Is a plant-based diet safe for children?

As more households choose plant-based diets, parents may be wondering if children can safely follow a vegetarian or vegan diet and still get all the necessary nutrients.

According to findings from Roy Morgan Research , between 2012 and 2016, Australian adults eating a vegetarian diet went from 1.7 million people (or 9.7 per cent of the population) to 2.1 million (or 11.2 per cent).

As for veganism, according to data from Euromonitor International, Australia is the third-fastest growing vegan market in the world (trailing the United Arab Emirates and China), explains Nicole Dynan, The Gut Health Dietitian, Accredited Practising Dietitian and Spokesperson for the Dietitians Association of Australia.

“Whilst the trend is firmly established with female Millennials, the general increase in interest in veganism could be for any number of reasons including concerns for animal welfare, health improvements, weight management or the desire for a more environmentally friendly lifestyle,” says Nicole.

People for the Ethical Treatment of Animals (PETA) Australia says a vegetarian diet doesn’t include any animals, and they may also avoid food which contain animal-derived ingredients such as gelatine and rennet (found in some common food products like cheeses and dairy desserts).

Typically, they do eat foods that are derived from animals, such as dairy, eggs and honey, but this is dependent on individual beliefs. A vegan diet however, eliminates animals and their by-products.

In 2013, the National Health and Medical Research Council (NH&MRC) recognised vegetarian and vegan diets as “healthy and nutritionally adequate”.

“Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle.

“Those following a strict vegetarian or vegan diet can meet nutrient requirements as long as energy needs are met, and an appropriate variety of plant foods are eaten throughout the day.

“Those following a vegan diet should choose foods to ensure adequate intake of iron and zinc and to optimise the absorption and bioavailability of iron, zinc and calcium.

“Supplementation of vitamin B12 may be required for people with strict vegan dietary patterns.”

Is it nutritionally adequate for children?

“As supported by lots of studies over generations, if the diet is well-planned, there is no risk of children being malnourished while following a vegetarian diet,” says Louisa Matwiejczyk, Lecturer and Advanced Accredited Practicing Dietitian at Flinders University.

“Both short-term and longitudinal studies¹ have found that vegetarian children grow at the same rate as their meat-eating peers and grow up into being very healthy adults.”

As for children on a vegan diet, Louisa says there needs to be more careful monitoring.

“That is a sub population that could be at risk of malnutrition as it is really hard to get calories in for children on a vegan diet,” she says.

“Because there are essential nutrients that are only found in animal products, there can be serious effects if children miss out on those nutrients.”

While there are not many recent studies on vegan children, a longitudinal study of vegan children from 1988 found, “the majority of children grew and developed normally but they did tend to be smaller in stature and lighter in weight than standards for the general population”.

“Energy, calcium, and vitamin D intakes were usually below the recommended amounts.

“Their diets, however, were generally adequate but a few children had low intakes of riboflavin and vitamin B-12.”

Nicole adds that most plant-based food are high in fibre, and too much fibre can lead to poor absorption of important nutrients like iron, zinc and calcium.

“Children need to be monitored regularly by their GP for growth and parents need some advice from a paediatric dietitian to make sure their children are getting essential nutrition,” advises Louisa.

Nicole and Louisa advise the following substitutes to ensure children receive the nutrients needed for their growth and development:

• Protein alternatives like nuts, eggs, legumes (for example: chickpeas, soybeans, kidney beans) and tofu.
• Iron rich foods like legumes, green leafy vegetables and iron fortified cereals, paired with vitamin C rich foods to help with iron absorption.
• Vitamin D and calcium rich foods like fortified plant milks, vitamin D enriched mushrooms, tahini, some nuts and seeds, tofu and some green leafy vegetables.
• Zinc rich foods like dairy and fortified breakfast cereals.
• Fats like extra virgin olive oil, nuts, seeks and avocado.
• B12 rich foods like fortified breakfast cereals, dairy and eggs.

Nicole adds that, “vegan children may need a B12 supplement as this comes predominantly from animal food sources”.

Louisa warns parents that, “if kids miss out on B12, it increases their risk of irreparable damage to their brain development”.

The Royal Children’s Hospital Melbourne explains that, “B12 deficiency can cause life threatening disease due to megaloblastic anaemia with cytopaenias or neurological abnormalities (regression/seizures)”.

“Findings in children include delay or regression of developmental milestones, feeding difficulties, hypotonia, lethargy or hyperirritability, microcephaly and coma.”

In relation to children under the age of one, Nicole recommends, “breast milk or formula remains an important food for babies up until 12 months”.

But it isn’t all bad news.

“Studies have shown that children raised on a vegetarian or vegan diet, when they become adolescents or young adults, they have a really healthy attitude about their body, they are very body satisfied,” says Louisa.

“The rates of eating disorders are less than their peers.

“Rates of disordered eating are lower as they have a much healthier relationship with food.”

Louisa adds that children on vegetarian diets have fewer allergies as they are exposed to typical allergy foods (such as nuts, eggs, diary) from an early age.

The current Australian recommendation is to introduce common allergy causing foods before the age of one as withholding these foods can increase their chance of developing an allergy.

“There hasn’t been much research around allergy development in children on vegan diets,” adds Louisa.

“As they are not exposed to dairy foods or eggs, it would be interesting to see if they would develop an allergy toward that food if they chose to consume it later on in their lives.”

What parents need to know

For parents considering feeding their child a vegetarian or vegan diet, both Louisa and Nicole recommend seeking advice from a paediatric dietitian to help carefully plan their child’s diet and understand any supplement requirements. This is not a formal requirement but it is also advisable to undertake regular blood tests (as advised by their GP) to monitor the child’s nutrition levels (particularly with vegan children).

They also highlight that it is important to understand the social side of becoming a vegetarian or vegan.

“When I talk to children and young adults who are vegetarian, they find it really difficult to tell people about their way of eating,” says Louisa².

“They feel embarrassed, they don’t like the attention or being perceived as being different to their peers.

“They don’t want to be perceived as judging people who are meat eaters.”

Nicole says, “parents should openly discuss their reasoning for dietary choice with their children, whether it be related to health, animal welfare or the environment (or all the above)”.

“Discussing the possibility of other people making different choices about the food that they eat, may help them understand why their friends eat in a different way.

“Help them to understand that it is okay for people to make different choices, and that we should respect that.

“Encourage children to be confident and proud of their eating pattern.

“With more and more people eating diets that are higher in plants, hopefully the stigma around them won’t be here forever.”