But is it OK for my children?

How did you get your kids to eat a vegetarian diet?" This question was asked as I lectured to some 65 students taking a nutrition class at the University of Washington. And the answer was quite simple. "Taste is learned."

Usually we like the kinds of food we eat while growing up. My children had been raised as lacto-ovovegetarians, so it was not a problem for them to eat vegetarian meals. Quite to the contrary. It would have been much more difficult to get them to eat meat, surprising as that sounded to the university students.

I well remember something that happened when my son, Marty, was about 3 years old. Marty's grandpa knew we were vegetarians and that Marty had never eaten meat, so why he did what he did, I'll never know. He took a piece of his hamburger and put it on Marty's plate. I didn't say anything. Not knowing what it was, Marty put a bite into his mouth. Immediately it came sputtering back out all across the table! No one said anything as I wiped things up. It was quite clear that Marty was not accustomed to meat.

But what about vegetarian diets for growing children? Can little ones get all the nutrients they need from such diets? It is during the early growth years when nutrient demands are relatively high that a deficient diet can have the greatest impact. That's why reports in the literature often focus on the nutritional adequacy of diets of preschool children. That's also why nutritionists have at times expressed concerns about some vegetarian diets for children. However, the concerns appear to be confined to those vegetarian diets with restricted intake.

Vegetarian Variety

A variety of dietary practices are called vegetarian. Some vegetarians use milk and other dairy products and/or eggs (lacto- or lacto-ovovegetarians), while others use no animal products at all (vegans, total, or strict vegetarians). Then there are macrobiotic vegetarians. If they eat any animal foods, it's more likely to be small amounts of fish. They emphasize whole grains and vegetables, including seaweeds and other foods less familiar to most of us.

In the 1970s one researcher described what she called the new vegetarians. She called them this because they do not follow the usual pattern of vegetarian diets. For example, they often avoid red meat and chicken but may eat fish. Or they do not drink milk but may eat yogurt. Some do not use any processed foods and may eat only organically grown foods. Also they may have negative attitudes toward regular medical and health care and rely instead on lay healers. Lacto-ovovegetarian Diet

The lacto-ovovegetarian diet is the one most often recommended for small children because it easily supplies all the nutrients needed for growth. In fact, recent research at Loma Linda University found that children and youth raised on a lacto-ovovegetarian diet were slightly taller than nonvegetarians. They were also leaner.

This suggests that the diet included not only adequate nutrients for growth, but an appropriate level of caloric intake. A comparison of the foods eaten showed that the vegetarians ate fruits, vegetables, and starchy foods much more frequently than did similar-aged nonvegetarians. The vegetarians also ate much less junk food. The percentage of calories as fat and saturated fat in the vegetarian diet was lower than in the nonvegetarian diet and was similar to current recommendations.

Vegan Diet 

Many children have been raised on a vegan diet. However, one of the main concerns about some vegetarian diets for children is bulkiness, or low-caloric density. This means the diets have fewer calories per weight of food than diets containing meat or other animal foods. This is one reason vegetarians tend to weigh less than nonvegetarians. This is especially true of vegans, who consume no animal products.

The bulkiness of some vegetarian diets may be of benefit to adults who need to control their weight. But children have a small stomach capacity and relatively great nutritional needs. Their small stomach size and the bulkiness of some vegetarian diets may limit the ability of young children to eat enough calories to meet their energy needs.

Another concern about limited caloric intake in children has to do with how the body uses protein. As you know, protein is needed for many essential functions. However, if caloric intake is inadequate, protein will be used to supply the body's energy needs rather than to build its tissues. Although this is more likely to occur in developing countries where food is often in limited supply, it may be seen whenever diets are too restrictive.

To illustrate the importance of adequate calories, a recent report appeared in the medical literature describing seven children, all under 2 years of age, who were not growing properly. They were experiencing what is called failure to thrive. The parents were well educated and wanted to prevent obesity and heart disease in their children. They were giving them diets that were very low in fat, although the parents were not vegetarians.

