Pediatric Nutrition in Practice

136 McEvoy  Woodside

year, owing to low iron bioavailability, insuffi-
cient vitamins and inappropriately high concen-
trations of minerals [5].
Weaning guidelines are similar to that for
non-vegetarian infants. Regular monitoring of
weight is paramount to ensure sufficient energy
and protein intake for normal growth. Vegetari-
an diets can be lower in energy and higher in di-
etary fibre compared to omnivore diets and can
result in early satiety in infants when small quan-
tities of foods are consumed [5]. Good sources of
nutrient-dense foods for vegetarian weaning di-
ets include: full-fat dairy products, mashed or
pureed beans/tofu, soy yogurts, mashed avocado
and mashed vegetables with added fats/oils.
Smooth nut butters, which are calorific, can be
introduced after 1 year.
Cow’s milk, if acceptable, can be started at 1
year of age. Vegan infants can commence forti-
fied full-fat soy milk at this time, which should
c ont i nue to b e supplemente d w it h hu ma n m i l k or
soy-based formula and other sources of adequate
protein and calories.
For vegetarian toddlers and older children,
the main challenge is to ensure adequate intake
of energy, protein, vitamins and minerals for op-
timum growth and development. In vegetarian
children, growth rates have been found to be sim-
ilar to those of omnivores, whereas vegans tend
to be smaller and leaner [6]. However, height
measurements for vegan children may still reside
within normal limits, and catch-up growth usu-
ally occurs by the age of 10 years [1].
Vegetarian diets that are adequate in energy
are also likely to provide sufficient protein to sup-
port optimum growth in children. However,
plant proteins tend to have lower biological val-
ues than animal protein, and vegan children are
estimated to require a 1.3 times higher protein
intake than omnivores to meet all essential ami-
no acid requirements [1, 6]. This is best achieved
when a wide range of plant proteins is consumed
(soy protein, textured vegetable protein, legumes,
nuts, seeds and grains) within the diet [1].

Special Nutrient Considerations in

Vegetarian Diets

Essential Fatty Acids

Essential long-chain (n–3) fatty acids, eicosa-

pentaenoic acid (EPA) and docosahexaenoic

acid (DHA), are derived largely from marine di-

etary sources and are important for immune,

cognitive and retina development in children.

Lower levels of DHA have been demonstrated

in milk from vegan mothers compared to omni-

vore mothers [7]. Vegetarian or vegan breast-

feeding mothers and children should aim for

adequate plant-derived α-linolenic acid such as

flaxseed and canola oils, as shown in table  2 ,

which can be converted to DHA/EPA in vivo,

although conversion rates are low. A vegan DHA

supplement (for example algal oil) may be indi-

cated in vegan children with insufficient dietary

intake and/or low serum DHA levels.

Vitamin B 12

Vitamin B 12 is only derived from animal sources

and important for infant neuronal, cognitive and

brain development. Deficiency can result in meg-

aloblastic anaemia, neurodevelopmental delay

and, in severe cases, irreversible brain damage.

Breastfed infants whose mothers have inadequate

vitamin B 12 intake or status should receive a sup-

plement (0.4–0.5 μg/day) due to their limited

body reserves at birth [5, 6]. The risk of vitamin

B 12 deficiency in vegan children is increased if the

diet is not supplemented with fortified foods, as

shown in table 2.

Vitamin D

Children with dark skin pigmentation, those liv-

ing in northern latitudes (with less sunlight expo-

sure) and those exclusively breastfed are especial-

ly at risk of vitamin D deficiency [5, 8]. Good di-

etary sources of vitamin D 3 include oily fish, egg

yolks and fortified food products (shown in ta-

ble 2 ). Vegan foods are fortified with vitamin D 2

from yeast, although this may not be as well ab-

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 134–138

DOI: 10.1159/000367873