Infants: Essential Nutrition

By Kara Rienzo, R.D.N.

Choosing a well-planned vegetarian or vegan diet for an infant can easily provide all of the nutrients necessary to support growth and development [1]. Breast milk is the most nutritionally complete food for infants [2]. When breastfeeding is not possible, commercial soy formulas can provide adequate nutrition. Parents may even decide to feed their baby a combination of both breast milk and soy formula. In the first six months of life, the only nourishment a baby needs is from breast milk or formula. Beginning at five to six months, most babies will start eating complementary solid foods and will also continue drinking breast milk and/or formula until turning one year old.

 You can share your questions and experiences with other veggie parents on Generation Veggie’s Forums and get answers to specific questions through our Everyday Nutrition for Vegan Kids advice column.

Breastfed Infants

An infant’s nutritional needs are most thoroughly met through breast milk [2]. Babies who are breastfed are less likely to contract a variety of infectious diseases, ear infections, and diarrhea [2]. Vegetarian and vegan women who follow a well-planned diet have a milk composition very similar to non-vegetarian women and can provide every thing a baby needs for normal growth and development [1]. If you need breastfeeding help, please visit our Breastfeeding Challenges and Solutions page.

Formula Fed Infants

Commercial soy formulas should be used for vegan infants who are not breastfed, who are receiving only some of their nutrition from breast milk, or for infants who have been weaned before the age of one. Infants who are fed soy formula grow and develop normally [8]. Homemade formulas, soy milk, rice, coconut, or nut milks are not recommended, as they are inadequate in meeting an infant’s needs [9]. Commercial formulas contain a specific ratio of carbohydrate, protein, and fat, as well as vitamins and minerals that help a baby to grow and develop properly. All soy formulas currently on the market in the United States contain vitamin D3, which is animal-derived, however this is the only option for vegan infants who are not breastfed. It is usually unnecessary for babies who are exclusively formula fed to receive nutrient supplements unless otherwise directed by their health care provider. Check out Generation Veggie’s formula guide for more information.

Vitamin D

Breast milk is typically low in vitamin D. Beginning in the first few days after birth, the American Academy of Pediatrics recommends that breastfed infants receive an oral supplement of vitamin D equaling 400 IU a day [3]. Many infant vitamin D supplements contain vitamin D3, also known as cholecalciferol, which is animal derived. Vitamin D2, or ergocalciferol, drops are vegan-friendly and can be used. Adequate vitamin D intake is necessary for proper bone growth and development. Deficiencies in vitamin D are linked to Rickets in children, as well as an increased risk in respiratory infections and Type 1 Diabetes.

DHA

DHA levels are lower in vegan breast milk than non-vegan breast milk; therefore, it is important for breastfeeding mothers to take a DHA supplement in the amount of 300mg each day. DHA is necessary for proper infant neurological and retinal development [4].

Vitamin B12

The amount of vitamin B12 in breast milk is dependent on the mother’s B12 intake. All vegans, especially breastfeeding mothers, should use a vitamin B12 supplement and eat fortified foods such as nutritional yeast. It is recommended that vegan infants who are breastfed receive a daily vitamin B12 supplement in the amount of 0.4 mcg per day for infants from birth to six months of age and in the amount of 0.5 mcg per day for infants age six to twelve months [5]. Many foods fortified with vitamin B12 are inappropriate for infants under the age of one year, so a supplement is necessary. Adequate levels of B12 are important for maintaining healthy nerve and red blood cell function.

Iron

Regardless of the mother’s diet, breast milk is generally low in iron. While babies are born with storage of iron, this begins to deplete around the age of six months. Beginning at four months of age, the American Academy of Pediatrics also recommends a daily iron supplement be given to babies who are exclusively breast fed in the amount of 1 milligram per infant’s weight in kilograms [6]. The baby should receive this supplement until he or she begins solid foods that contain an adequate amount of iron.

Fluoride

Lastly, at the age of six months, infants should be given a fluoride supplement if the public water system is not fluorinated, and the child’s health care provider prescribes it [7].

Tips for Feeding

It is important to look for the infant’s hunger and fullness cues. Many parents worry about the number of ounces of breast milk or formula the baby is consuming; however, it is better to observe the baby for the following cues to know when it is time to feed or when feeding time is over. When babies are hungry, they may turn their head towards the breast, suck on their hands, fingers, or lips, or make fussy sounds [10]. A baby shows these signs before crying. It is not recommended to wait until a baby cries to feed him or her. When babies are full, some signs they may show are pushing the nipple (from breast or bottle) out of their mouth, turning their head away from the breast or bottle, slowing down or stopping sucking, becoming distracted by other things in the room, or falling asleep [10]. These are signs that the baby is done feeding. It is not recommended to continue feeding the baby when he or she shows these signs, as forcing a baby to continue to eat after he or she is full can lead to overfeeding, which can result in spitting up or undesirable weight gain. Growth is the best indicator that a baby’s nutrient needs are being met. As long as babies are appropriately gaining weight and thriving, which the health care provider assesses using growth charts from the World Health Organization and the Centers for Disease Control and Prevention, there is no reason to worry that they are not getting enough nourishment.

