Ask the Pediatrician: My child wants to be a vegetarian. Is that OK?

Children and adolescents who follow a vegetarian eating plan tend to consume more fruits and vegetables and less sweets, salty snacks, and saturated fat than their nonvegetarian peers. They also tend to be at lower risk for obesity and overweight.

In the past, experts worried that following a vegetarian diet, which tends to be low in saturated fat and animal protein and high in fiber, folate, vitamins C and E, carotenoids and some phytochemicals, would lead to nutritional deficiencies in children.

Today, we know that's generally not the case with well-planned 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 (beans, peas, lentils, peanuts and soy) helps ensure they'll get enough. Vegan children and adolescents may need to eat more of these foods than nonvegan 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. Being low in iron is common in children in general, and more so in children who follow a vegetarian eating plan. Overall, vegetarians need about 1.8 times higher iron intake compared to non-vegetarians.
• 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, which in nature 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.
• Eicosapentaenoic and docosahexaenoic omega-3 fatty acids (EPA and DHA). These healthy fats, primarily found in cold-water fish, are generally low in vegetarian (and absent in vegan) eating plans. A small proportion of alpha-linolenic acid (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 at 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.

Using recipes you find, you can involve kids in meal preparation and cooking. Some of my favorite places to access recipes kids love are Healthychildren.org/recipes or Chopchopfamily.org.

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