Restricting animal source foods puts the young at risk


Paediatric guidance and parental responsibility are crucial in the case of strict vegetarian diets. Animal foods provide key nutrients, such as vitamin B12, iron, EPA/DHA, and choline, the absence of which could seriously compromise the health and well-being of young children. Moreover, a low supply of these nutrients during pregnancy and lactation can lead to negative outcomes for infants. Deficiencies in essential nutrients can lead to serious health problems, including failure to thrive, anaemia, neuropathies, and cognitive impairment. Clinical case reports of children on strict vegetarian diets have shown severe health consequences, emphasizing the need for proper nutritional planning and monitoring. Professional associations worldwide caution against vegan and vegetarian diets for pregnant women, infants, children, and adolescents.




This article addresses the following five questions:
  • How can malnutrition in the young relate to a low intake of animal source foods?
  • How can the health of infants be affected by maternal animal source food avoidance? 
  • What is known from the medical literature about the risk of vegetarian diets for the young?
  • What is the role of parental responsibility and paediatric guidance?
  • What is the advice from professional associations and health authorities?
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       ASF and malnutrition in the young 



      The global situation of infant and child malnutrition is concerning. More than half of children under the age of five suffer from micronutrient deficiencies necessary for healthy development, and nearly a quarter of children are stunted. Stunting is influenced by various factors, including poverty-driven issues, poor intake of protein and micronutrients, and maternal nutritional status. The early childhood period, especially the first 1000 days, is crucial for development, and animal source foods play a significant role during this time. Undernutrition during early age can lead to irreversible damage, particularly concerning neural health. On the long term, this can have an adverse impact on education, lifelong achievement, economic productivity, and community outcomes. Micronutrient deficiencies and growth issues are still prevalent in various countries. For example, India faces significant micronutrient deficiencies, stunting, and wasting rates. In the West, strict vegetarian diets may also create a risk for suboptimal physical or cognitive development, while paralleling reduced bone mineral content, vitamin B-12 deficiency, and iron-deficiency anaemia. 

      Further reading (summary of the literature): 

      Documented benefits of animal source foods

      Animal source foods (ASF) are the best source of nutrient-rich foods for children aged 6-23 months, especially in view of cognitive development [Balehegn et al. 2019]. Early childhood, particularly so during the first 1000 days [Martorell, 2017], represents a critical window during which ASF play a particularly valuable role [Maluccio et al. 2009; Heys et al. 2010; Smithers et al. 2012]. Intervention studies have shown how they contribute to both the physical and cognitive development of infants and children [see elsewhere]. Plants, although valuable in their own right, have a limited capacity to fully meet the nutritional needs of infants [Balehegn et al. 2019], while the stomachs of young children are too small to deal with the large volumes needed to meet all protein and micronutrient requirements [Nordhagen et al. 2020]. Diets low in (or devoid of) ASFs and dominated by plant staples can therefore harm development in the early stages of life, while deficiencies also persist at later age. A longitudinal analysis of data from low- and middle-income countries has emphasized the need for sustained consumption of ASFs for growth benefits to persist and to avoid stunting in young children [Zaharia et al. 2021]. 

      Global data and low- and middle-income countries

      Globally, over half of the children under five are deficient in micronutrients that are needed for healthy development and nearly a quarter is stunted [Nordhagen et al. 2020]. Stunting has a complex and often poverty-driven aetiology but also relates to a poor intake of protein and micronutrients [Neufeld et al. 2020] and a suboptimal maternal nutritional status [Allen 1993]. Even if global ASF consumption by children and adolescents is increasing, intake levels remain low in certain regions [Miller et al. 2023]. In Brazil, for instance, 33% of children suffer from anaemia [Noguiera-de-Almeida et al. 2021]. Young populations in sub-Saharan Africa and South Asia are particularly vulnerable [Miller et al. 2023]. Micronutrient deficiencies still affect 80% of children and adolescents in India, while stunting and wasting rates are rampant [Sethi et al. 2019; Adesogan et al. 2020; Headey & Palloni 2020]. Globally, one third of the stunted children <5 years of age live in India [Neufeld et al. 2020], while micronutrient deficiencies are rampant [Venkatesh et al. 2021; Stevens et al. 2022]. The country is nonetheless often hailed as an example of successful vegetarian eating by nationalist discourse or from a romanticized Western perspective [see elsewhere]. 