Introducing Solid Foods

Exclusive breastfeeding and/or formula feeding will continue until the baby is about five or six months old. At around six months of age, solid foods can begin to be introduced. Signs an infant is ready to start solid foods are when they can hold their head upright, sit with little support, and are able to move their tongue back and forth without moving their head [11][12]. If foods are introduced and the infant is spitting it out or is not able to chew and swallow it, then the baby is not ready for solid foods. He or she can try again in a week, or until they show these signs [11]. A great first food to try is iron fortified infant cereal, which is prepared in a bowl with breast milk or formula to a thin consistency and fed to the baby with a spoon. Cereal should never be put in a baby bottle, as it can cause choking. Babies are born with iron stores that begin to deplete at around six months of age, which is why the iron-fortified cereal is a good choice for a first food. It is recommended that infants do not have wheat products until they are eight months old, because it is considered an allergenic, so try rice or oat cereals. Once the baby can tolerate cereals, she can try fruits, vegetables, and juices. Initially, fruits and vegetables should be pureed or mashed, but as the baby gets older, she will be able to tolerate soft or well-cooked fruits and veggies. Once the infant gets better at chewing, foods like soft cooked pasta and rice, dry cereals, and crackers can be introduced. Be sure to only introduce one new food at a time, waiting seven days between trying new foods to easily identify food allergies.

Many parents may opt to use commercially prepared baby foods. Many of these are vegetarian or vegan, but you should read the ingredient label just to make sure. Parents may also choose to prepare their own baby foods at home. Infants like their food plain, so these should be made without sugar, salt, or spices.

Babies need enough fat and calories to have adequate growth. Higher calorie foods can help vegetarian or vegan babies meet their recommended calorie and fat needs as they transition from breast milk and formula. Foods like avocado, mashed tofu, or pureed beans can help them meet these needs. Older infants can be given foods like avocado, soft margarine, and vegetable oils.

A Typical Daily Diet for Babies Who Are 6 to 8 Months Old [12]

A Typical Daily Diet for Babies who are 8 to 10 Months Old [13]

A Typical Daily Diet for Babies Who Are 10 to 12 Months Old [14]

Foods to Avoid

Nuts, seeds, small pieces of raw vegetables, vegetarian hot dogs, whole kernel corn, popcorn, whole grapes, whole berries or cherries, raisins or dried fruit, and large pieces of fruit are choking hazards and should not be given to infants.

Nut butters should not be given to infants, as they are a choking hazard and generally viewed as allergenic.

Honey and corn syrups can be contaminated with spores of bacteria that cause botulism and should not be given to infants under the age of one.

Resources

1. Messina VK, Burke KI. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 1997;97:1317-1321.
2. American Academy of Pediatrics. Policy statement: Breastfeeding and the use of human milk. Pediatrics. 2012 March;129(3):e827-e841.
3. Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-52.
4. Byrd-Bredbenner, C., Moe, G., Beshgetoor, D., Berning, J. Wardlaw’s Perspectives in Nutrition, 8^th ed. New York: McGraw-Hill, 2009
5. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press, 1998.
6. Baker RD, Greer FR; Committee on Nutrition American Academy of Pediatrics.Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126;1040-50.
7. American Academy of Pediatric Dentistry Liaison with Other Groups Committee, American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on fluoride therapy. Pediatr Dent. 2008-2009;30(7 Suppl):121-4.
8. Bhatia J, Greer F; American Academy of Pediatrics Committee on Nutrition. Use of soy protein-based formulas in infant feeding. Pediatrics. 2008 May;121(5):1062-8.
9. Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc. 2001;101:670-677
10. New York State Department of Health. (April 2009). I am newborn [PDF file]. Retrieved from http://www.health.ny.gov/publications/4319.pdf
11. New York State Department of Health. (April 2009). Now I can sit with some help [PDF file]. Retrieved from http://www.health.ny.gov/publications/4322.pdf
12. New York State Department of Health. (April 2009). Now I can sit on my own [PDF file]. Retrieved from http://www.health.ny.gov/publications/4325.pdf
13. New York State Department of Health. (April 2009). Now I can crawl [PDF file]. Retrieved from http://www.health.ny.gov/publications/4328.pdf
14. New York State Department of Health. (April 2009). Now I am learning to walk [PDF file]. Retrieved from http://www.health.ny.gov/publications/4331.pdf