Vegan Diets in Children

Our world has become inundated with the newest food and diet crazes. It seems like every social media persona provides “expert” opinions on the best way to nourish our bodies. Adults are one thing, but how does that translate to our growing, developing pediatric patients? Today we are focusing on vegan diets in children, and which nutritional deficiencies we need to remain vigilant to spot!

Vegan Diets in Children: Basics

  • Vegan Diets avoid/prohibit consumption of any animal products
    • Exclusion of meat, eggs, honey, dairy products, etc
    • This is often adopted due to heightened concern of animal maltreatment, but also for religious reasons or health benefits
    • Roughly 2-5% of Western nation populations follow a vegan based diet (Sutter, 2021)
    • Historically, there was significant discouragement of vegan diets by medical providers due to concerns for nutritional deficiencies and poor growth (Hovinen, 2021)
      • There are case reports documenting severe developmental delay, rickets, and failure to thrive in “inappropriate vegan diets” (Kiely, 2021)
  • Recently, several European countries released guidelines stating that vegan diets are viable options as long as strict supplementation of essential vitamins are provided (Sutter, 2021)
  • Guidelines advocate for vegan mothers of infants to either breastfeed or utilize commercially available formula, (containing soy or plant based protein) both with vitamin supplementation (Baroni, 2019)
    • Examples include Similac Sensitive and Enfamil Lactofree 
    • They strongly discourage individually created formula due to safety concerns and negative health effects.

Vegan Diets in Children: Nutritional Considerations

Potential deficiencies of protein, vitamins A, D, B12, iron, calcium, folate, zinc, selenium, and fatty acids (Kiely, 2021)

  • Vitamin B12 (Qudsiya, 2023, Sutter, 2021)
    • Deficiency results in macrocytic anemia, dementia, and subacute combined generation of spinal cord and peripheral nerves
    • Vegan adults were found to be significantly more deficient in B12 (52%) compared to their vegetarian counterparts (7%) 
    • Poor studies involving vegan children and vitamin B12 levels
    • Presence in diet through fortification of soy milk and nutritional yeast
  • Vitamin A (Hovinen, 2021)
    • Significant vitamin A deficiencies can result in vision loss
    • Despite normal intake of vitamin A containing foods, vegan infants and toddlers had significantly lower levels compared to vegetarians and omnivore children
  • Vitamin D (Sutter, 2021)
    • Deficiency can result in rickets and osteomalacia 
      • Poor bone growth, bowed legs, spinal deformities
    • Up to 14% of the United States is deficient
    • Significantly lower levels of 25-hydroxyvitamin D in un-supplemented vegan adults 
    • Lack of data involving vegan children 
  • Iron 
    • Vegan children had adequate iron intake (Sanders, 1988)
    • Found to have lower ferritin levels, but no increased risk of iron deficiency anemia (Messina, 2001, Sutter, 2021)
  • Calcium 
    • 52% of the vegan children population receiving adequate calcium intake (Sanders, 1988)
      • Those deficient had no decrease in growth 
      • 30-57% of the adult European population are deficient in calcium (Mensink, 2013)
  • Protein 
    • Vegan children were found to have increased protein intake compared to German national recommendations (Alexy, 2021) 

Vegan Diets in Children: Potential Benefits

  • Lowest BMI and obesity rates in vegan adults compared to vegetarian and omnivores (Spencer, 2003)
  • Cholesterol
    • Significantly lower non-HDL cholesterol in vegan children and adults (Hovinen, 2021)
  • Improved fasting blood glucose (Hovinen, 2021)

Moral of the Morsel

  • Specialized diets are becoming more popular! Ask about any restrictive diet practices in your patient populations.
  • Supplementation is key! Key nutrients and vitamins are not always found in specialized diets (or picky children) and adherence to multivitamins is a must! 
  • Remember to specifically counsel vegan parents of infants on the importance of utilizing commercial formula or breastmilk ALWAYS with vitamin supplementation!
  • Look out for nutritional deficiencies! Those pesky vitamins you learned (forgot) in medical school are extremely important for children to continue to grow and thrive!


  • Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, Keller M. Nutrient Intake and Status of German Children and Adolescents Consuming Vegetarian, Vegan or Omnivore Diets: Results of the VeChi Youth Study. Nutrients. 2021 May 18;13(5):1707. doi: 10.3390/nu13051707. PMID: 34069944; PMCID: PMC8157583.
  • Baroni L, Goggi S, Battaglino R, Berveglieri M, Fasan I, Filippin D, Griffith P, Rizzo G, Tomasini C, Tosatti MA, Battino MA. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. Nutrients. 2018 Dec 20;11(1):5. doi: 10.3390/nu11010005. PMID: 30577451; PMCID: PMC6356233.
  • Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients. EMBO Mol Med. 2021 Feb 5;13(2):e13492. doi: 10.15252/emmm.202013492. Epub 2021 Jan 20. PMID: 33471422; PMCID: PMC7863396.
  • Kiely ME. Risks and benefits of vegan and vegetarian diets in children. Proc Nutr Soc. 2021 May;80(2):159-164. doi: 10.1017/S002966512100001X. Epub 2021 Jan 28. PMID: 33504371.
  • Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Arch Pediatr. 2019 Oct;26(7):442-450. doi: 10.1016/j.arcped.2019.09.001. Epub 2019 Oct 12. PMID: 31615715. 
  • Mensink GB, Fletcher R, Gurinovic M, Huybrechts I, Lafay L, Serra-Majem L, Szponar L, Tetens I, Verkaik-Kloosterman J, Baka A, Stephen AM. Mapping low intake of micronutrients across Europe. Br J Nutr. 2013 Aug;110(4):755-73. doi: 10.1017/S000711451200565X. Epub 2013 Jan 14. PMID: 23312136; PMCID: PMC3785176. 
  • Messina V, Reed Mangels A. Considerations in planning vegan diets: children. J Am Diet Assoc 2001;101:661–9.
  • doi:10.1016/S0002-8223(01)00167-5.
  • Qudsiya Z, De Jesus O. Subacute Combined Degeneration of the Spinal Cord. 2023 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32644742.
  • Sanders TA. Growth and development of British vegan children. Am J Clin Nutr. 1988 Sep;48(3 Suppl):822-5. doi: 10.1093/ajcn/48.3.822. PMID: 3414589.
  • Spencer EA, Appleby PN, Davey GK, Key TJ. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003 Jun;27(6):728-34. doi: 10.1038/sj.ijo.0802300. PMID: 12833118.
  • Sutter DO, Bender N. Nutrient status and growth in vegan children. Nutr Res. 2021 Jul;91:13-25. doi: 10.1016/j.nutres.2021.04.005. Epub 2021 May 18. PMID: 34130207.


Ali Rosser
Ali Rosser
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