If you are vegetarian while pregnant or breastfeeding, take vitamin B12 every day; the child's solid foods need animal foods, and if you insist on fully vegan, see a doctor first

Cost

A bottle of vitamin B12 supplements costs a few dozen yuan, one tablet a day. Adding egg, meat or fish to the child's solid foods costs little. The hard part is changing your mind when the whole family has decided that vegetarian is healthier.

What you get

In 2003, the U.S. Centers for Disease Control and Prevention reported two children. Both were breastfed by vegetarian mothers, both were short of vitamin B12, and both failed to grow and had delayed development. The first child's mother had been fully vegan for 7 years. The child was hospitalized at 15 months, with severe anemia found and an MRI showing shrinkage of the whole brain. After B12 was given the child improved, but at 32 months speech and language were still delayed. The report said the most common cause of B12 deficiency in infants and young children is a lack in the mother's diet. In breastfed children it generally shows at 4 to 8 months of age. When the deficiency lasts long, some children are left with irreversible nerve damage, the degree depending on how severe the deficiency was and how long it lasted. The only reliable sources that don't rely on fortification are animal foods: meat, dairy products and eggs. Most B12 that occurs naturally in plants can't be used by the body. Cereals, soy milk and nutritional yeast with B12 added can serve as a steady source. The report asked vegetarians, especially pregnant and breastfeeding women, to find out how much B12 is in what they eat, or to ask a nutrition professional. The 2017 position paper on complementary feeding from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition states that all infants should eat iron-rich complementary foods, including meat or iron-fortified foods. A vegan diet should be followed only under proper supervision by a doctor or dietitian, and parents must understand the serious consequences of not following supplement advice. The National Health Commission's 2020 core feeding messages require that complementary foods include no fewer than 4 kinds of food each day, and at least one animal food, one vegetable and one cereal or tuber food.

Notes

Disputed: the 2016 position of the Academy of Nutrition and Dietetics in the U.S. is that well-planned vegetarian and vegan diets are suitable at every stage of life, including pregnancy, breastfeeding, infancy and childhood. But it equally states that people on a vegan diet need a reliable source of B12, such as fortified foods or supplements. The two sides disagree on whether a fully vegan diet can feed an infant, and do not disagree on the need to supplement B12. Vegetarians who eat eggs and dairy are at lower risk, but those who eat them very little are just as likely to be short. In the report, the second child's mother had been vegetarian for 20 years and hardly touched meat, fish and dairy. The early symptoms of B12 deficiency have no special features, and the Centers for Disease Control and Prevention says anemia markers are not suitable for screening. If the child is growing slowly or development lags, tell the doctor at the visit that the family is vegetarian, and the doctor decides what to test. Don't refuse treatment the doctor gives because you trust folk remedies; see §16.4 (don't stop proper treatment to try folk remedies). For how to add solid foods, see §20.4 (add solid foods from 6 months), and for folic acid in pregnancy, see §27.1 (take 0.4 mg of folic acid every day).

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Centers for Disease Control and Prevention (2003). Neurologic impairment in children associated with maternal dietary deficiency of cobalamin—Georgia, 2001. MMWR, 52(4), 61-64. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5204a1.htm
2. Fewtrell M, Bronsky J, Campoy C, et al. (2017). Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 64(1), 119-132. https://doi.org/10.1097/MPG.0000000000001454
3. 国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm
4. Melina V, Craig W, Levin S (2016). Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics, 116(12), 1970-1980. https://doi.org/10.1016/j.jand.2016.09.025（备注里的反方）

Translated from the Chinese original. Original book, section 20, tip 14. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer