Dr. Carina Saunders: Weaning a baby on a vegetarian or vegan diet

It can still be common to hear people express concerns about babies meeting their unique nutritional demands as they embark into the world of food when following a vegetarian or vegan diet. In reality, we are seeing more and more babies being weaned on plant-based, vegetarian or vegan diets due to increased interest in factors such as sustainability, the environment and health.

Whilst additional considerations and awareness of key nutrients are very important, with the right guidance babies and children can readily achieve all the energy and nutrients they need for growth & development when following these diets. Knowledge and practical understanding can help ensure your child’s nutritional needs are met. Below I’ve shared some key aspects to consider and top tips from weaning and beyond.

Variety

Like any baby starting their journey with foods, variety really is key! Dietary diversity is a hot topic when it comes to weaning, both from the perspective of offering your baby plenty of exposure to tastes and textures but also populating your baby’s gut with plenty of different gut bacteria and microbes! A vegetarian or vegan weaning diet offers a huge amount of scope when it comes to dietary diversity, across key food groups below:

· Fruits and vegetables - offer lots of colours, eating the rainbow! Frozen, tinned (in spring water or juice) and dried options count too.

· Grains & starchy foods - e.g. oats, buckwheat, teff, quinoa, bulgur wheat, potato, rice, pasta, noodles, cereals. You can now also find higher protein versions of options such as pasta, made with pea, lentil or chickpea flours too.

· Vegetarian or vegan protein & iron sources - e.g. beans, lentils, pulses, soya, quinoa, nuts and seeds (ground or in butter form for babies). Dairy and eggs are additional protein sources in a vegetarian diet.

· Dairy (or fortified alternatives) – whilst babies following a vegetarian diet can look to include dairy sources such as cow’s milk, yoghurt and cheese, fortified alternatives are becoming increasingly available as an alternative for vegan babies. Higher protein options to use in food during weaning include unsweetened soya or pea milk, yoghurt alternatives and cheese. There are also oat and coconut options available. Choosing those which are fortified with Calcium, Iodine, B12 and ideally B2 helps support intake of these key nutrients in vegan babies, or those with milk allergy.

· Healthy fats e.g. avocado, vegetable oils like rapeseed, olive, avocado oil, groundnuts/seeds or butter version and vegetable-based spreads are all examples of plant-based fats that can be incorporated into meals. In the absence of meat, fish (especially oily fish) and dairy, including fats into meals is important for vegan babies who can often have diets naturally higher in fibre, and lower in fat

Iron

Iron is a key nutrient for babies when weaning. Requirements for iron are increased from 6-12 months of age & a baby’s stores are waning. In the absence of meat, there are plenty of iron-rich vegetarian or vegan options a baby can include within their diet such as; beans, pulses, lentils, eggs (if eaten), quinoa, fortified cereals, soya produce e.g. tofu, dried fruit e.g. apricots or figs, green leafy vegetables, nuts & seeds (ground or in butter forms form).

Tips:

· Aim to include good plant-based iron-rich food at each mealtime for baby

· Iron from plant-based sources can be more difficult to absorb. Combining these foods with Vitamin C rich options such as fruits, vegetables & even options like new potato can help optimise absorption. Onion and garlic have also been found to support iron absorption from some foods.

· Avoid combining with foods that may reduce iron absorption such as tea (which shouldn’t be given to babies or young children anyway)

Protein

Whilst many parents worry about vegetarian or vegan babies getting enough protein, meeting a baby’s protein requirements on a plant-based diet is completely achievable with regular inclusion of some of those iron-rich foods above like beans, lentils, legumes alongside nuts & seeds (ground or butters), soya-based produce, high protein grains e.g. quinoa or products using pea/soya/legume flours, For babies on a vegetarian diet, dairy and eggs will contribute to protein intake too

Tips:

· If using dairy/milk alternatives (often used on a vegan diet, or for babies with milk allergy) which are much lower in protein e.g. oat or coconut-based options, aim to include a protein-rich food at each mealtime as you progress through weaning.

Energy

Babies have high energy requirements for rapid growth and development but small stomachs! As a baby progresses onto more solids through weaning and beyond it can be particularly important for ensuring meals offered remain energy & nutrient-dense. This can be more important to consider on a vegetarian and especially vegan diet, where meals may be naturally higher in fibre (which fills up small stomachs more quickly) and lower in energy.

To help achieve this, it can be helpful to think about combining:

Iron rich food + Vitamin C rich food + Energy rich food.

Energy-rich foods can include starchy or carbohydrates and/or fat and/or dairy options– examples of all are included above. Combining starchy foods with some fat e.g. spread or nut butter on toast, ground seeds on cereal, pesto with pasta, cooking potatoes in oil, cheese on toast, blended avocado into a smoothie bowl are examples of easy ways to boost energy intake,

Omega 3 Fatty Acids

Omega 3 fatty acids are essential nutrients in babies and children, with important roles in brain development and vision. Docosahexaenoic acid (DHA) particularly is the main fatty acid in the brain, so has an essential role in a baby’s cognitive development.

The main dietary source of DHA is oily fish such as salmon, mackerel or sardines and shellfish. Other sources of DHA can include Omega 3 enriched eggs, which may be used on a vegetarian diet and certain brands of milk, yoghurt, bread and spreads. In general, however, plant-based babies and children may need to consider other sources.

Top tip:

Alpha Linoleic Acid (ALA) is a plant-based Omega 3 fatty acid, found in foods such as vegetable oils, rapeseed oil, nuts and seeds e.g. walnut, pecans, hazelnuts, chia, hemp and flaxseed (offer these well ground for babies). ALA can be changed in the body to DHA, but this can take a long time and often is only in small amounts.

For this reason, an Omega 3 supplement containing plant-based DHA (from microalgae) would be recommended for most children following a predominately plant-based or vegan diet (The same goes for breastfeeding mothers if they also follow a predominately plant-based or vegan diet too).

Other key nutrients to consider, if your baby is following a vegan diet include:

Calcium

In the absence of dairy, for babies and children following a vegan diet or requiring milk exclusion due to allergy, other sources of calcium within the diet need consideration. For most, choosing fortified milk alternatives such as soya, oat, pea or coconut-based produce is a helpful alternative. Milk alternatives are typically fortified with between 120-180mg calcium/100mls. Fortified yoghurt, crème fraiche, hard and soft cheese alternatives are also becoming more widely available, which are helpful and versatile options to include in a child’s diet.

Aside from fortified milk or dairy alternatives, other plant-based sources of calcium include; calcium set tofu, green leafy vegetables (broccoli, kale, bokchoi, watercress, sprouts), certain legumes e.g. red beans, white beans, and tahini (sesame seed paste). You can also increasingly find fortified cereals and grains e.g. oats, and bread that is fortified with calcium too.

Top tips:

· Steer away from organic plant-based milk alternatives, these will not have added calcium (or any vitamins/minerals). Fortified options are a must!

· By around 12 months of age, aim for your little one to be having 2-3 portions of fortified dairy alternatives per day as part of their balanced diet. If your baby is breastfeeding or on formula, these will still be providing a source of calcium too, alongside other nutrients

Vitamin B12

Vitamin B12 is predominately found in animal-based produce, and for this reason, it often needs extra attention for babies and children following a vegan diet. In fact, supplementation for this group is recommended to ensure a reliable intake, unless they have a regular and consistent source of foods fortified with B12 (which can be a challenge). The deficiency of B12 can lead to some serious health effects.

Foods fortified with B12 including plant-based milk alternatives (as described above), - not all brands fortify with B12 so check the label carefully. Nutritional yeast (‘Nooch’) enriched with B12 can also be a helpful vegan source of B12, and is super easy to include within your child’ meals or sprinkled on foods.

Top tips:

· Discuss with your child’s health care professional about appropriate Vitamin B12 supplementation (including dose) based on their age and dietary intake. (note that babies <1year may be getting sufficient amounts from breast or formula milk)

Iodine

With the rise in plant-based eating and vegan diets, Iodine has received a lot more attention and for good reason. This nutrient has an important role to play in a child’s cognitive development and metabolism. This can be another nutrient that is tricky to get consistent and reliable amounts of for babies and children following a vegan diet, with main dietary sources including dairy, white fish, seafood and iodised salt (we don’t recommend adding salt to little one’s meals though!)

Iodine can be found in some plant-based milk alternatives, which can be a helpful source when following a vegan diet. Other sources of iodine can include some fruits and vegetables, although the quantity of iodine is hugely dependent on the iodine content of soil – so these are not a particularly reliable source. Seaweed and kelp can also be very concentrated sources of iodine, and because it’s also important babies and children don’t have too much iodine they are not often recommended on a regular basis. Like, Vitamin B12, supplementation with iodine for vegan children is recommended to ensure a reliable intake of this nutrient (note that babies <1year may be getting sufficient amounts from breast or formula milk)

Top tips:

· Try to choose a plant-based milk alternative that is fortified with iodine, alongside calcium and ideally B12 too

· Discuss with your child’s health care professional about appropriate iodine supplementation (including dose) based on their age and dietary intake

Vitamin D

The sunshine Vitamin, aka Vitamin D, is an important consideration for all babies and young children. It has an important role in bone health and immunity. This Vitamin (actually a hormone) is not easily obtained from food or diet but in fact the act of sunlight on the skin. In the UK and northern hemisphere, it can be more difficult to get enough, especially during the winter months. Regular supplementation is therefore recommended

In the UK regular supplementation of Vitamin D for breastfeeding mothers, babies and children are recommended in the amounts as below:

· 10 micrograms/day for breastfeeding mothers

· 8.5-10 micrograms per day for breastfed babies from birth until 5 years of age

· 10 micrograms per day for babies taking <500mls formula milk per day, ongoing until the age of 5

Top tips:

Vegan Vitamin D formulations will use Vitamin D2 or D3 (from lichen, rather than sheep’s wool). Be sure to check the label.

To summarise

A carefully planned and conscious vegetarian, vegan or predominately plant-based diet for babies and children can provide the nutrients required for healthy growth and development, alongside targeted supplementation as needed. At a weaning age, it’s important to remember that breast or formula milk will still be providing a predominant source of nutrients for your baby. The advice above is aimed to support you with the details of what to consider when establishing healthy balanced meals for babies and children, including intake of key foods and food groups as you transition your baby from those first weaning tastes towards plant-based family meals.

If you are a vegetarian or vegan mother who is breastfeeding, please also consider whether you would benefit from dietary support and appropriate supplementation too, particularly of key nutrients as above such as Omega 3, Calcium, Iodine, B12 and Vitamin D

For babies following a vegan diet, and those who have multiple dietary restrictions individualised advice from a Paediatric Dietitian is often recommended to ensure their intake meets their unique nutritional needs.

Specific recommendations for people living in Norway (source: helsenorge.no):

All children who are breastfed are recommended vitamin D supplements. Children who are breastfed by mothers who have a vegan diet may also need vitamin B12 and iodine supplements. If the mother takes vitamin B12 and iodine supplements and regularly checks that she has good B12 status (via a blood test), it may be sufficient to give the child vitamin D, as long as the child is fully breastfed or gets a lot of breast milk.

Breast milk contains good levels of long-chain omega-3 fatty acid (DHA), but when the baby gradually gets less breast milk, as solid food is introduced, the baby should be supplemented with both vitamin B12 , iodine and DHA, in addition to vitamin D. The content of DHA in breast milk can be increased by the mother taking supplements of algae oil. Formula (both cow's milk and soy) has all these nutrients, but when the amount is reduced in parallel with the child eating more solid food, supplements should be given

In Norway there are currently no special vegan supplements for infants on the market, but 1/3 tablet daily of the supplement VEG 1, Vegan multivitamin, produced by Vegan Society UK, can be used.

1 tablet VEG 1 contains 20 micrograms of vitamin D3, 25 micrograms of vitamin B12, 150 micrograms of iodine (and in addition vitamin B2, vitamin B6, folic acid and selenium). A third tablet of VEG 1 will provide an intake of these nutrients close to what is recommended for infants.

The tablet can be crushed and 1/3 of the powder mixed with a little breast milk or breast milk substitute (possibly juice) and given on a spoon. Use a tablet crusher that you can buy at the pharmacy. The tablet may be crushed between two spoons, but make sure that there are no pieces that can get in the child´s airway.

This article was first published on Dr. Carina Saunders, see the original here: https://www.drcarinasaunders.com/post/weaning-a-baby-on-a-vegetarian-or-vegan-diet