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April 4, 2001
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PEDIATRICS & PARENTING
The Meat of the Matter
Parents of vegetarian children should keep a watchful eye on nutrition
By Leah Shafer
 ugo was born to a vegetarian mom, Molly Gove, who takes joy in teaching her daughter to respect animals. At first, Molly was also teaching Hugo to follow a vegetarian diet. But when Hugo was 18 months old, she got very sick with a virus she couldn't shake. Hugo lost almost all of her baby fat and didn't want to eat; even after she recuperated from her illness she seemed lethargic and didn't grow for almost a year. Molly became worried about her daughter.
A year later, when Hugo was 2, a naturopath diagnosed the little girl as severely protein deprived. Molly added dairy products and eggs to Hugo's diet for a month, trying to help her daughter thrive by feeding her non-meat proteins. Ultimately, Molly decided that eating fish, meat, and poultry was the only way to give Hugo the protein she needed.
Molly says it was a difficult transition but that her daughter's health was her primary concern. Hugo is 5 now, and flourishing. "I honor life in all animals and want her to have a sense of that," Molly says. "We talk about where meat comes from and kind of say a 'thank you' to that animal so that Hugo has an understanding that life supports life."
According to a recent Roper poll, 2 percent of American children don't eat meat, fowl, or fish. That's about 1.5 million vegetarian kids. But Hugo's story raises a serious question: Is a vegetarian diet adequate for growing children, who need concentrated energy and nutrition? The answer, experts say, is a conditional "yes."
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Several studies have determined that, for the most part, vegetarian kids grow and gain weight at the same level as their meat-eating peers.
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"Children are different than adults -- children are growing," says Sheah Rarback, a registered dietitian and spokesperson for the American Dietetic Association (ADA) in Miami, Florida. "Everyone needs vitamins and minerals, but with children it's more critical. Being a vegetarian is a fine way to eat, but the more you put restriction on certain food groups, the more you have to plan for proper nutrition."
As Molly learned the hard way, restrictive diets don't work if they aren't nutritionally sound.
Types of vegetarian diets
On the most basic level, all vegetarians restrict the consumption of meat, fowl, and fish. Those who eat dairy products and eggs are called lacto-ovo vegetarians -- the most common type in the United States. Vegans [pronounced VEE-guhns] do not eat anything derived from animals. Hugo was vegan, which may have accounted for her health problems. Between lacto-ovo and vegan lie a variety of diet plans that differ in levels of restriction.
It's the level of restriction that, in part, determines the nutrition level of the diet. "For any child, variety is the key," says Reed Mangels, Ph.D., a registered dietitian and nutrition advisor for the Vegetarian Resource Group. "If you're eating a limited diet, there's less chance you're going to get everything you need."
But although vegan diets are more likely to be associated with poor nutrition because of the lack of protein, vitamin B-12, and calcium that dairy products offer, with proper planning a vegan diet can be a nutritious one.
Are they healthy and growing?
Several studies over the years have looked at vegetarian kids and determined that, for the most part, they grow and gain weight at the same level as their meat-eating peers.
In the Farm Study of 1989, 404 vegetarian kids aged 4 months to 10 years were examined for growth, height, and weight gain. Researchers found that, compared with rates for the United States as a whole, the Farm Study children were within normal range. They did tend, though, to be somewhat leaner than the average American child.
Another study of 1,765 children ages 7-18 in Southern California years found that the vegetarian kids were actually taller than their meat-eating counterparts.
But as might be expected, several studies have shown that children following extremely restricted vegetarian diets -- macrobiotic or fruitarian, for example -- may weigh less and not grow as tall as meat-eating children or kids following a less restrictive vegetarian diet.
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Proper Nutrition for Veggie Kids
It is the parents' responsibility to make sound dietary choices for their children. If a restrictive diet has been chosen for the family, it is up to the parents to educate themselves about nutrition and to make sure that children remain healthy, happy, and growing. Many nutrition experts recommend that a vegetarian child be evaluated by a pediatrician or a registered dietitian on a regular basis to prevent any health problems from occurring.
- Protein: One myth about vegetarians is that protein is lacking and hard to get. In fact, vegetarian diets are rarely short in protein -- especially lacto-ovo diets. It is not necessary to carefully plan and combine plant food proteins, as was once the practice among vegetarians. Just make sure your child eats a wide variety of legumes, grains, soy products, meat analogs (soy "meats," like fake bacon or veggie burgers), and nut butters, and the body will do the combining for the child all day long.
