How healthy are they Are their nutritional needs being met

Concerned parents who want to raise healthy vegetarian children often ask about their children's specific nutritional requirements. Are they getting enough iron or calcium Should they be taking supplements Will they be as strong and grow as fast as their omnivorous friends These are valid concerns, but all of them can be resolved if parents provide a balanced and varied diet.

Of course, vegetarianism means different things to different people. At one end of the spectrum are vegans, who eat no animal products whatsoever. They exclude all foods associated with animals, including honey and gelatin. Then there are lacto-ovo vegetarians, who eat eggs and dairy products but no meat. Lactovegetarians eat dairy but not eggs or meat. At the other end of the spectrum are semivegetarians, who occasionally eat fish or fowl but no red meat and definitely emphasize a plant-based diet.

Vegetarian children are becoming more common as many parents choose vegetarianism in their search for alternative lifestyles. Parents, however, must understand how to translate children's special nutritional needs into tonight's dinner.

Vegetarians are often nutrition savvy and can provide a model of healthy eating, but there are different nutritional requirements for children and adults. Most important, children have higher metabolic rates and consequently higher energy requirements than adults.

Vegetarian diets are typically high in fiber, so children eating this diet, unlike their carnivorous counterparts, get sufficient fiber.1 But bulky, fibrous foods can fill up small stomachs before enough calories are consumed. Recent studies confirm that sufficient calories may be a concern for preschool vegetarians,2 so they need plenty of higher-calorie, nutrient-dense foods such as nut butters and dried fruit. Studies from 15 and 20 years ago raised concerns that vegetarian children were shorter,3 but a landmark study of a commune called "The Farm" in Summertown, Tenn., found that slightly slowed toddler growth completely normalized by age 10.4 Children older than seven who follow a nutritious vegetarian diet can be expected to grow well--maybe even better than their omnivorous counterparts.5,6

Some nutrients are found predominantly in animal products, so vegetarians must make sure these nutrients are included in their diets, whether by careful food selection or supplementation. Prime among them is iron, which is required for making red blood cells. Vegetarian children do have fewer red blood cells than omnivores.7,8 When levels are too low, the result is anemia, which may cause learning and psychomotor problems, fatigue and infection. My observation is that vegetarian children whose basic diet consists of fast food, macaroni and cheese, instant noodle soups and pizza are often anemic. Vegetarian children in carnivorous households who eat only parts of the family meal often eat a high-starch diet that puts them at risk of anemia. I have noticed that children who eat beans or tofu several times a day and dark green vegetables along with a source of vitamin C at mealtime (to increase iron absorption) have plenty of red blood cells. Despite the risk of lower iron levels affecting learning in young children, older vegetarian children may actually have higher IQs than carnivores.9

Anemia is also caused by a vitamin B12 deficiency. Because vitamin B12 is found in all animal products, deficiency is of primary concern for vegans. B12 is stored in the body, so a deficiency can take several years to manifest. However, only dietary B12 is incorporated into breast milk, so it is important for breast-feeding vegans to get enough B12. The risk is a B12 deficiency in the baby, which can cause severe neurological damage. Because B12 is also found in bacteria, young children do get a bit from putting toys or objects in their mouths. A B12 deficiency in young vegan children can slow their gro