Vegetarian Eating for Children and Adolescents

Laurie Dunham, MS, RD, LD; Linda M. Kollar, RN, MSN

Disclosures

J Pediatr Health Care. 2006;20(1):27-34. 

In This Article

Abstract and Introduction

During the past decade, vegetarianism has risen in popularity among American families. Well-planned vegetarian diets can satisfy the nutritional needs and promote normal growth of infants and children. Research has highlighted nutritional advantages to vegetarian diets and has indicated that this style of eating can lead to lifelong healthy eating habits when adopted at a young age. Several vitamins, minerals, and macronutrients may be deficient within a vegetarian diet. Careful nutrition assessment and counseling will allow nurse practitioners to play a key role in encouraging families to adopt healthy eating habits to assist in disease prevention.

The American Dietetic Association and the American Academy of Pediatrics agree that well-planned vegan and vegetarian diets can satisfy the nutritional needs and promote normal growth of infants and young children (American Academy of Pediatrics Committee on Nutrition, 1998; Messina & Burke, 1997). In addition, a vegetarian style of eating follows the dietary guidelines and meets requirements of the Recommended Dietary Allowances for nutrients (National Academy of Science, 2003; United States Department of Agriculture, 2005). Many well-designed studies have concluded that children and adolescents who follow a properly designed vegetarian diet grow and develop normally (Nathan, Hackett, & Kirby, 1997; O'Connell et al., 1989; Sabate, Lindsted, Harris, & Sanchez, 1991; Sabate, Lindsted, Harris, & Johnston, 1990; Sanders & Manning, 1992; Sanders & Reddy, 1994). Birth weights of infants born to well-nourished vegetarian women have been shown to be similar to birth weight norms and to birth weights of infants born to nonvegetarian mothers (O'Connell et al.). Research has highlighted nutritional advantages to vegetarian diets and has indicated that this style of eating can lead to lifelong healthy eating habits when adopted at a young age. Studies show that children and adolescents who follow a vegetarian diet have a lower intake of cholesterol, saturated fat, and total fat and a higher intake of fruit, vegetables, and fiber than their nonvegetarian counterparts (Fulton, Hutton, & Stitt, 1980; Neumark-Sztainer, Story, Resnick, & Blum, 1997; Novy, 2000; Sanders & Manning). In addition, research suggests that vegetarian children are leaner than nonvegetarian children (Krajcovicová-Kudlácková, Simoncic, Bederova, Grancicova, & Magalova, 1997; Sabate et al., 1990). We also have learned that vegetarian adults have a decreased risk for several chronic diseases such as diabetes, coronary artery disease, hypertension, obesity, and some types of cancer (Appleby, Thorogood, Mann, & Key, 1999; Beilin, 1994; Dwyer, 1988; Fraser, 1999; Fraser, Lindsted, & Beeson, 1995; Kahn, Phillips, Snowdon, & Choi, 1984; Key et al., 1999; Key, Thorogood, Appleby, & Burr, 1996; Knutsen, 1994; Messina & Burke, 1997; Phillips et al., 1980; Rajaram & Sabate, 2000; Roberts, 1995). Aside from nutritional advantages, individuals may choose to adopt a vegetarian style of eating for other reasons. For instance, religion, economic status, environmental issues, and concerns of world hunger may play a role in a person's decision to exclude animal products from his or her diet (Messina & Burke; Rajaram & Sabate). The purpose of this article is to provide practical, factual information about vegetarian eating for infants, children, and adolescents.

The eating patterns of vegetarians can vary greatly. With the exception of vegans, most vegetarian diets consist of grains, fruits, vegetables, legumes, oils, nuts, seeds, dairy products, and eggs. Vegans exclude all foods of animal origin, including dairy, eggs, butter, honey, and gelatin (Messina & Burke, 1997). Some persons may describe themselves as vegetarian if they just limit meats, making exploration of a patient's definition of vegetarian extremely important (Barr & Chapman, 2002).

Assessing the nutritional intake of a child or adolescent is essential to monitor proper growth and development. This assessment is especially critical if they have adopted a pattern of eating, such as vegetarianism, that partially or completely eliminates an entire food group. Several dietary assessment tools can be used in a clinical setting to assess a patient's eating habits. A 24-Hour Food Recall (Figure 1) and Food Frequency Questionnaire (Figure 2), used together, can provide detailed and adequate information for evaluation. The 24-Hour Food Recall and Food Frequency Questionnaire can be sent home, filled out by the patient, and brought to the next appointment, or if time allows, it can be administered in the office. During a 24-hour food recall, a teen or a child's parent is asked to remember everything (food and beverage) consumed during the previous day. It is important to obtain a good estimate of portion sizes from the reporting individual. Food models, pictures, or measuring cups can serve as visual aids to assist the family in accurately describing intake. If the food recall is done at home, they can look at food labels to record exact measurements. The more details the patient or parent can provide, the more accurate the assessment will be. It is very helpful to ask if this was a typical day in terms of dietary intake; this information should be noted. A clinician can quickly compare the patient's intake to the dietary recommendations in MyPyramid, accessible at www.mypyramid.gov, to determine where the inadequacies, if any, lie (Stang, 2002).

24-Hour Food Recall chart.

Food Frequency Questionnaire.

A food frequency questionnaire aims to assess how often a person is eating or drinking certain foods and beverages from each of the food groups over a certain period (day, week, or month). The questionnaire can be short and simple, or it can be several pages long. For clinical purposes, a short form targeting the major food groups (grains, fruits, vegetables, dairy or dairy alternatives, meats or meat alternatives, and fats) would be appropriate. This tool gives a broader sense of what the child or adolescent consumes over a more extended period. If filled out and mailed to the office prior to the appointment, suitable educational materials or a referral to a dietitian could be arranged if necessary.

The purpose of these tools is to identify potential deficiencies in dietary intake and provide direction for patient education discussions. Dietary education materials are readily available through the newly released Food Guidance System of the United States Department of Agriculture (USDA). This interactive and individualized tool replaces the 1992 Food Guide Pyramid. MyPyramid.gov is the access point for this food guidance system. Health care providers can print useful handout materials for parents and adolescents or encourage families to explore the easy-to-use Web site. Vegetarian choices are included in the meat and bean group, including specific tips to increase variety and ensure adequate protein intake without consuming excess calories. Serving sizes for all food types are shown graphically and are described in weight or volume. The Web site includes the recommended daily total intake of each food group by age (2 through > 51 years old) and sex.

Nurse practitioners (NPs) can reassure parents, children, and adolescents that a well-planned vegetarian diet is a healthy choice that promotes growth and decreases the risk for diabetes, heart disease, and cancer. Within a vegetarian diet, there are several vitamins, minerals, and macronutrients a person may not be consuming in adequate quantities. Each of these key nutrients will be discussed briefly. If there is concern about a child's intake of a particular nutrient, a referral to a registered dietitian may be appropriate.

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