Mr. Koletzko, there is currently a heated debate about whether children can be safely fed a vegan diet. What do you think?

A vegan diet leads to nutrient deficiencies if you do not take additional supplements. The risk of such deficiencies is particularly high in children because they are still growing. A vegan diet does not contain vitamin B12, which is essential for blood formation and the functioning of the nervous system.

The risk of deficiencies is also increased for other nutrients, for example the long-chain omega-three fatty acid DHA, calcium, iron, zinc and iodine. A mixed vegetarian diet is less problematic, but there are certain things you have to watch out for. We pediatricians believe that a flexitarian diet, in which many plant-based foods are eaten, but fish or meat is eaten now and again, is best.

Berthold Koletzko, specialist in pediatrics and adolescent medicine.
Berthold Koletzko, specialist in pediatrics and adolescent medicine. | ​​Image: LMU Hospital Press Office

Is there a certain age at which it is safer to feed a child a vegan diet?

A vegan diet is not compatible with healthy growth and development unless supplements are used. This applies to all ages. However, the faster the growth, the faster deficiencies become apparent. This is because the need for nutrients is particularly high at this time.

Such phases of rapid growth include infancy and toddlerhood, and puberty. During this time, young people experience a real growth spurt and often eat like crazy because they have such great needs.

Girls also lose iron through menstruation. If they follow a vegetarian or vegan diet, they are at a particularly high risk of iron deficiency.

But some parents absolutely want to feed their children a vegan diet, even babies. Is there a suitable vegan baby food?

Yes, soy-based infant formula. Although it is not equivalent to cow’s milk-based formula, it is well suited to feeding non-breastfed infants. However, this is different from a soy drink that you buy in a health food store – that is not suitable for infant nutrition.

Isn’t soy infant formula problematic because it contains hormones in the form of phytoestrogens?

Therefore, it is not our first choice. Our first choice is breastfeeding from a well-nourished mother, the second choice is infant formula based on cow’s milk protein. We would only recommend soya formula if this is not acceptable for ideological reasons.

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So is it healthier to breastfeed vegan babies for a long time?

First of all: Breastfeeding is not a vegan diet, but an animal-based diet. We recommend that all children be breastfed for six months if possible and that breastfeeding should continue after the introduction of solid foods. If the mother does not have any nutritional deficiencies, this is very healthy. However, if she has been on a vegan diet for a long time, then her breast milk will also contain too little vitamin B12, for example.

In such cases, it is important that mother and/or child are supplemented. In children’s hospitals, we often see children who suffer from severe neurological damage such as seizures and brain damage because they were breastfed by vegan mothers for a long time and were given vegan supplementary food for a long time.

Do such disturbances disappear again?

The tragic thing is that half of these children suffer permanent damage. If a woman on a vegan diet is breastfeeding, she should definitely take nutritional supplements – this applies even during pregnancy. This time and the first two years of the child’s life are particularly sensitive phases, as the brain and nervous system are developing. But functional impairments can also occur later on. If you want to protect your child, you have to combine a vegan diet with supplements.

Do you need medical advice for this?

It is always good to discuss such things with your pediatrician. They can also recommend a specific preparation. The best option is to take a multi-nutrient preparation that also contains vitamin B12. This is available as a tablet or juice and is taken daily. It is important that the dosage is correct.

Are children who are fed this way as well cared for as children who eat non-vegetarian food?

It is better to meet your nutritional needs with food. It contains more than just the essential nutrients. The availability of nutrients is also different. For example, the body can absorb iron from fish or meat much better than from many supplements.

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How well has the topic been scientifically researched?

There are many studies on this, including in Germany. One study, for example, has shown that children who eat a vegan diet not only have a lower body weight, but also a shorter body length. This shows very clearly that the body is not optimally supplied with nutrients and is therefore not making full use of its growth potential.

It has also been seen that children who eat vegan and vegetarian diets are significantly more likely to have iron deficiency than those who eat omnivorous diets, i.e. those who also eat fish or meat. It must be said that even small amounts of fish or meat are enough. In principle, all experts advocate a plant-based diet.

In a vegan diet, it is important to cover protein needs with pulses and whole grains. However, most children prefer spaghetti and pizza to lentils and buckwheat groats. Can “picky eating” pose an additional risk?

This can be a problem, it depends on the child and the family. It also depends on what the child is used to. Most children who eat vegetarian and vegan diets do not have a protein deficiency. But it is important to cleverly combine foods to meet protein needs, for example beans or lentils with rice or wheat.

When older children decide to live vegan, there is not much parents can do about it. But what can you do if their diet is very unbalanced? Maybe they only eat chips and soy pudding?

Parents can provide support and advice. They can also suggest that the young person get examined by a pediatrician. The doctor can then also talk to them about the question of supplementation.

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How is the issue of vegan nutrition for children viewed in other countries?

In the USA, this is viewed less critically. However, it must be taken into account that supplementation is much more widespread there. A lot of foods are enriched with nutrients. In the USA, it is also considered good form to go to the drugstore and buy a nutritional supplement.

That’s why a vegan diet is easier there, because vegan ready-made products usually contain the critical nutrients and many people take supplements anyway. In Germany, we don’t have nearly as many enriched foods, especially in the organic sector, which is preferred by vegans. Taking supplements is also not that common.

And apart from the USA?

There are a large number of people in India who eat a vegan diet. Vitamin B12 deficiency is widespread there. I have just spoken to an Indian pediatrician who found vitamin B12 deficiency very frequently during newborn screening. The babies often had developmental disorders and other problems, such as anemia. This is a very big health problem that people are now trying to tackle with various initiatives.