If you are eating vegetarian while pregnant or breastfeeding, take vitamin B12 or eat fortified foods; the child's complementary foods need animal foods, and if you insist on a fully vegan diet, see a doctor first

Vitamin B12 is found almost only in meat, eggs, and milk. Someone eating fully vegan has to rely on fortified foods or a supplement. If the mother eats fully vegan and does not supplement, a breastfed child is likely to run short. The trouble usually shows at 4 to 8 months of age: not growing, development falling behind, and, if it drags on, nerve damage that may not come back. The child's complementary foods need animal foods every day.

Cost

1 bottle of vitamin B12 supplement is a few dozen yuan, 1 tablet a day. Adding egg, meat, or fish to the child's complementary foods does not cost much. The hard part is changing your mind when the whole family has decided that eating vegetarian is healthier.

Benefit

In 2003 the US Centers for Disease Control and Prevention reported 2 children. Both were breastfed by mothers who ate vegetarian, both were short of vitamin B12, and both failed to grow and fell behind in development. The 1st child's mother had eaten fully vegan for 7 years. The child was admitted at 15 months of age, was found to have severe anemia, and a brain scan showed atrophy of the whole brain. After B12 was given the child improved, but at 32 months of age speech and language were still behind. The report says the most common reason an infant or young child is short of B12 is that the mother's diet is short of it. A breastfed child usually shows it at 4 to 8 months of age. If the shortage lasts long enough, some children are left with nerve damage that cannot be reversed. How bad it is depends on how severe the shortage was and how long it lasted. The only reliable sources that do not depend on fortification are animal foods: meat, dairy products, and eggs. Most of the B12 that occurs naturally in plants cannot be used by the body. Cereal, soy milk, and nutritional yeast with B12 added can be a steady source. The report asks people who eat vegetarian, especially women who are pregnant or breastfeeding, to find out how much B12 is in what they eat, or to ask a nutrition professional. The 2016 position paper of the Academy of Nutrition and Dietetics states: "People who eat fully vegan need a reliable source of vitamin B12, such as fortified foods or a supplement." The 2017 complementary-feeding position paper of 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 fully vegan diet should be followed only under proper supervision by a doctor or a dietitian, and parents have to understand the serious consequences of not supplementing as advised. The National Health Commission's 2020 core feeding messages require no fewer than 4 kinds of complementary food a day. That includes at least 1 animal food, 1 vegetable, and 1 cereal or tuber food.

Notes

Disputed. The 2016 position of the Academy of Nutrition and Dietetics is that a well-planned vegetarian diet and a well-planned vegan diet are suitable for every stage of life, including pregnancy, breastfeeding, infancy, and childhood. It also states that people who eat fully vegan need a reliable source of B12, such as fortified foods or a supplement. The 2 sides disagree on whether a fully vegan diet can feed an infant. They do not disagree that B12 must be supplemented. A vegetarian diet that includes eggs and milk is lower risk, but eating very little egg and milk can still leave a person short. The mother of the 2nd child in the report had eaten vegetarian for 20 years and almost never touched meat, fish, or dairy. Early symptoms of B12 shortage have no particular pattern. The US Centers for Disease Control and Prevention says anemia markers are not suitable for screening. If the child is growing slowly, or development is not keeping up, tell the doctor at the visit that the family eats vegetarian, and let the doctor decide what to test. Do not refuse treatment the doctor gives because you trust a folk remedy. See Section 16, item 4 (do not stop proper treatment to try a folk remedy). How to add complementary foods is in item 4 of this section (add complementary foods from 6 months). Folic acid in pregnancy is in Section 27, item 1 (supplement 0.4 milligrams of folic acid every day).

Sources · 4

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. 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. 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. gov.cn/zhengce/zhengceku/2020-08/01/content_5…
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. doi.org/10.1016/j.jand.2016.09.025（备注里的反方，收益栏里的 B12 来源也出自这里）