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Vegetarian Diets For Children

Children can safely ingest planned vegetarian diets and attain normal growth and development . A review of the composition of the individual diet is important to ensure adequate provision of energy, vitamins, and minerals. A supportive, nonjudgmental approach is important in establishing a relationship that will result in the parents' willingness to accept suggestions.

It is possible to get complete balanced nutrition from a variety of vegetarian diets. More restrictive diets (eg, vegan) require particular care to ensure that all nutritional needs are met. Overall, a lactovegetarian diet has greater health benefits and reduced health risks than a vegan diet.

Some adolescents choose a vegetarian diet as a means of weight control, and clinicians should be alert for evidence of inappropriate dietary restriction and other disordered eating behaviors. An adolescent whose BMI is less than the 15th percentile, or whose actual weight is less than 85 percent of ideal body weight, is a candidate for referral for more intensive medical and psychological care.

Energy The small stomach capacity of young children combined with low-caloric density foods may limit energy intake. To meet energy needs, children need three meals and three snacks per day. Both energy- and nutrient-dense foods should be included. The intake of fat should not be restricted in children younger than 2 years of age. For older children, some foods higher in unsaturated fats, such as nuts, seeds, nut and seed butters, and avocado, should be included to help meet nutrient and energy needs.

Omega-3 fatty acids Vegetarian diets generally are rich in omega-6 (n-6) fatty acids, but marginal in omega-3 (n-3) fatty acids, which are important for cardiovascular health and eye and brain development. Vegetarians should include good sources of alpha-linolenic acid in their diet, such as flaxseed, walnuts, canola oil, and soy.

Protein Intake of essential amino acids may be a problem for infants if intake is limited to plant-based low-quality protein products. Protein intake should be adequate if vegan children eat a variety of complementary plant foods to meet caloric needs.

Iron Heme (meat) iron is more readily absorbed than is non-heme iron, the absorption of which is adversely affected by other dietary constituents. Growing children who consume only non-heme iron are at risk of iron deficiency. A source of ascorbic acid should be provided at each meal to significantly enhance the absorption of non-heme iron. Teas containing tannin should be limited.

Zinc The zinc in vegetarian diets has a lower bioavailability than that in omnivorous diets because of the high content of phytate and/or dietary fiber. The clinical importance of reduced intake in vegan children is not known.

Calcium Milk and other dairy products provide approximately 75 percent of the calcium in the average American diet. Vegetarian children who do not drink milk should receive at least one calcium-rich or fortified food at each meal and with several snacks each day to provide a daily calcium intake that approximates 500 mg for children 1 to 3 years, 800 mg if they are 4 to 8 years, and 1300 mg if they are 9 years and older.

Vitamin D Most foods do not contain any vitamin D. The principal dietary source of vitamin D for omnivores, lactoovovegetarians, and lactovegetarians is fortified milk. A vitamin D intake of 400 IU/day is necessary for adequate calcium balance. This balance can be provided by using soy milk or breakfast cereal fortified with calcium and vitamin D. Fatty fish can provide a source of vitamin D for macrobiotic children, particularly during winter. Vitamin D supplementation should be used for children without adequate sunlight exposure or dietary intake from enriched foods.

Vitamin B12 Animal products (meat and dairy products) provide the only dietary source of vitamin B12 (cobalamin) for humans. Vegan children and other vegetarians whose diets do not contain adequate vitamin B12 should consume a regular and reliable source of the vitamin, either fortified foods (soy milk or cereals) or an oral B12 supplement. Provision of fish two to three times per week can provide a source of vitamin B12 for macrobiotic children.

Fiber Fiber intake for children should be age-appropriate and approximate the currently recommended DRI. The mineral content of the diet should be adequate.
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