The children consumed low-fat or nonfat milk, complex carbohydrates, and only lean meat. They simply were not getting enough to eat, even though the food they ate was of very high quality.

Undoubtedly some of the protein they ate was being used to supply their energy needs. Fortunately the children began to grow normally after their diets were changed to include whole milk and other foods more suitable for their age.

The diets given by the well-meaning parents were quite appropriate for adults, but they did not meet the needs of their children because young children have different nutritional needs than adults.

Fat is important for infants and young children not only because it supplies a concentrated energy source but because it is needed for the development of nervous tissue. it also contains essential fatty acids and is necessary so the body can absorb the fat-soluble vitamins. It's recommended that fat intake should not be aggressively limited in children under 2 years of age. However, in adults and older children it should be 30 percent or less of total calories.

New Vegetarian and Macrobiotic Diets

Sometime ago I received a letter from a young mother concerned about her 2-year-old boy. She told me his age, how tall he was, how much he weighed, and a bit about the diet he ate. It was almost totally vegetarian, including only a small amount of cottage cheese and rarely yogurt. The diet was based primarily on brown rice, tofu, and soup. She said her pediatrician emphatically suggested" she write. The doctor was concerned that the little boy was not getting enough calories and other nutrients.

I immediately plotted the information from the mother on a growth chart. The boy's weight for height was very low.

That meant that he was a very t n little boy. It was understandable why the physician, after ruling out other causes, wanted him to have more calories.

A number of studies have reported that new vegetarian and macrobiotic children were small for their age, compared with the standards. It's easy to understand why the children who were given the most restricted diets were also the smallest. Some vegetarians in the study limited how much food their children could eat because they believed it was best for them to be thin.

We recognize that there is legitimate concern today because of the increase in children who are obese. However, while we do not want to raise obese children, neither do we want to stunt children because they do not receive enough food. it's important to supply them with all the calories and other nutrients they need to grow to their genetic potential.

Vitamins and Minerals

How can you be sure your vegetarian child will get all the vitamins and minerals he or she needs? First, a broad variety of food is perhaps the most important principle in planning any diet. Not every food contains all the nutrients, and eating many different kinds of food over the course of days and weeks assures an adequate intake of the many nutrients needed.

There should also be variety in how food is prepared. Some can be boiled and some baked; some steamed and some should be eaten raw. All nutrients are important for growing children, but it is more difficult to get adequate amounts of some. And it becomes more difficult the more the diet is restricted.

Studies have found low intakes of calcium and vitamin D in children following total vegetarian diets. It is recommended that children who do not drink cow's milk should be given a soy milk that has been fortified with calcium and vitamin D as well as vitamin B12' There are many new soy beverages on the market, but most of them are not fortified and do not provide the nutrients found in cow's milk. It is important to read labels to determine the nutrient content.

It is also important to provide good sources of iron and zinc. These include dried beans and peas, enriched and fortified breads and cereals, dried fruit, nuts, and seeds. A vitamin C-rich food eaten with a source of iron will increase the availability of the iron. Citrus fruits or juices, tomatoes, melons, strawberries, green pepper, and broccoli are all good sources for vitamin C and should be included regularly.

Vitamin B12 is of special concern to total vegetarians because the usual practical sources are animal food products. it can be found in fortified soy milk or other fortified foods, or a supplement may be used. It is very important to assure a source of this vitamin for growing children. A deficiency, although rare, can lead to permanent impairment.

It's Not Mat You Call It Although vegetarian diets may be lower in fat intake, the actual amount present depends on the foods included. We must understand that the nutrients we get from a particular diet depend, not on what we call the diet, but on the foods that are actually eaten.

Lacto-ovovegetarian or lactovegetarian diets can easily supply the nutrients needed by children to grow and develop into healthy young adults. However, in planning meals when no animal products are used, greater care must be taken to assure an adequate supply of all nutrients.

Patricia K Johnston, Dr.P.H., M.S., R.D., is associate dean of the School of Public Health and chairman and associate professor of the Department of Nutrition at Loma Linda University, Loma Linda, California.