      Regional data in high-income countries 

      High-income countries are not immune to the problem, partially related to the fact that the intake of certain animal source foods is decreasing in some populations (red meat in particular), sometimes associated with vegetarianism or veganism. In Poland, 5-10-y-old vegan children were shorter and displayed lower bone mineral content, lower 25-hydroxyvitamin D status, more vitamin B-12 deficiency, and more iron-deficiency anaemia [Desmond et al. 2021]. Some 40% of Australian teenage girls as well as 8% (boys) to 15% (girls) of toddlers (2-3y) may be facing iron deficiency due to fussy eating, excessive milk (in the case of infants and toddlers), restrictive diets, and confusion among parents regarding meat [Cumming 2021]. European data suggests that 28% of the male and 86% of the female adolescents did not meet the recommendation for bio-available iron intake, with the ratio of haem/non-haem iron intake being lower for girls [Vandevijvere et al. 2013].

      A worsening situation in high-income countries? 

      The paediatric case in high-income countries is suspected to become worse due to the rising popularity of vegan and vegetarian diets [Kramarz et al. 2023], often interlinked with the targeted propagation of climate anxiety by activist NGOs [e.g., Greenpeace 2020] and political authorities [e.g., Scallan 2023; see also elsewhere]. Climate anxiety is not only pushing a vulnerable population towards restrictive eating but also creates worrying symptoms of mental stress. A survey indicated that 59% of children and young people (16-25y) from various countries were 'very or extremely worried', reporting sadness, anxiety, anger, helplessness, and guilt; almost half of the respondents said this negatively affected their daily life and functioning [Hickman et al. 2021].

      Risks of vegetarianism at young age

      A systematic review has indicated that 'the risk of critical micronutrient deficiencies or insufficiencies and growth retardation is high' during the complementary feeding period for vegan and vegetarian diets [Simeone et al. 2022]. The more restrictive the diet and the younger the child, the more this risk increases [Chouraqui 2023]. Vegan diets for infants and children could come with greater need for expert guidance, planning, and supplementation than less restrictive vegetarian diets [Jones & Burton 2023]. Moreover, genetic differences in fat metabolism and brain function can affect the response to vegetarian diets [Yaseen et al. 2023], so that health outcomes can differ considerably between individual children and tailored dietary advice is required. However, this does not mean than omnivore children are always necessarily reaching nutritional adequacy. Whereas vegan and vegetarian young populations tend to have lower intake of protein, vitamins B2 and B12, iron, zinc, and calcium, meat-consuming ones tend to obtain less fibre, magnesium, potassium, folate, and vitamins C and E [Koller et al. 2023; Neufingerl & Eilander 2023]. 

      Irreversible neural damage

      Undernutrition at young age may translate into irreversible (neural) damage [Levitsky & Strupp 1995]. Impact can be long-term [Baldassarre et al. 2020], with effects possibly becoming worse over time [Hoang et al. 2019]. This is highly relevant for societal well-being, given the impact on education, lifelong achievement, economic productivity, and other community outcomes. Vitamin B12 deficiency is one of the main concerns related to neural health, with children and adolescents on vegan and macrobiotic diets being most at risk [Jensen 2022]. In general, nutritional peripheral neuropathies occur frequently secondary to B-vitamin deficiencies (B1, B2, B6, B9, and B12) [Kramarz et al. 2023].

       


       Risks of maternal avoidance of ASF 
       



      Addressing infant health requires careful attention to maternal nutrition, particularly for women following restrictive vegetarian diets. Pregnant and lactating women have elevated nutritional needs, requiring various nutrients that are highly bioavailable in animal source foods. Maternal undernutrition can lead to alterations in growth trajectories and neurocognitive development. Deficiencies in iron, DHA, choline, and B12 are of particular concern. 

      Further reading (summary of the literature): 

      A global issue

      Dealing with infant health also needs to factor in the maternal diet, as pregnant and lactating women have higher nutrient requirements due to foetal growth and milk production [Fewtrell et al. 2017]. Multiple critical nutrients (vitamins B2, B12, and D, DHA/EPA, calcium, iron, iodine, zinc) can be critical during a maternal vegan diet [Richter et al. 2016]. This needs particular attention in lower-income and culturally diverse countries, as most dietary recommendations for pregnant women derive from data obtained in high-income countries; moreover, some crucial nutrients like choline are still being neglected [Robb et al. 2023]. Anaemia, for instance, already affects 1/3 of the women of reproductive age [Nordhagen et al. 2020]. Among Indian preschoolers, stunting and wasting were associated with the vegetarian status of their mothers [Headey & Palloni 2020]. 

