Discussing formula options with parents who are vegan

Using vegan, plant-based, and vegetarian formulas isn't as easy as an adult choosing to have such a diet and making that choice for an infant can carry consequences.

There are a number of reasons that adults might choose to cut meat—or all animal products for that matter—from their diets. However, doing the same for infants can have big health consequences.2

Donna Hallas, PhD, RN, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, a pediatric nurse practitioner and professor at New York University Meyers College of Nursing in New York City, says although there are some vegan, plant-based, and vegetarian formulas for infants on the market, switching an infant to these types of diets isn’t a simple matter of preference. Even strict vegan mothers that breastfeed their infants need to be aware of the risks and take steps to make sure their babies grow and develop in a healthy way when using these diets, she said.

“I am opposed to strict vegan diets for babies,” Hallas said. “Because I work with very high risk children in my practice. Whenever I encounter a family who wanted to pursue a strict vegan diet, their babies did not thrive.”
Brain growth in the first 3 years of a child’s life is critical to their overall development, Hallas explained, adding that proper nutrition is a key part of healthy brain development. A number of nutritional deficiencies can occur with diets that lack certain minerals and nutrients, including rickets and overall malnutrition.

A study in early 2021 revealed that the risk of nutritional deficiency increased with more restrictive diets. Some of the deficiencies noted in children who followed vegan and vegetarian diets include1:

  • Iron
  • Zinc
  • Selenium
  • Calcium
  • Riboflavin
  • Vitamin A
  • Vitamin B12
  • Vitamin D
  • Essential fatty acids
  • Fiber

Guidelines used throughout North America tend to support well-planned and executed vegan and vegetarian diets for any age, the study continues, but European guidance recommends strongly against them without close medical and dietary supervision.1

Pediatricians who are asked about vegan formulas—or even breastfeeding by a strictly vegan mother—should be aware of the nutritional concerns and advise patients and caregivers on appropriate supplementation. Not all families come forward with the choice to live a vegan or vegetarian lifestyle, Hallas said, and mothers who are breastfeeding might not even be as healthy as they think.

Strict vegan mothers who breastfeed should continue taking prenatal vitamins while nursing, she said, and pediatricians should do their best to assess the mother’s intake and have them do a recall of a few days worth of their diet. One 2020 case study shared a report of a 13-month-old breastfed infant that developed rickets due to the mother’s nutritional deficiencies and lack of supplementation.3

“A lot of vegan mothers who aren’t in the high risk group will willingly give you the list of foods they’re eating,” Hallas said, adding pediatricians can use this information and their assessment of the infant to make appropriate nutrition and supplementation recommendations.

Sometimes, however, families don’t share their diet preferences either out of omission or simply a lack of time. Hallas noted she has seen some cases where infant vegan diets weren’t obvious until deficiencies resulted in serious nutrition, growth, or development problems.

“Sometimes I think in today’s world maybe more telehealth visits will be helpful because people are in and out so quick [at pediatric visits], how much time is there to discuss diet?” Hallas said.

There is also a matter of trust and whether vegan parents regard the pediatrician as a source of expertise when it comes to nutrition. One recent paper detailed the refusal of a family to follow the dietary advice of a pediatrician caring for a young child with failure to thrive. Follow-up was almost non-existent and the family failed to show up for appointments after the initial visit or utilize the recommended diet and supplements. The report authors caution that pediatricians need to be well versed in vegan and vegetarian preferences among patients and families, adding that interest in these types of diets has increased by an estimated 350% over the last decade.4

Allergens are another issue when it comes to helping families choose formulas and breastfeeding plans that align with different food allergy concerns. Hallas said oral immunotherapy has proven effective in managing peanut allergies, although use of this therapy in practice depends a lot on the individual assessment and family history. She recommends that families with a strong history of food allergies or anaphylaxis from a food allergy see a specialist for more exact testing. A good assessment is important in cases of food allergies, Hallas said, adding that it’s important to know where the family’s concern is coming from—a family history or a report on a blog?

Some common food allergies that cause concern with infant diets include milk proteins and gluten. The Asthma and Allergy Foundation of American makes several recommendations for formulas that meet the needs of infants with food allergies5:

  1. Milk-based formulas
  2. Soy formulas
  3. Partially hydrolyzed formulas
  4. Extensively hydrolyzed formulas
  5. Amino acid formulas

Breastfeeding is the preferred feeding choice for infants with food allergies, the organization notes, and homemade formulas are not recommended at all.

References

1. Kiely, M. Risks and benefits of vegan and vegetarian diets in children.Proceedings of the Nutrition Society. 2021;80(2):159-164. doi:10.1017/S002966512100001X

2. Michaelsen KF, Neufeld LM, Prentice AM. Global Landscape of Nutrition Challenges in Infants and Children.Nestlé Nutr Inst Workshop Ser. Nestlé Nutrition Institute. 2020;93:103–110. doi: 10.1159/000503348

3. Lemoine A, Giabicani E, Lockhart V, Grimprel E, Tounian P. Case report of nutritional rickets in an infant following a vegan diet. Archives de Pédiatrie. 2020;27(4):219-222. doi:10.1016/j.arcped.2020.03.008

4. Farella I, Panza R, Baldassarre ME. The difficult alliance between vegan parents and pediatrician: a case report. International Journal of Environmental Research and Public Health. 2020;17(17):6380. doi: 10.3390/ijerph17176380.

5. Asthma and Allergy Foundation of America. Formula options for infants and toddlers with food allergies. Accessed October 5, 2021. https://www.kidswithfoodallergies.org/formula-options-for-infants-with-food-allergies.aspx