nutrition habits. Meal planning and preparation can become a time for quality instruction and interaction—even if little helpers who are fascinated by the process cause these jobs to take longer. Meals needn’t be exotic or complicated. In fact, most youngsters reject fancy foods and prefer easily identified finger foods: raw vegetables, fruit, simply prepared chunks of tofu, and toast or crackers with a spread. By encouraging consumption of these foods and guiding youngsters’ developing palates, vegan parents can ensure their children will continue to build on the healthy start they’ve provided.
There’s no “ideal” rate of growth for children, despite the prevalence of growth charts and percentile rankings. At certain stages, children seem to shoot up a few inches overnight or change from a roly-poly toddler to a lean older child. During other periods, increases in height or weight are tiny and development occurs mainly in other realms, such as language or motor skills. If one or both parents are small or tall, their genetic influence probably will appear in the next generation.
Bigger isn’t always better, and slightly slower development can be healthier overall. For example, the fastest rates of growth and early puberty in girls may be linked to a higher risk of breast cancer later in life. However, if there’s a marked, significant change in a growth pattern, there may be other possible causes.
The standard growth charts used in medical clinics have been developed by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) and are available online. They include WHO Growth Charts (birth to 24 months) that reflect growth among children who were predominantly breast-fed for at least four months and who were still breast-feeding at their first birthday. The CDC Body Mass Index (BMI) Percentile Calculator for Child and Teens also is available. See Resources on page 449).47,48,69
Several decades ago, the CDC studied the growth of 288 vegan children ranging in age from 4 months to 10 years old. These children lived in a community called The Farm in Summertown, Tennessee. Researchers viewed their parents as “relatively well informed regarding issues related to vegetarianism.” The resulting data showed that the average weights and heights of the children in the study group were within normal ranges and were between the 25th and 75th percentile.
Infants born at The Farm had normal birth weights, and their growth was typical of predominantly breast-fed children. The importance of weaning vegan children on to nutritious foods that provide plenty of calories was emphasized.49 The children received full-fat soy milk fortified with vitamins B12, D, and A, plus other nutritious vegan foods. Peanut butter sandwiches were a favorite food at lunchtimes. Many children consumed Red Star Vegetarian Support Formula nutritional yeast in a variety of dishes (a product made popular in the marketplace by this predominantly vegan community).
For healthy growth throughout childhood and adolescence, children need foods and beverages that are concentrated sources of calories, minerals, and vitamins,1 including:
• avocados, nut butters, seed butters, hemp hearts, and bean-based spreads, such as hummus
• fortified full-fat soy milk, tofu, or soy yogurt
• whole-grain breads, cereals, and baked goods, such as healthful muffins, energy bars, and cookies
• refined, enriched grain products (such as pasta); used occasionally, these can increase caloric intake
• thick soups or stews (a cup of pea soup provides 136 calories and 9 grams of protein, whereas a cup of snow pea pods provides 26 calories and 2 grams of protein)
• puddings, frozen desserts, and shakes made with healthful ingredients
Consuming soy foods during childhood and/or the teen years may reduce cancer risk in later life by as much as 60 percent. In girls, soy isoflavones impact breast cells during breast development in ways that confer some protection against breast cancer. Most girls in Asia grow up eating soy foods, which may help to explain the lower rates of breast cancer in those countries.50,51
By setting vegan children apart, a vegan diet may cause difficulties at school, but many parents find this isn’t a big hurdle to overcome. Many nonvegan parents have children with food allergies; others wish to have healthier foods at special events. When parents collaborate to help school staff plan food-related events that support children’s health, would be accepted by the children, and don’t involve extra work for the staff, improved dietary choices can be integrated smoothly.