      Data from high-income countries 

      Even in Europe, about 1/2 women of reproductive age have small or depleted iron stores, 10–32% are iron deficient, and 2–5% have iron deficiency anaemia; only 20–35% have sufficient iron stores to complete a pregnancy without supplementary iron [Milman et al. 2017]. Belgian data shows that iron status deteriorates in the third trimester of pregnancy, not only leading to 40% of women with too low serum ferritin overall, but also to 16% and 7% of iron-deficiency anaemia and tissue iron deficiency, respectively [Vandevijvere et al. 2013]. In Slovenia, about 30% and 10% of premenopausal women suffer from depleted and critically depleted iron stores, respectively [Lavriša et al. 2022]. In the US, the majority of women of child-bearing age does not meet adequate DHA and choline intakes, which play a role in infant neural health and brain and eye development [Wallace & Fulgoni 2017, Mun et al. 2019].

      Maternal undernutrition and nutritional outcomes

      Some consider strict vegetarian diets as 'totally inadequate' for pregnant and lactating women [Wagnon et al. 2005]. Newborns may be at an increased risk of small-for-gestational-age, involving lower birth weights and lower mean gestational weight gain [Tan et al. 2019; Avnon et al. 2020; Hedegaard et al. 2024]. Maternal undernutrition, due to veganism or otherwise, may potentially alter placental weight, nutrient transfer capacity, and foetal growth trajectories [Sebastiani et al. 2019]. In general, low ASF intake can lead to a problematic status of key nutrients, such as iron, EPA/DHA [Burdge et al. 2017] or vitamin B12 [Specker et al. 1988, 1990; Renault et al. 1999; Bjørke Monsen et al. 2001; Koebnick et al. 2004], but not carnitine or B2 [Juncker et al. 2023]. Maternal undernutrition may also affect nutrient transfer via lactation. Vegan diets may increase the risk of vitamin B12 deficiency in pregnant women and infants, and decrease the iron stores evaluated by ferritin [Oussalah et al. 2021]. Breast milk from US women on a vegan diet tends to have more selenium but less iron and iodine than milk from omnivore women [Perrin et al. 2023]. The problem of maternal deficiencies may become more acute as vegetarianism and veganism become more widespread among pregnant women [Rashid et al. 2020].

      Examples of specific nutrients include:

        • Iron: an increased risk of latent iron deficiency in newborns may be related to low meat intake during pregnancy, which may then affect myelination and neurocognitive development [Moraes Castro et al. 2020]. 
        • DHA: a low maternal status can affect the DHA status of newborn and breast-fed infants, with potential implications for short- and long-term neural development [Sanders & Reddy 1992; Innis 2008; Coletta et al. 2010; Sinclair et al. 2023]. Spanish vegan/vegetarian mothers tend to have low DHA levels in breastmilk, in addition to lower iodine [Ureta-Valesco et al. 2023]. In the US, however, DHA levels in breastmilk are rather low in general, and do not correlate well with dietary patterns [Perrin et al. 2019].
        • Iodine: levels in breast milk can sometimes be inadequate [Andersson & Braegger 2022], which is of particular relevance for vegan mothers given that iodine is rather difficult to obtain from plants other than seaweed [Pawlak et al. 2023]. In Ireland, most women of childbearing age already do not meet the iodine recommendation set for pregnant women [McNulty et al. 2017], especially during summer [Nawoor et al. 2006], which could be further aggravated by changes to the current dairy practices. 
        • Choline: levels in maternal milk are associated with better infant recognition memory, especially when paired with high DHA content [Cheatham & Sheppard 2015]. However, a maternal plant-based diet by itself is not necessarily a risk factor for low breast-milk choline [Perrin et al. 2020].
        • Vitamin B12: pre-dominantly vegetarian diets in some regions of the Global South, which are low in ASFs, may lead to vitamin B12 shortage in breastmilk, as found for a majority of Kenyan women (89% of cases) [McLean et al., 2007; Williams et al. 2016; Balehegn et al. 2019] and for 64% of exclusively breastfed infants of South-Indian women [Kadiyala et al. 2020]. In Nepal, being a vegetarian was associated with lower plasma levels of vitamin B12 during gestation [Schwinger et al. 2021]. Although B12 deficiency is a known pitfall of vegan diets that can be corrected by supplementation [Ureta-Valesco et al. 2023], many fail to supplement adequately [see elsewhere]. As a result, vitamin B12 deficiency remains one of the most serious complications of vegetarianism and its variants [Aguirre et al. 2019]. 
        • Vitamin D: vegetarianism and vitamin D deficiency in pregnant women can lead to gestational diabetes mellitus when severe [Teotia et al. 2021].

