A letter from London - and its translation for vegans: ESPGHAN on vegan babies, 2017

A new position paper (1) by the ESPGHAN Committee on Nutrition - published online yesterday - includes some information on vegan babies!

ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology, and Nutrition

This position paper is on complementary feeding (CF), i.e. what to feed babies once you begin to wean them at about 4 to 6 months of age. (See the WHO's definition of complementary feeding here).

In the following I've listed the vegan-relevant quotes from the position paper and my comments in square brackets.


"All infants should receive iron-rich CF including meat products and/or iron-fortified foods. [Iron is very important. If iron-fortified foods are really necessary for vegan babies as long as they eat legumes every day is not certain.] No sugar or salt should be added to CF and fruit juices or sugarsweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision [Visit your GP/medical doctor for checking normal growth and development - as recommended with a non vegan baby. Make sure you pay attention to certain nutrients and have access to science-based vegan nutrition info for babies. SEE BELOW***] and parents should understand the serious consequences of failing to follow advice regarding supplementation [especially regarding vitamin B12 - and to a lesser extent iodine - supplementation] of the diet."

*** You can get take care of all the necessary nutrients by providing: 
  • enough calories: feed your baby some white pasta/rice, some juice (not too much) - not 100% whole foods - as this would probably be too bulky (too much fibre). 
  • enough protein, iron, and zinc: feed your baby soft legumes, i.e. well cooked beans/peas, mashed, and/or soft tofu
  • give your baby half a VEG1 tablet (or similar supplement) - this will take care of vitamin B12, iodine, vitamin D, selenium, and vitamin B2.
  • include cooked mashed carrots/pumpkin/orange sweet potato or carrot juice - great sources of provitamin A
  • include some rapeseed (canola) oil or a little linseed (flax) oil - these contain omega 3 fatty acids
Check out these two links:






In "TABLE 1. Nutrients that may become deficient in different vegetarian and vegan diets" the following nutrients to pay attention to are listed:
  • iron
  • zinc
  • calcium
  • vitamin B12
  • vitamin B2
  • vitamin D
  • vitamin A
  • n-3 fats (DHA) [n-3 = omega 3; DHA is a long-chain omega 3 fatty acid that occurs in certain fishes and certain vegan microalgae-supplements.]
  • protein

[Note: With the recommendations I've given above you've already taken care of all these nutrients - except calcium and DHA - see the comments below.
It's surprising that they have left out iodine - which is very important to pay attention to, especially in vegan diets, especially in vegan babies' diets - as it's important for brain development in babies (2,3).]






"Particular care is required to ensure an adequate nutrient intake during CF when vegetarian or vegan diets are used, and the nutrients that may be insufficient increases [!] as the diet becomes more restricted as shown in Table 1. Vegan diets have generally been discouraged during CF [no source given - the ADA/AND has not discouraged vegan diets for babies/children for a long time]. Although theoretically a vegan diet can meet nutrient requirements when mother and infant follow medical [! How many medical doctors are able to provide good vegan nutrition advice?] and dietary advice regarding supplementation, the risks of failing to follow advice are severe [The risk is severe IF vitamin B12 is NOT supplemented. The risk is no higher than in meat eaters IF vitamin B12 is adequately supplemented.], including irreversible cognitive damage [brain damage] from vitamin B12 deficiency, and death. If a parent chooses to wean an infant onto a vegan diet this should be done under regular medical and expert dietetic supervision and mothers should receive and follow nutritional advice [.] [see above: normal regular medical check-ups, plus vegan nutrition info by a science-based vegan nutrition expert - see the links to the Vegetarian Resource Group and the Vegan Society. These are good websites to start.]. Mothers who are consuming a vegan diet need to ensure an adequate nutrient supply, especially of vitamins B12, B2, A, and D, during pregnancy and lactation either from fortified foods or supplements. Careful attention is required to provide the infant with sufficient vitamin B12 (0.4 µg/day from birth [from breast milk - the vegan mother should take a daily supplement of at least 10 µg], 0.5 µg/day from 6 months [half a VEG1 tablet provides plenty of B12]) and vitamin D [sunshine during late spring/summer/early autumn, supplement in winter], and iron, zinc [both from soft legumes and nut butters], folate [don't worry; beans and greens are great sources], n-3 fatty acids (especially DHA) [see below], protein [legumes], and calcium [once the baby is ~6 months old you can use some calcium-fortified soya milk - about 1/2 to 1 glass per day between meals - or use tofu with calcium], and to ensure adequate energy density of the diet [not 100% wholegrain, not too many raw vegetables]. Tofu, bean products, and soy products can be used as protein sources. Infants who are not receiving breast milk should receive a soy-based infant formula."



"Vegan diets with appropriate supplements can support normal growth and development [yes - highlighted by me]. 
Regular medical and dietetic supervision should be given and followed to ensure nutritional
adequacy of the diet. The consequences of failing to do this can be severe and include irreversible cognitive impairment and death [Vitamin B12 deficiency is in fact very dangerous, especially for babies]."




"Vegan diets should only be used under appropriate medical or dietetic supervision to ensure that the infant receives a sufficient supply of vitamin B12, vitamin D, iron, zinc, folate, n-3 LCPUFA, protein, and calcium, and that the diet is sufficiently nutrient and energy dense. Parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet."
[It's questionable whether a DHA supplement is really necessary or will provide any beneficial effect for vegan babies. Vegan DHA supplements are available though. Many vegan babies have been raised without them.]






References:

(1) Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C: Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):119-132. doi: 10.1097/MPG.0000000000001454.

(2) Zimmermann MB: The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol 26 (Suppl 1): 108–117 (2012)

(3) Rohner F, Zimmermann M, Jooste P, Pandav C, Caldwell K, Raghavan R, Raiten DJ: Biomarkers of nutrition for development – iodine review. J Nutr 144: 1322S–1342S (2014)