For those who wish to make more-permanent positive changes in local school meals, allies may include vegetarian-friendly teachers, school food-service personnel, or other parents. Naturally, the school food-service staff will appreciate supportive ideas, input, encouragement, and praise for their efforts. It may interest school personnel to know that there’s a widespread movement to improve the healthfulness of school meals and to include entirely vegetarian options for those who want them. The Vegetarian Resource Group offers numerous practical and helpful resources,52 as does the Physicians Committee for Responsible Medicine (see Resources on page 449).
To make lunch box challenges a little less daunting, invest in BPA-free containers of various sizes and with spill-proof lids, of the type available at outdoor equipment stores. These will safely transport a serving of fortified soy milk, a protein-rich vegan soup or stew, hummus, a veggie burger, or marinated tofu to school and special events. Hot foods, such as soups, stews, chilis, beans, and veggie wieners, can be packed in a thermos bottle and will keep safely for several hours (preheating the thermos bottle with boiling water helps it to retain heat). Perishable cold foods can be placed in an insulated lunchbox or bag with frozen gel packs.
When children dine away from home, it often helps to supply them with a high-protein item to help hosts who are unfamiliar with vegan foods. Typically, the rest of the meal presents no problems.
The safety of more restrictive diets, such as fruitarian and 100 percent raw diets, has not been established for infants and children, although there have been a few unfortunate case reports in the medical literature. These diets can be very low in energy, protein, some vitamins, and some minerals and cannot be recommended for this vulnerable population.1
If parents are consuming a well-balanced raw diet—as described in Becoming Raw by Brenda Davis and Vesanto Melina (Book Publishing Company, 2010)—their diet can be adapted and extended for children with the addition of more energy-dense food, including cooked legumes, grains, and starchy vegetables, such as steamed yams. It’s essential that reliable sources of vitamin B12, vitamin D, and iodine are provided.
When children are involved, dining out can be a pleasure or a nightmare. Some children are natural explorers; others want familiar foods. For the latter, it can make a big difference to bring favorite crackers, individual packs of chocolate soy milk, mini portions of peanut butter, a well-liked sandwich, or a favorite trail mix. With one or two items brought from home for the child, the rest of the meal can come together easily.
When possible, advance planning helps, including online searches for vegan-friendly restaurants (see Resources on page 450). A good alternative may be an ethnic restaurant, including Chinese, East Indian, Mexican, Middle Eastern, Japanese, or Thai.
Breakfast can include oatmeal, cereals, fruit, toast, jam, peanut butter, and juices, which are all widely available. Cereal can be eaten dry, with juice, or with fortified nondairy milk brought separately. For lunch or dinner, most food outlets typically serve rice, baked potatoes, pasta, vegetables, or salad; salad bars often include peas, chickpeas, beans, and tofu.
For car travel, a big bottle of water is helpful to wash berries, cherry tomatoes, or peas in the pod purchased en route; a knife to cut fresh fruit or vegetables is useful, too.
Based on observations of what their friends may be eating, children are likely to ask for treats. Sometimes, when the treats requested are unhealthy, a gentle, firm “no” is essential.
However, is it essential that a treat be a sugary or fatty food that undermines health? In establishing lifelong eating patterns, the definition of a healthy treat—and the appropriate time to enjoy it—is worth considering. Though children ask, adults don’t have to buy unhealthful foods and beverages. Instead, the meaning of “treat” can be redefined to include nutritious choices, organic foods, fresh berries, or fruit juice. A healthy alternative to soda pop can be made with sparkling water plus a fresh-squeezed orange or a small amount of fruit juice. Frozen popsicles can be prepared with blended fresh mango and orange juice or with fruit and nondairy yogurt. This doesn’t mean that the occasional serving of chips, chocolate, or candy is forbidden—they’re just not regular fare.
Some adults try to numb their feelings with unhealthful foods or beverages. If youngsters know where these “treats” are and whether or not they’re prized, a message is relayed to impressionable minds that “treats” are the best solution to life’s problems. However, if a child is upset, but not hungry, the use of food shouldn’t be a remedy. Attention and affection might be the appropriate reward instead.
Grocery shopping can be a challenge when children push for nonnutritious products. Before giving in, a parent or caregiver should reflect on typical North American diets and their troubling effects. Among children between 6 and 19 years of age, one in six is overweight or obese. During the last two decades, the proportion of American children who are overweight has doubled; the proportion of overweight teens has tripled.53,54
Trends that have accompanied this startling weight gain among youngsters include increased soft drink consumption, low fruit and vegetable consumption, and inactivity. Although seeing an infant drinking cola from a baby bottle is shocking, this situation is more common than most parents would care to imagine. By adolescence, 32 percent of girls and 52 percent of boys drink three or more 8-ounce (240 ml) “servings” of soda per day. Meanwhile, just 21 percent of children eat as many as five servings a day of fruits and vegetables, whereas at least six to nine servings are recommended for school-age children.55 When an American child eats a vegetable, 46 percent of the time, they consume fried potatoes. When children are awake, one hour out of four is spent watching television; those who watch the most TV are most likely to be obese. Worse, high-calorie snacks tend to accompany the TV viewing.54,56
These habits are largely responsible for the 300 percent escalation in health care costs directly attributable to childhood obesity. Compared to children with an optimal BMI, those who are overweight are more likely to become obese adults, with a correspondingly greater likelihood of developing coronary heart disease, hypertension, diabetes, gallbladder disease, respiratory ailments, orthopedic problems, and some cancers. In addition, children who carry excess weight often experience psychological stress, poor body image, and low self-esteem.54
Besides shifting to a healthier diet, other strategies can redirect societal trends toward physical fitness and optimal weight. For example, activity levels have been shown to increase when bike lanes are installed on streets, when walkways are well lit, and when space is created for indoor and outdoor recreation. Even a little more exercise is beneficial.54 Parents should take the lead by providing healthier meals and snacks and initiating appropriate physical activity to instill good habits at an early age.
The nutritional needs of rapidly growing children are quite different from those of adults. Youngsters are involved in a remarkable bodybuilding project, which eases off slightly through the preteen years and then revives with new force in early adolescence.
At around 2 years of age, a toddler may weigh 27 pounds (12 kg) and be 34 inches (86 cm) tall. Three years later, that child may weigh 50 percent more and be 9 inches (23 cm) taller. To support this growth, the child’s diet must be rich in protein, minerals, essential fats, and the other nutrients required to form new cells. Vegan food choices throughout the day can meet these demands.
Starting the day with a healthy meal helps children pay attention, concentrate, remember, and do better in English, science, and overall test scores.57 Appealing and nutritious breakfasts can include scrambled tofu or a smoothie with hempseeds, pumpkin seed protein, sunflower seeds, or another type of smoothie booster (see page 387). A breakfast bar (similar to a salad bar) consisting of muesli, granola, or flaked unsweetened cereal, along with jars of seeds, nuts, and shredded coconut, can be left in place near the breakfast table (this arrangement also provides convenient snacks). These choices can be supplemented by cooked cereal, fresh fruit, and fortified nondairy beverages in the morning. When there’s time for a leisurely breakfast, prepare pancakes together, and top them with fruit or fruit sauce. (For an instant version, warm vegan frozen waffles in the toaster.)58 Such activity gives children skills and confidence about cooking.
Advance planning can help to ensure that children do have breakfast. For those who are too sleepy to eat before heading to school or day care, prepared items (such as a nutritious home-made muffin or a nut butter sandwich) can be eaten in the car or during a morning break with a cup of fortified soy milk.
If lunches are packed at home, they should include protein-rich foods and whole grains to supply energy through the afternoon. Some children prefer the security of the same sandwich every weekday. Others prefer a rotation of favorite foods. Nutritionally, an important feature of any lunch is that it gets eaten, so children should participate in choosing the lunch menu; packing lunch bags or boxes can then be a pleasant evening (or morning) task.
