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Is it healthy for children to be vegetarians?

A study has found that 40% of American children between the ages of 4 and 7 think that hot dogs come from plants.

Q: My daughter wants to be a vegetarian. Is that OK for her health?

A: Vegetarian diets are healthy for kids, as long as they get key nutrients needed to grow healthy and strong. This can take some extra planning at mealtime, though.

Vegetarian diets are becoming more common. Reasons range from a desire to be healthier to concerns about animal welfare and the environment.

It’s important your child understands that a "vegetarian" diet means a vegetable-based diet. Some kids who stop eating meat may just start eating more bread or pasta. This may fill them up, but it won’t give them the balanced nutrition they need.

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Vegetarian diets are healthy for kids, as long as they get key nutrients needed to grow healthy and strong.

Overall, vegetarian diets tend to be low in saturated fat and animal protein and high in fiber, folate, vitamins C and E, carotenoids, and some phytochemicals. Children and adolescents who follow a vegetarian eating plan tend to consume more fruits and vegetables and fewer sweets, salty snacks and saturated fat than their nonvegetarian peers. They also tend to be at a lower risk for overweight and obesity.

In the past, experts worried that following a vegetarian diet would lead to nutritional deficiencies in children. Today, we know that’s generally not the case with careful vegetarian eating plans that include enough of the following nutrients:

Protein: Children who follow a vegetarian plan tend to get enough protein variety and quantity. Regularly eating legumes (such as beans, peas, lentils, peanuts and soy) helps ensure they'll get enough. Children and adolescents who are vegan may need to eat more of these foods than non-vegan children because plants don't always have the same level of protein found in dairy and eggs.

Iron: Iron from vegetarian sources (non-heme iron) is not as high quality as that from nonvegetarian sources. Overall, vegetarians need about 1.8 times higher iron intake compared to non-vegetarians. Excellent vegetarian sources of iron include soy, lentils, chickpeas, black-eyed peas, beans and seeds like sesame and hemp. Vitamin C enhances iron absorption. Excellent sources of vitamin C include citrus fruits, cantaloupe, kiwi, mango, papaya, pineapple, strawberries, broccoli, Brussels sprouts, green and red peppers, and leafy green vegetables.

Zinc: Zinc levels may be lower in children following a vegetarian diet, though deficiency is rare. Some great vegetarian sources of zinc include soy, legumes, grains, cheese, seeds and nuts. Also, soaking and sprouting beans, grains, nuts and seeds and leavening bread can help the body better utilize zinc. So can leavening bread and fermenting foods.

Vitamin B12: In nature this vitamin is primarily found in animal products. There are very small amounts in some fermented foods, nori, spirulina, chlorella algae and unfortified nutritional yeast. While most vegetarian plans contain sufficient vitamin B12, children who follow a vegan eating plan should take a vitamin B12 supplement or eat fortified foods, such as fortified nutritional yeast.

Calcium: The body's ability to use calcium from plant foods can be hampered by some other naturally occurring compounds such as oxalates and phytates. While spinach, beet greens and Swiss chard contain a lot of calcium, for example, they also have high oxalates. This makes them a poor calcium source. On the other hand, low-oxalate greens such as kale, turnips, Chinese cabbage and bok choy are good sources of calcium. So are fortified plant milks and soy, white beans, almonds, tahini, figs and oranges.

Vitamin D: Few foods naturally contain vitamin D. Eggs yolks contain some. Mushrooms contain vitamin D if they've been exposed to sunlight or artificial ultraviolet light. Cow's milk, some nondairy milks, tofu, orange juice, breakfast cereals and margarines often are fortified with vitamin D.

EPA and DHA omega-3 fatty acids: These healthy fats, primarily found in cold-water fish, are generally low in vegetarian (and absent in vegan) eating plans. A small proportion of ALA (omega-3 from plants) is converted to EPA and DHA. The best sources of ALA include seeds (flax, chia, camelina, canola and hemp), walnuts and their oils.

Be sure to talk with your pediatrician about your child’s diet during well-child visits. If there are concerns about your child’s nutrient status, particularly with regard to iron or vitamin B12, they may recommend doing a blood test to check levels.

If your child is interested in a vegetarian diet, it helps to start slow. Consider "meatless Mondays," for example. Sampling vegetarian eating one day a week lets them test it out and see if it is something they would like to continue. Be sure to use recipes from a vegetarian eating plan, rather than just leaving out the meat.

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