       
       What is know from the medical literature? 
       

      Neonates and infants born to vegan, vegetarian, or macrobiotic mothers may experience reduced birth weight and various nutrient deficiencies, which can result in serious or irreversible pathological symptoms. The latter may include failure to thrive, hyperparathyroidism, macrocytic anaemia, neuropathies, psychosis, lethargy, spinal cord degeneration, cerebral atrophy, and optic neuropathies. Of particular concern is vitamin B12 deficiency, which can be life-threatening and may lead to impaired cognitive functions later in life. Additionally, strict vegetarian children may face vitamin D deficiencies, potentially leading to conditions like rickets. Numerous clinical case reports have documented that avoiding animal source foods can lead to harm in infants, children, and adolescents. Such reports are considered lower on the hierarchy of evidence, but they nonetheless raise serious concerns given their severity. Larger and more controlled studies looking into restrictive diets for vulnerable populations are limited due to ethical reasons.

      Further reading (summary of the literature): 

      The fact that (strict) vegetarian diets can put young groups at risk is documented by a list of clinical  case  reports. Although such reports are generally at the lower end of the hierarchy of evidence, they provide a serious case for concern given the dramatic outcomes (and the limitation that more controlled and larger studies are not acceptable for ethical reasons).
       
      Symptoms include, but are not limited to, failure to thrive, hyperparathyroidism, macrocytic anaemia, neuropathies, psychosis, lethargy, spinal cord degeneration, and cerebral atrophy. With the rise of vegan diets, optic neuropathies are also becoming increasingly common [Roda et al. 2020]. Deficiency of vitamin B12, in particular, can be life threatening [David and Fencl 2021]. In subjects with inadequate vitamin B12 intake during the early years of life, impaired cognitive functions may be encountered in later life [Louwman et al. 2000], whereby moderate consumption of ASFs can fail to restore normal vitamin B12 status [Van Dusseldorp et al. 1990]. Vitamin D deficiencies are also a recurrent problem in strict vegetarian children, potentially leading to rickets [Huang et al. 2021].

       


       Parental responsibility vs. paediatric guidance 




      The responsibility for ensuring a nutritionally suitable diet is primarily placed on the parents, but it has been argued that paediatricians need to be closely involved in monitoring and managing the diets of pregnant and lactating women, as well as their children, when following diets low in or devoid of animal source foods. Even with diligent supplementation, vegetarian diets may still put children at risk in the short and long term. It is recommended to seek expert advice and guidance when transitioning to a vegan diet in such cases. Children on a vegan diet may require various nutritional supplements to prevent deficiencies. Providing paediatric guidance to vegan parents can be challenging due to the philosophical beliefs associated with veganism and a distrust of family paediatricians. When parents reject intervention and a child's health is at serious risk, some have argued that legal consequences are necessary, and that such cases may have to be treated as child abuse.

      Further reading (summary of the literature):

      The need for expert advice and guidance

      Although primary responsibility is placed with the mother 'to ensure that her diet is nutritionally suitable for herself and her child' [Winter 2019], management by paediatricians should be encouraged for pregnant and breastfeeding mothers, and children at any age following diets that are low in or devoid of animal source foods (ASF) [Petit et al. 2019]. When transitioning to a strict vegetarian diet, it is recommended to seek expert guidance, especially when one is planning to become pregnant [Niklewicz et al. 2022] or when the wish is to raise infants and children on such diets [Jones & Burton 2023]. The problem is complicated by the fact that avoidance of ASFs, and meat in particular, can be associated with problematic eating behaviour, depression, and other forms of mental disorders [see elsewhere]. In adolescents, vegetarianism is a fast-growing phenomenon observed in a majority of patients with anorexia nervosa [Albertelli et al. 2024].