Choices that can be packed in insulated lunch bags include soy yogurt and bean, potato, pasta, or grain salads. Leftover pizza, pasta, and rice dishes, including gluten-free options, are also nutritious. If a child prefers sandwiches, table 10.5 provides a selection that meet a child’s nutritional needs when combined; start with a grain product from the column on the left, then add a spread or two and a protein filling. Where appropriate, garnish with a few vegetables or provide them on the side.
TABLE 10.5. Grain products, spreads, protein fillings, and vegetables for vegan sandwiches
It’s well-known that most people return repeatedly to six to ten favorite meals. Time-tested meals that children love include vegan pizza, chili (with or without veggie meat), pasta sauce (with cooked red lentils) and spaghetti, veggie burgers, falafels, and tacos or burritos. With the right ingredients, these meals are very nourishing.
Children also should be introduced to a wider variety of healthful foods. They can be encouraged to try ethnic or international meals, perhaps with an occasional theme day that includes music, a movie, or a dinner guest from the region where the food originated. If children aren’t fond of homemade soups, cooked vegetables, or stir-fries, involving them in preparation can help them to become more “vegetable friendly”; they can harvest lettuce from the garden, wash carrots, and (when capable of handling a knife safely) chop avocado, celery, or zucchini.
Desserts aren’t a necessary part of daily meals. If dessert is served, it should be a nutritious choice, such as frozen fruit “ice cream,” fresh fruit salad, or fruit crumble.
As alternatives to peanut butter and jelly sandwiches or expensive junk-food snacks, leftovers from lunch and supper (or the breakfast bar) make nutritious snacks when hunger strikes after school, or at any time. Although many children don’t mind eating cold grains or pasta, these may be warmed with a little tomato sauce or peanut sauce. Provide fresh fruit in a bowl on the countertop and jars of dried dates, apricots, or figs to satisfy a sweet tooth. (Children should brush their teeth after eating these sweet treats.)
There’s no need (and it’s virtually impossible) for children to achieve perfect nutrition every day—a more realistic approach averages healthy intakes over time. Good nutrition is a worthy goal, and menus that meet recommended intakes for all nutrients leave little room for junk foods.
Table 10.6 shows sample menus that more than meet the nutrient needs of children at three stages of growth. Each menu provides more protein than required (the protein content of each food is shown). Vitamin and mineral amounts can be compared with the recommended intakes for different ages shown in the appendix (pages 446 to 447). Although a complete nutritional analysis for each menu is provided, the exact amount of protein, minerals, and vitamins can vary, depending on which soy milk, veggie burger, or other product is chosen (check labels for specific amounts). Analysis is based on metric measures.
Menu 1 relies on fortified foods, such as iron-fortified cereals, with dry cereal on some days and cooked cereal on other days. This menu can suit a child with a soy allergy; soy milk and tofu are not included. When relying on nondairy beverages, check the labels for calcium and vitamin B12, D, and A. Be aware that soy milk is far higher in protein and several other nutrients than most other nondairy beverages. One cup (250 ml) of soy milk provides 6 to 8 grams of protein per cup, compared to only 1 to 2 grams for most other nondairy milk choices. So, if using the lower-protein milks, be sure to provide plenty of other protein-rich options as part of the standard daily fare. Menu 2 includes whole, natural foods, along with fortified soy milk and soy yogurt. Menu 3 features meals that are quick to prepare (though all three menus are simple). Active children are likely to burn more calories than the amounts supplied by these menus; for these youngsters, parents can increase portions or add foods.
Ensuring reliable sources of vitamins B12 and D is essential for children. The menus in table 10.6 include fortified foods that contain these nutrients. However, the amounts of vitamins and minerals provided in supplements are more tightly controlled than those in fortified foods.44,60 Children should obtain vitamins B12 and D in supplement form every few days or during periods when their intake may be less than adequate.
• Vitamin B12. In the menus in table 10.6, fortified nondairy beverages and a veggie burger provide vitamin B12; some fortified breakfast cereals also are sources of B12 and of many other nutrients.
TABLE 10.6. Sample menus for children at three weights
• Vitamin D. Fortified nondairy beverages provide about 2.5 mcg (100 IU) of vitamin D per cup (cow’s milk is fortified with the same amount), and usual menus typically fall short of the RDA, which is 15 mcg (600 IU) from age 1 to adulthood. Thus, vitamin D must be topped up with a supplement, exposure to sunlight, or both. For children who live at latitudes above 37 degrees N, sunlight is insufficient for vitamin D production during the winter, so supplements are especially important from October or November through March or April (see pages 224 to 226). Children should be out in the sunshine for ten to fifteen minutes without sunscreen. Then, for longer exposure, add a protective layer of sunscreen.
• Iodine. Iodine could come from ¼ teaspoon (1.5 g) of iodized salt used in cooking, at the table, or as part of a supplement.
• Potassium. Plenty of fruit is needed to meet recommended potassium levels; vegetables also provide potassium (see table 6.2 on page 204). If more foods are added to the menus to satisfy a need for additional calories, fruit is a wise choice to increase intake of this mineral.
A major task for adolescents is to achieve a sense of their unique identity and individuality; as a result, the teen years can be a period of challenge. Issues related to nutrition can become an arena for conflict—or shared learning for all concerned—if parents and caregivers can relax and allow teens to gradually increase their independence (along with more responsibility). In some homes, vegan families find that their teen has decided to experiment with being a meat eater. On the other hand, some teens become vegans, independent of their family’s way of eating. Nonvegan parents do well to support such a position if the youngster is willing to eat a nutritionally adequate vegan diet.
It helps if a teen has an honest commitment to a healthy vegan diet, perhaps preparing his own veggie burger or other foods to complement the plant foods the rest of the family eats. Typically, when a teen adopts a vegan lifestyle, he needs to add protein-rich beans, peas, lentils, and veggie meat substitutes. Fortunately, vegetarian teens aren’t doing too badly, compared to their non-vegetarian counterparts.
Studies comparing teens at Adventist schools (whose diets are predominantly vegetarian, including vegan) with children in public schools found that BMIs were lower among vegetarians, especially girls. Vegetarian teens were found to have better dietary intakes than their nonvegetarian counterparts and were less likely to be overweight and obese. (Although some teens who suffer from eating disorders follow a vegetarian diet [see pages 390 to 402], the diet is typically adopted after the onset of the disorder as a means of limiting caloric intake.)61,80
Studies also have found that vegetarian girls, and girls with higher intakes of soy foods, began menstruating an average of seven months later than their non-vegetarian counterparts. Later onset of menstruation is linked with two health benefits: longer life and less risk of breast cancer as adults.62
An Australian study compared teens who were predominantly vegetarian with those who were nonvegetarian. Findings showed that, on average, the vegetarian and near-vegetarian adolescents had a lower BMI, smaller waist circumference, lower LDL levels, and a better ratio of total cholesterol to HDL. Heights, hemoglobin levels, and activity levels were similar in the two groups; the one disadvantage of the predominantly vegetarian group was lower levels of vitamin B12.63,64
Adults and teens share a common desire: for teens to gain skills in decision-making. Learning from mistakes can provide important and long-lasting lessons. A key is helping teens to avoid irreversible mistakes while adults and teens establish new patterns and boundaries. Food-related concerns that can affect long-term health include:
• use of supplements
• the need for increased nutrients during a major growth spurt
• rebellion against family food traditions
• lack of interest or being uninvolved in food preparation
• not prioritizing good nutrition
• lack of interest about skin problems or premenstrual syndrome (PMS)
• anxiety about body weight (see chapter 12) and shape (see chapters 12 and 13)
• development of eating disorders (see pages 390 to 402);
• eating to improve athletic performance or participation in sports (see chapter 13)
The short answer is yes. As at any age, adequate intake of vitamin B12 is essential; because a consistent level is provided in a supplement, getting this vitamin in supplement form is ideal. Vitamin D supplements are important for teens (on any diet) who spend little time outdoors or who live farther from the equator than 37 degrees latitude; supplements are especially needed during winter, when sunlight is limited. Research is accumulating on the numerous advantages of adequate vitamin D status. In this age group, higher vitamin D intakes (as from fortified beverages and supplements) are associated with fewer stress fractures in girls from 9 to 15 years old who participate in highimpact sports.65 (For more information on these vitamins, see chapter 7; also see the appendix on page 446.)
