When the seventh and posthumous – edition of Dr. Benjamin Spock’s “Baby and Child Care” was published recently, the guru’s endorsement of a vegetarian diet for kids over 2 caused many nutritionists and doctors to choke on their leafy greens.
Dr. T. Berry Brazelton, professor emeritus of pediatrics at Harvard Medical School, thinks it’s “absolutely hopeless” to try to get kids to eat enough vegetables to offset the loss of nutrients they would suffer from giving up meat and milk.
Dr. Ronald Kleinman, author of the kids’ nutrition guide, “Let Them Eat Cake!” and chief of pediatric gastroenterology and nutrition at Massachusetts General Hospital, calls it a “terrible recommendation for the population as a whole.”
Even Dr. Steven Parker, the Boston Medical Center pediatrician who co-authored Spock’s last edition, can’t stomach the elderly pediatrician’s “advocacy of what amounts to a vegan diet for kids – no meat, fish, dairy or eggs.”
“This was an area upon which we didn’t agree,” says Parker, noting there’s little data – for or against – a vegan diet for kids. So how did they resolve it? “Spock trumped Parker.”
But not everybody thinks it’s nuts to feed kids a diet limited to grains, legumes, seeds, veggies, and fruits. After all, that does leave peanut butter, pasta, bagels, and cereal.
And not everyone thinks it’s impossible to do in a culture where kids are bombarded by images of burgers and ice cream.
Dr. Neal Barnard, president of the Washington-based Physicians’ Committee for Responsible Medicine, an animal rights group, contends that a vegetarian diet for kids is a valuable way to reduce diet-associated diseases in later life because “childhood is a time when adult dietary patterns are set.”
The American Dietetic Association says “appropriately planned vegan” and vegetarian diets that include dairy products and eggs “satisfy nutrient needs of infants, children, and adolescents and promote normal growth.” The American Academy of Pediatrics adds that if meal planning is adequate, vegan children grow normally.
Reed Mangels, 41, a nutritionist and registered dietician in Amherst who has been feeding her kids a vegan diet for years, says it’s “quite doable.” They’re happy with bean burritos, soy milk on cereal, lots of p-b-and-j’s, veggie burgers, and veggie hot dogs. “We’re talking quick and easy,” she says.
But are we talking enough protein, minerals, and calories?
That depends.
A good vegan diet is “perfectly compatible with good health and is probably preferable to a diet of Coca-Cola, pizza, and MacDonald’s,” says Dr. Walter Willett, professor of nutrition and epidemiology at the Harvard School of Public Health.
If parents consult a registered dietician and use fortified cereals and plan meals well, a vegetarian diet that includes milk and eggs can be “a fine option” for kids,” says Johanna Dwyer, director of the Frances Stern Nutrition Center at Tufts and one of the few nutritionists who has studied the issue. “But I take a dim view of a strict vegan diet for kids” – one that excludes eggs and dairy products.
If, however, parents are haphazard about nutrition and ignore other health measures – such as routine immunizations – a vegetarian diet can contribute to poor growth and anemia.
Without any animal products, for instance, kids may become deficient in iron, calcium, some B vitamins, vitamin D, and zinc. In Northern climates like Boston’s, vitamin D deficiency can be a particular problem because the body makes the vitamin from precursors that are activated by sunshine.
And some kids who avoid animal products may become so deficient in vitamin B-12 they are at increased risk of seizures, adds Willett, who suggests that vegan kids take a multi-vitamin supplement daily.
Milk is a particular bone of contention.
Six years ago, Spock (who went on a nondairy, low fat, meatless diet in 1991, at age 88) triggered controversy when, with Barnard of the animal rights group, he proclaimed that neither adults nor kids should drink cow’s milk, contending that it “causes intestinal blood loss, allergies, indigestion and contributes to some cases of childhood diabetes.”
Milk may be “culturally normal” to Americans, though it’s not for much of the rest of the world, but it interferes with absorption of iron, Barnard contends.
Willett disagrees: Milk doesn’t interfere with iron absorption “in any major way” and is such a rich source of calcium that if a child is on a dairy-free diet, he should take a calcium supplement – 800 to 1,000 milligrams a day.
You can get enough calcium from vegetables, adds Kleinman of MGH, but it takes four cups of broccoli to equal a cup of milk.
And while a report in 1992 in the New England Journal of Medicine did suggest that cow’s milk may increase the risk of diabetes in genetically-susceptible children – perhaps by triggering production of antibodies that attack the pancreas – research since then has debunked that notion, Kleinman adds.
And what of the anti-milk argument that the fatty liquid leads to clogged arteries, even in kids?
Both the National Cholesterol Education Program, a government-sponsored committee of nutrition specialists, and the American Academy of Pediatrics say that fats should not be restricted in kids under two, but after that they should follow the same guidelines as adults – a diet of not more than 30 percent fat. In other words, kids should eat dairy products, but the low-fat kinds.
Getting enough protein is not a serious problem for children on vegan diets, provided the sources of plant protein are varied – not just carrots, celery, and lettuce, but beans and other legumes. While nutritionists once thought it was necessary to eat “complementary” proteins such as beans and grains at the same meal to get the full range of amino acids, many now think it’s fine just to balance proteins over 24 hours.
But getting enough calories on a veggie diet can be a problem. Granted, 30 percent of American kids are obese – they eat too many calories and expend too few in exercise. But kids on veggie diets, which are low in fat and high in fiber, may not provide enough energy for a growing child.
Very high fiber diets, says Dwyer of Tufts, means some kids “just can’t eat enough, especially when they are small and are being weaned from breast milk. They eat all the time.”
For Reed Mangels, the vegan mom, the bottom line is that even if parents don’t follow all of Spock’s recommendations, at least he’s made “people think a little bit about what kids eat.”
But Parker, Spock’s co-author, thinks a diet of all veggies is silly, especially since there’s little evidence that the eating habits you form in childhood stick with you for life.
“Personally,” he says, “I think a childhood without ice cream just isn’t worth it.”