Pediatricians must play a role in early plant-based diets

Pediatricians must play a role in early plant-based diets | Image Credit: © sonyakamoz - © sonyakamoz- stock.adobe.com.

Roughly 1 in 10 American adults considers themselves vegetarian or vegan, and these adults may explore similar diets for their children’s Vegan and vegetarian parents are likely to turn to their pediatrician for advice on ensuring a plant-based diet meets an infant’s nutritional needs. Many studies point to breastfeeding as the best option for parents who want to use a plant-based diet, but new formula options are available.¹ This article will explore how pediatric health care practitioners can offer the best guidance to parents interested in plant-based nutrition for newborns and infants.

Results of recent studies suggest that young children raised on plant-based diets had similar growth patterns to children who ate diets including animal protein,^2,3 but current guidance from the American Academy of Pediatrics still cautions against the use of strictly vegan and vegetarian formula options for infants.⁴ Even organizations that champion vegan and vegetarian diets warn that some animal-based products may be needed to provide infants with balanced nutrition.⁵

Overall, for parents looking for vegan or vegetarian diets, breastfeeding is recommended as the best choice, assuming the mother consumes a nutritionally complete and balanced diet. Some breastfeeding mothers who follow a vegan or vegetarian diet may need supplementation, depending on their individual nutritional status.⁶

A 2021 study found that well-planned and nutritionally complete plant-based diets are suitable for pregnancy, during lactation, throughout infancy, and beyond. Some of the key nutrients that are vital to include in the diets of breastfeeding mothers are the following⁶:

• Protein
• Fiber
• ω-3 fatty acids
• Iron
• Zinc
• Iodine
• Calcium
• Vitamin D
• Vitamin B₁₂

The study went on to add that pregnant and lactating mothers who follow vegan diets should increase their protein intake by 10% during these periods. Specifically, additional servings of grains, protein-rich plant foods, nuts, seeds, and other foods were suggested during the second and third trimesters of pregnancy and lactation.⁶

Supplementing the maternal diet for breastfed babies is reasonable, considering that lactating mothers and mothers in late pregnancy have increased caloric needs to start. When breastfeeding is not an option, though, sustaining a plant-free diet for a newborn or an infant gets complicated. In those cases, or when formula shortages have forced parents to get creative on formula choices, pediatricians should guide parents on safe alternatives.

Homemade formulas are typically not recommended, and both the CDC and the US Department of Health and Human Services recommend sticking to formulas that meet minimum federal guidelines for nutritional content.^7,8 Specifically, nutrients like iron and vitamin D are critical elements of infants’ nutrition, regardless of the protein source.³ Many plant-based drinks and milk alternatives that are crafted to specifically meet the nutritional needs of infants and toddlers often provide adequate nutrition alongside a balanced diet, according to a recent report. Some popular choices for plant-based milk alternatives—because of lifestyle choice or allergy avoidance—include soy and rice proteins.³

Another study revealed that soy-based formulas are most similar to cow’s milk–based formulas for protein content, whereas rice is the least similar. Even with similar protein levels, though, the study authors also cautioned that the amino acid profile of animal-based proteins is more complete than plant-based proteins. Alternatives like rice proteins also tend to have higher levels of carbohydrates, so providers and parents must carefully consider specific formulas when weighing options for alternative infant formulas.⁹

Education does not stop when weaning begins, however. Maria Elisabetta Baldassarre, MD, a pediatrician and neonatologist at the University of Bari Aldo Moro in Italy, led a study on weaning infants on vegan and vegetarian diets and found that few parents who adopt these diets seek out nutritional guidance from pediatricians. Baldassarre said vegan and vegetarian mothers in the study tended to breastfeed longer than their omnivorous peers, but about half claimed that their pediatricians could not offer guidance or were not seen as an appropriate resource on the weaning process for parents interested in plant-based diets.

Most research poses questions and concerns over meeting an infant’s nutritional needs during alterative weaning processes, Baldassarre added, with severe nutritional deficiencies found in many children weaned on alternative diets. “Since the nutritional deficiencies in the early stages of life are high, pediatricians have a pivotal role in guiding parents and advising them on the most appropriate and complete diet regimen during childhood,” Baldassarre said.

For parents set on vegan or vegetarian diets in infancy and young childhood, pediatricians should monitor growth, development, and nutrition to avoid the negative long-term effects that could result from an unsupervised plant-based diet.

Click here to read more from the June, 2023 issue of Contemporary Pediatrics®.

References:

1. Norwood FB, Bir C. 1 in 10 Americans say they don’t eat meat: a growing share of the population. Alliance for Science. March 10, 2022. Accessed May 2, 2023. https://allianceforscience.org/blog/2022/03/1-in-10-americans-say-they-dont-eat-meat-a-growing-share-of-the-population/

2. Elliott LJ, Keown-Stoneman CDG, Birken CS, et al. Vegetarian diet, growth, and nutrition in early childhood: a longitudinal cohort study. Pediatrics. 2022;149(6):e2021052598. doi:10.1542/peds.2021-052598

3. Vandenplas Y, De Mulder N, De Greef E, Huysentruyt K. Plant-based formulas and liquid feedings for infants and toddlers. Nutrients. 2021;13(11):4026. doi:10.3390/nu13114026

4. Choosing a baby formula. HealthyChildren.org. Updated June 22, 2022. Accessed May 1, 2023. https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Choosing-an-Infant-Formula.aspx

5. A nutrition guide for vegans under five years old. The Vegan Society. Updated May 2017. Accessed May 2, 2023. https://www.vegansociety.com/sites/default/files/uploads/downloads/Under-fives%20PDF%202_0_0.pdf

6. Baroni L, Goggi S, Battaglino R, et al. Vegan nutrition for mothers and children: practical tools for healthcare providers. Nutrients. 2018;11(1):5. doi:10.3390/nu11010005

7. Choosing an infant formula. CDC. May 16, 2022. Accessed May 1, 2023. https://www.cdc.gov/nutrition/infantandtoddlernutrition/formula-feeding/choosing-an-infant-formula.html

8. Information for families during the formula shortage. US Department of Health and Human Services. July 11, 2022. Accessed May 2, 2023. https://www.hhs.gov/formula/index.html

9. Baldassarre ME, Panza R, Farella I, et al. Vegetarian and vegan weaning of the infant: how common and how evidence-based? a population-based survey and narrative review. Int J Environ Res Public Health. 2020;17(13):4835. doi:10.3390/ijerph17134835