- Calories and fat: Little kids have little stomachs, and foods high in fiber -- like fruits, vegetables, and whole grains -- can fill them up without providing enough calories or fat, which are essential for growth. Try nut butters, fruit juices, whole-fat dairy products, avocados, dried fruits, soy products, and the occasional refined grain product to pack the caloric punch your growing child needs.
- Fiber: Most American children don't meet the fiber-intake guidelines set by the American Academy of Pediatrics -- a child's age plus 5 grams every day. The dietary fiber intake of vegetarian kids is closer to the recommendations but can also be excessive. Include a balance of high- and low-fiber foods.
- Iron: Getting adequate iron isn't a problem just for vegetarian kids. But the body's ability to absorb iron found in plant foods varies depending on what is eaten along with these foods. Iron-rich foods include whole grains, iron-fortified cereals and grain products, dried fruits, legumes, blackstrap molasses, leafy green vegetables, and baked potatoes with skin. Vitamin C enhances iron absorption, so pair citrus fruits with these iron-rich foods.
- Calcium: Kids are building bone density, so this mineral is essential. Dairy products are the easiest way to get calcium, and as a result a lacto-ovo vegetarian diet is higher in calcium than a vegan one. Nondairy sources of calcium include fortified soy and rice milks, calcium-set tofu, textured vegetable protein (found in many vegetarian convenience foods), calcium-fortified orange juice, and some legumes. If a child isn't getting enough calcium, parents might consider adding a children's vitamin and mineral supplement.
- Vitamin D: Our bodies will produce vitamin D with sunlight exposure -- but since kids need to wear sunscreen outdoors, this natural process can be hampered. Vitamin D is found in dairy milk, fortified soy and rice milks, and cereals. If your child is vegan or is dark-skinned, check with your pediatrician to make sure he or she is getting enough vitamin D.
- Vitamin B-12: Vegetarians can easily meet their B-12 needs by eating dairy products or products fortified with B-12 -- like soy milk, meat analogs, cereals, or nutritional yeast.
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Every vegetarian child should visit a pediatrician regularly to monitor growth, development, and health. And all parents -- even those of meat-eating kids -- need to identify their child's nutritional needs and plan the family diet around those needs (see sidebar).
Lifelong benefits
A vegetarian diet in childhood can set healthy eating and lifestyle patterns that last a lifetime and may help the child avoid certain chronic diseases, says Mangels.
"It looks like a lot of chronic diseases that plague adults have their origin in childhood," Mangels explains. For instance, an overweight child has a greater chance of being overweight as an adult. And obesity greatly increases the risk of type 2 diabetes, hypertension, heart disease, and even some types of cancer.
It also appears that a vegetarian diet has a positive effect on several risk factors for coronary heart disease. A 1995 German study found that vegetarians tend to have lower body weight, lower cholesterol levels, and lower blood pressure. They also have fewer cases of bronchial, breast, and colon cancers.
Masking a disorder?
There is no evidence that vegetarian children are at a higher risk for eating disorders, but for a small number of adolescent girls, becoming a vegetarian can be a mask for an existing eating disorder. "It's a way of avoiding food," explains Rarback.
Such young women will often have an extreme degree of food restriction -- often eating only carbohydrates -- and a preoccupation with food, says Rarback. They will often stop growing, lose weight, and lose their menstrual periods.
If parents suspects that their newly vegetarian child is using the diet as a shield to hide an eating disorder, they should have their child evaluated by a physician and possibly by a dietitian. A health professional will go over the child's diet to make sure she's getting adequate nutrition, Rarback says.
Making it healthy
It appears that the number of vegetarian kids will continue to grow as more Americans convert to this lifestyle. In fact, teenagers are the fastest-growing segment of the vegetarian population in the United States.
Many vegetarian kids are part of a vegetarian family, so the most important thing is parent education, says Jo Ann Hattner, a registered dietitian with a specialty in pediatric nutrition and an ADA spokesperson. A parent needs to become aware of what nutrients a child risks losing and learn how to be sure the child is getting the appropriate amounts. "You need to design the diet for the child," Hattner stresses. "Parents need to realize that the vegetarian child has different needs from the vegetarian adult."
Hattner also points out that if the child is a teenager, parents will need to assist with education around making appropriate food choices.
When parents plan the family diet to put a child's health first, vegetarianism can be a healthy lifestyle for kids. And perhaps more importantly, such a diet can assist children in becoming healthy adults.
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