      Planning and its complications

      Certain paediatricians and gynaecologists consider strict vegetarian diets as 'totally inadequate' [Wagnon et al. 2005], which should be discouraged to pregnant and lactating mothers and to young children [Chouraqui 2023]. When discouragement is rejected, the next best step is to provide dietary guidance, as parents often may lack the required nutritional knowledge themselves. According to Spanish neonatologists, plant-based diets during pregnancy and lactation indeed 'require a strong [nutritional] awareness' [Sebastiani et al. 2019]. According to an editorial on 'The Risk of Breastfeeding on a Plant-Based Diet' by Eidelman [2023], maternal plant-based diets 'should be a red flag that [clinicians] cannot ignore', for instance because infantile hypothyroidism is often subtle and without specific clinical manifestations. Other authors have expressed concern about potential deficiencies in vitamin B12, calcium, and vitamin D when diets are poorly planned, and indicate a lack of information related to the status of omega-3 fatty acids, zinc, iodine, and selenium [Sutter & Bender 2021]. Because vitamin B2 supplementation is not typically recommended to vegan pregnant women, too low intakes have the potential to lead to life-threatening deficiencies in neonates [Jaeger et al. 2022]. In a Germany survey, only 60% and 40% of lactating vegan women affirmed that they did supplement with vitamin B12 and DHA, respectively [Delgas et al. 2024]. Moreover, only a minority those reported the top-three multivitamin supplements, known to bring in adequate doses. In German 1-3 year olds, 36-39% of the vegan and vegetarians had inadequate selenium intake levels [Weder et al. 2022]. When put on a vegan diet, children need various nutritional supplements so that insufficient compliance will cause deficiencies [Vlaardingerbroek et al. 2023]. 
       
      Yet, even realistic vegetarian diets that include diligent supplementation may still put children at risk, both in the short and long term [Cofnas 2018]. A Finish study of daycare centers found that nutritionist‐planned vegan meals led to vitamin A insufficiency and border‐line sufficient vitamin D, consistently lower serum levels of essential amino acids and docosahexaenoic acid (DHA), and distinct phospholipid and bile acid profiles compared to omnivores [Hovinen et al. 2021]. At present, official nutrient recommendations may insufficiently take into account the risk of some nutrient deficits in vegan and vegetarian populations, as has been argued for vitamin B12 recommendations in the UK [Niklewicz et al. 2022].

      Medico-social challenges

      Guidance poses medico-social challenges as it needs to face vegan philosophy [Shinwell & Gorodisher 1982] and widespread distrust of family pediatricians [Baldassarre et al. 2020], a problem also documented by tragic reports in mainstream media [e.g., Estcourt 2020]. Some have argued that, when parents reject intervention, legal consequences are required and cases should be treated as child abuse [Roberts et al. 1979]. According to Hunt [2019], there is 'moral reason for parents to not raise their child on a vegan diet because a vegan diet bears a risk of harm to both the physical and the social well-being of children'. From that perspective it is 'unethical' to bring up kids as vegans [Hopkin 2005], and 'alarming in a developed country to find situations in which a child's health is put at risk by malnutrition, not through economic problems but because of the ideological choices of the parents' [Giannini et al. 2006].

       


       Professional associations and authorities 
       

      Professional associations and authorities worldwide have issued warnings and caution against vegan diets, especially for vulnerable population groups such as pregnant and lactating women, infants, children, and adolescents. Notable exceptions are the position papers of the US Academy of Nutrition and Dietetics. They are to be interpreted with caution given the ideological and activist background of their authors. Warnings are based on the difficulty of attaining adequate nutrient supply through vegan diets in populations with elevated needs, which may lead to severe nutrient deficiencies and irreversible health consequences. 

      Further reading (summary of the literature): 

      In a remarkable contrast to all above-mentioned risks, the US Academy of Nutrition and Dietetics (AND) has stated that vegan and vegetarian diets are appropriate for all stages of life in its various position papers. However, its latest position paper has expired [Melina et al. 2016], and should no longer be cited as the Academy's official position [AND 2024]. In any case, all previous position papers are to be interpreted with extreme care as most of the authors involved were ethical vegetarians/vegans or Seventh-Day Adventists [for the religious beliefs of SDA with respect to meat, see elsewhere]. A detailed look at the potential ideological conflicts of interests has been provided by Southan [2012a,b,c,d,e,f,g,h]. To take the most recent paper [Melina et al. 2016], Vesanto Melina is a consultant and author of raw vegan cookbooks [Wiki], Winston Craig is employed by Seventh-Day Adventist institutions [Andrews and Loma Linda University], and the late Susan Levin was a member of PCRM, an animal rights front for PETA [Jarvis 2001; Activists Facts]. 