Iron, zinc, and calcium (see chapter 6) also are important during teen years.66 Though these and all other essential nutrients are available in a balanced vegan diet, a multivitamin-mineral supplement can top up any potential nutrient shortfalls. For example, iron deficiency is common among teens on any diet (including vegan patterns), especially among menstruating girls. Also, although a teen’s recommended intake of calcium (1,300 mg) can be obtained from several servings of fortified nondairy milk plus some combination of calcium-set tofu and other calcium-rich plant foods (see “Calcium, Vitamin D, and Bone Building,” below), those who consistently fall short of the RDA are well-advised to make up the difference by using a daily supplement.
Before puberty, a boy may weigh 100 pounds (45 kg) and be 5 foot 2 inches (157 cm) tall. Four years later, he may have gained 50 pounds (23 kg) and 7 inches (18 cm). To accomplish this, he needs plenty of proteins, vitamins, minerals, carbohydrates, and essential fats—and this is reflected in a markedly increased appetite. Teenage boys have been known to consume a dish intended for the whole family, mistaking it for a single portion. They may devour double servings of dinner at home and then have another meal elsewhere. Such a voracious appetite is the body’s normal response to the demand for additional building materials during this stage.
Girls aged 11 to 14 begin their growth spurt at about the same average weight (100 pounds or 45 kg) and height (5 foot 2 inches or 157 cm) as boys of the same age—in fact, girls might be an inch or so (2 to 3 cm) taller than the boys. During the growth spurt that lasts about four years, their growth is typically less than that of boys. They may gain about 20 pounds (9 kg) and 2 inches (5 cm). This 20 percent increase in weight still requires plenty of nutritious food. In addition, with the onset of menstruation, their iron requirements are greater.
Obtaining enough calcium during adolescence is crucial for heightened bone mineralization; this process lasts through several decades, lessening the risk of osteoporosis in later years. Youngsters from age 9 to 19 years have particularly high requirements (1,300 mg of calcium per day). Vegan diets can be short of calcium unless care is taken to ensure adequate intakes.1,67
Good calcium sources include fortified nondairy milks and juices, low-oxalate greens (kale, collards, napa cabbage, bok choy, broccoli, and okra), beans (soy, white, navy, great Northern, and black turtle), blackstrap molasses, and figs. Some corn tortillas are fortified with calcium, too; check labels. The Vegan Plate (page 434) gives additional guidance regarding calcium-rich foods and serving sizes. Following the recommendations in this food guide also delivers many other nutrients involved in bone building.
Bone health relies on more than proper nutrition. Participating in outdoor activities is advantageous in two ways. First, the effect of sunlight on skin encourages the body’s vitamin D production, supporting calcium absorption, utilization, and retention. Second, weight-bearing exercise encourages the body to respond by maintaining stronger bones.
Along with other matters of appearance, skin health is a major interest to adolescents. A surge in the level of sex hormones (androgens) can enlarge and stimulate oil glands in the skin, particularly around the nose and on the neck, chest, and back. Despite similar levels of hormones, some bodies produce more oil than others, and some people’s skin is less efficient at exfoliation (clearing away discarded cells). The result can be acne and pimples.