      Be that as it may, and as indicated in the overview below, other professional associations and authorities worldwide are often much more cautious with respect to the avoidance of ASFs and some are explicitly warning against vegan diets for vulnerable population groups. 
        • The European Society for Paediatric Gastroenterology Hepatology and Nutrition states that 'vegan diets have generally been discouraged during complementary feeding' because 'the risks of failing to follow advice [for supplementation] are severe, including irreversible cognitive damage from vitamin B12 deficiency, and death' [Fewtrell et al. 2017].
        • The German Nutrition Society 'does not recommend a vegan diet for pregnant women, lactating women, infants, children or adolescents' as it is 'difficult or impossible to attain an adequate supply of some nutrients' [Richter et al. 2016].
        • The German society for Pediatrics and Nutrition Science states that 'a vegan diet is disadvised during all periods with intense growth and development' and warns that 'children on pure vegan diet need ongoing elaborate dietary strategies and continuous supplementation at any age, similar to nutritional management in children with metabolic disorders' [Kersting et al. 2018].
        • The German Society for Paediatric and Adolescent Medicine argues that 'mothers with vegan or vegetarian diets need to take vit B12 supplements, preferably combined with other critical nutrients such as Fe, Zn, I, vit D & DHA [...] to prevent serious clinical complications' [Rudloff et al. 2019]. 
        • The Swiss Federal Commission for Nutrition disrecommends a vegan diet for pregnant and lactating women  infants, toddlers, adolescents, and elderly or people with debilitating diseases [FCN 2018].
        • The Belgian Royal Academy of Medicine claims that a vegan diet comes with bioethical problems and is not suitable for pregnant and lactating women, infants, children, and adolescents, and can therefore not be recommended [ARMB, 2019]. 
        • The Belgian Superior Health Council warns for a risk of nutrient deficiencies (protein, EPA/DHA, vit D and B12, Fe, Zn, I, Ca), increasing with dietary restrictiveness. Vegan diets are advised against for pregnant and lactating women and their infants and children (<3 y), as they 'likely do not meet nutritional requirements'. Due to the often elevated consumption of certain foods, the Council also warns for an increased exposure to problematic components, including acrylamide, heavy metals, pesticides, mycotoxins, arsenic (in algae and rice), and - arguably - phyto-oestrogens [BSHC 2021].
        • The Spanish Paediatric Association agrees with AND that a vegetarian diet is not necessarily unsafe but finds it nevertheless 'advisable for infant & young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet' [Redecilla Ferreiro et al. 2019].
        • The Spanish Society for Gynaecology and Obstetrics warned that the trend towards more vegan and vegetarian diets worsens anaemia in females of fertile age [DiarioMedico 2022; GNDiario 2022].
        • The American Medical Association and American Academy of Pediatrics underline the importance of choline during pregnancy and lactation; because choline is found predominantly in animal-derived foods, vegetarians and vegans may be at greater risk of inadequacy [Wallace et al. 2018]. 
        • The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition argues that plant products should not replace breast milk, formula, or cow's milk (>1 y) [Merritt et al. 2020].
        • The Danish National Health Authorities disadvises vegan diets for young children [Lund 2019].
        • The French Pediatric Hepatology/Gastroenterology/Nutrition Group (GFHGNP) claims that the 'craze for vegan diets has an effect on the pediatric population' and that it 'does not provide all micronutrient requirements and exposes children to [...] deficiencies [that] can have serious consequences' [Lemale et al. 2019]. 
        • The Food Safety Authority of Ireland emphasizes the importance of nutrient-rich foods (incl. 3x meat/w, dairy, ...) and discourages plant 'milks' for 1-5 year olds [FSAI 2020].
        • The Società Italiana di Pediatria Preventiva e Sociale (SIPPS), the Federazione Italiana Medici Pediatri (FIMP) and the Società Italiana di Medicina Perinatale (SIMP) have stated in a joint position paper that vegan and vegetarian diets are inadequate for the correct neuro-psycho-motoric development of children, whereby lack of B12, iron, and DHA can cause irreversible damage; in addition, vegan diets cannot be recommended as they also lead to insufficient calcium and vitamin D supply [SIPPS/FIMP/SIMP, 2020].

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