To deal with such blemishes, it’s important to clean the skin gently and regularly with water and mild soap, to avoid oil-based cosmetics, and to keep the skin dry. Some teens find that certain foods (such as sweets, processed foods, artificially flavored beverages, and fried foods) can cause skin reactions. Vegan teens have an advantage, because they avoid whey, cow’s milk, and fish, all of which are known to cause skin problems in some people.
In contrast, many vegan foods are beneficial to skin health. Soy foods, such as tofu, tempeh, and soy milk, not only are sources of protein, iron, and zinc, but also contain isoflavones that may protect skin health. Foods that provide essential fatty acids support healthy skin (see pages 117 and 436). Fruits and vegetables help keep skin clear, partly because they contribute nourishing vitamins and phytochemicals. Carotenoid-rich yellow, orange, red, and green vegetables and fruits also give skin a warm, healthy glow, which scientists have found increases attractiveness to others; this fact can increase the appeal of such foods.68
Consumption of fruits and vegetables also helps to meet the body’s demand for water; fruits and vegetables consist of 80 to 95 percent water by weight. Water is an important cleanser inside the body; it carries away the toxins flushed out through the kidneys. The effectiveness of drinking 6 to 8 cups (1.5 to 2 L) of water daily in promoting skin health shouldn’t be underestimated.
Although menstruation is a natural body function, some girls experience excruciating cramps at its onset each month. Attention to some diet-related factors may help to ease or eliminate such discomfort.
• A low-fat, high-fiber vegan diet. A study conducted at Georgetown University in Washington, DC, found a plant-based diet to be beneficial in relation to PMS. When girls and women who experienced mild to moderate PMS pain switched from meals that included animal products and fatty foods to a pattern of whole grains, beans, vegetables, and fruit plus a vitamin B12 supplement, their PMS symptoms were reduced. These included the intensity and duration of pain, water retention, and weight gain. An added advantage of the dietary switch was more energy. Researchers suggest that these benefits may be related to the impact of diet on hormone levels.70 To lessen the effects of PMS, follow the recommendations of The Vegan Plate (page 434), avoid fried foods, and limit added fats and oils.
• Plant foods rich in thiamin and riboflavin. Research has shown food sources of the B vitamins thiamin and riboflavin to be effective in reducing pain and improving mood. These vitamins are found in whole grains, fortified cereal products, nutritional yeast, legumes, soy foods, seeds, and nuts (see pages 240 and 241).71
• Beneficial oils. Though a PMS-prevention diet should be moderately low in fat, it’s important to include recommended levels of omega-3 fatty acids. For example, 2 tablespoons (15 ml) of ground flaxseeds or ¼ cup (60 ml) of hempseeds or walnuts are excellent additions to daily menus.72 On the other hand, several well-designed studies have shown oils that contain gamma-linolenic acid, such as borage oil and evening primrose oil, are ineffective in alleviating the symptoms of PMS.73
• Vitamin D. A pilot study of college-age women showed that those with higher intakes of vitamin D had lower rates of PMS. This may be related to improved calcium absorption and retention, or the vitamin’s impact on hormones or neurotransmitters.74
• Avoidance of alcohol. Researchers have found links between greater alcohol intakes and higher incidence of PMS among female students.75–78
Because adolescents may crave privacy and independence, it can be a challenge for parents to ensure that teens are eating a well-balanced diet. Parents can respect the need for personal space while balancing this with a required half hour together at dinner, not only to share family time but also to monitor their dietary intakes. Teens that have regular breakfast, lunch, and supper meals fare best in terms of fruit and vegetable intake.30
A variety of eating styles can effectively deliver the nutrients teens need. Samples are described below; all are supplemented with vitamin B12.
• The “convenience” lifestyle. Parents can cope with teens who are determined to survive on fast foods by stocking the freezer with vegan burger patties, “hot dogs,” and individual portions of favorite entrées that can be warmed at a moment’s notice. The freezer also can hold muffins plus fruit crumbles, based on seasonal fruit.
Families with little time for food preparation can enlist teens in chopping quantities of raw vegetables once or twice a week; the vegetables should be kept in a container near the front of the refrigerator for easy snacking, along with several flavors of hummus or guacamole from the supermarket. Fortified nondairy milks, prepared bean soups, pea soups, vegan chilis, trail mixes, and other ready-to-eat choices can be obtained from grocery stores; deli departments offer delicious seasoned tofu, wraps, salads, and main dishes. On days when there’s time to cook, if each family member has learned how to make his or her own special dish, such as a stir-fry, pasta dish, Thai curry, or burgers and salad, the unique combinations will result in diverse, healthy, and tasty meals.
Take-out pizza is the ultimate convenience food, and it can be a delightful family treat. Check with local pizzerias, because many now offer vegan pizza using meltable vegan cheese and meatless pepperoni; request that they start to supply vegan pizza if it’s not yet being offered. Of course, cheeseless pizza can be ordered and toppings added at home—just heat for a few more minutes and serve.79
• The athletic lifestyle. Teens often participate in numerous sports and add workouts to improve their performance. A vegan teen athlete who is working to develop a powerful, healthy body is likely to have high caloric demands. Although a high-protein diet helps to increase muscle mass, carbohydrates are the body’s preferred fuel.
A young athlete’s goals may include a protein intake of at least 1.5 grams per kilogram of body weight per day. Preparing vegan chili in quantity and freezing portions, or learning a few quick ways to prepare tofu can provide a series of high-protein meals. Dishes from ethnic restaurants, such as samosas, chickpea dishes, and dahl, can supplement homemade foods, while prepared items, such as marinated or seasoned tofu from the deli or supermarket, can deliver a quick source of protein. Adding soy protein or vegan smoothie enhancers to shakes and smoothies can help to meet that goal.
Baked potatoes, rice, pasta, cereals, and breads are ideal for the constant stream of energy needed by active athletes. Trail mix that consists of dried fruits, nuts, and seeds provides extra calories, while serving as a nutritious snack.
To deal with team travel, vegan athletes can bring containers with leak-proof lids (available from an outdoor-equipment store) to carry items from home or from local supermarkets. To discover options for vegan-friendly restaurants in various locations, an app for helpful websites can be added to a cell phone, or a search can be done online (see Resources on page 450).
• The weight-conscious lifestyle. Teens concerned about their weight and appearance may consider a vegan diet to be a valuable tool that prevents weight gain.80,81 Designing a diet that limits calories while meeting requirements for vitamins and minerals can be a valuable learning experience for teens.80 Deficiencies can cause unwanted health concerns. For example, insufficient dietary iron results in brittle nails and goes on to cold hands and feet, dizziness, headaches, frequent infections, and extreme fatigue.66 Shortages of several nutrients can lead to depression.
Weight-conscious teens need information about healthy eating as well as easy access to nourishing foods, such as whole-grain or fortified ready-to-eat cereals (for iron). They need confirmation that vitamin C–rich fruits and vegetables help to absorb iron as well as provide a foundation for clear, glowing skin; a bowl of fresh fruit on the kitchen counter is a good reminder. Avoid keeping high-calorie, low-nutrient snack foods, such as chips, cookies, or vegan ice cream in the house; these tempt teens and undermine their efforts.
Parents can help their weight-conscious teens by noting that beans, peas, and lentils are very low in fat and high in iron and zinc. A practical approach is to work with teens to cook batches of bean or lentil soup, freezing extra portions for quick meals in the future. Chopped salads with a variety of healthy vegetables can keep for several days when refrigerated (in a container with a tight lid) and provide a series of nutritious instant meals. Parents can ensure that teens get enough calcium by keeping on hand fortified soy milk, calcium-set tofu, beans, leafy greens, and tahini dressing for salads.
For family recipes accompanied by a complete nutritional analysis, see Cooking Vegan by Vesanto Melina and Joseph Forest (Book Publishing Company, 2012).
