A recent cohort study of nearly 1.2 million babies in Israel compared growth trajectories among infants from vegan, vegetarian, and omnivorous households, from birth until age two. The overall conclusions were reassuring to non-omnivores, with two-year-olds in all groups having statistically similar growth parameters, and mean differences in length, weight, and head circumference that were clinically small. However, infants in vegan families had slightly higher odds of underweight in the first 60 days of life, while omnivorous infants were more likely to have high birth weight.
While reassuring to me, this is my guidance for families who ask me about veganism:
Especially During Critical Time Periods, Like Pregnancy and Breastfeeding, Vegan Moms Should Review Intake of Omega 3 Fatty Acids, Iron, B12, and Vitamin D With Health Care Teams
While omega-3 fatty acids and iron can be found in carefully planned vegan diets, B12 almost always requires supplementation. B12 is synthesized by soil microbes, ingested by animals, and present in animal tissue and milk. It can also be found in some mushrooms.
In American diets, vitamin D is most often consumed in fortified products, like dairy, cereals, or juices. Naturally, vitamin D is synthesized in your skin with sunlight exposure or found in fatty fish, liver, and egg yolks. I generally recommend continuing a prenatal vitamin and vitamin D after pregnancy if breastfeeding.
For standard nutritional requirements for pregnancy, click here. For children’s vitamin and mineral needs, click here. I do not recommend blanket use of multivitamins and supplements, but I do make individual recommendations after thoroughly reviewing diets, family history, and genetics. Have that conversation with a health care provider versed in nutrition.
If Children Can Eat Dairy, I Recommend They Eat Dairy
Of course, an omnivore or a vegan diet can survive on donuts and bagels, but assuming a vegan diet focuses on lentils, beans, nuts, seeds, and whole grains in addition to fruits and vegetables, iron and most other key nutrients should be plentiful. A potential gap I worry about is calcium and vitamin D (and of course, B12, as mentioned above).
Despite plant foods having plenty of calcium, bone mineral density is lower and fracture risk is higher in children who avoid milk, and low dairy intake in childhood and adolescence has been associated with lower bone mass and higher fracture risk later in life. While I do believe this can be overcome with careful attention to mineral content in high quality non-dairy foods, I have not seen enough data to confidently recommend dairy avoidance for children.
My Recommendations for Kids Raised in Vegan Households
Sometimes, families have their reasons for raising their children vegan. In these cases, of course I recommend B12 (only found in meat, animal milk, and select mushrooms) and vitamin D supplementation (since most Americans ingest vitamin D through fortified dairy products), and I review dietary histories in more detail. I often recommend bloodwork confirming adequate iron stores and B12 levels. I then decide whether to recommend additional supplements.
Takeaways
According to this study, vegan and vegetarian families are at higher risk for small babies at birth, but these growth parameters tend to converge with their omnivorous counterparts at age two. Omnivore families are at higher risk for large babies at birth.
Vegan diets often require supplementation, with B12 and sometimes other nutrients, like omega-3 fatty acids, iron, and vitamin D.
Whatever your favorite foods or fads may be, discuss your dietary habits with your health care provider, especially if you are pregnant, nursing, or feeding precious mouths.
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For the Nerds: Additional Findings From the Aforementioned Study
This study was far from ideal, with several limitations, but there were some interesting findings, especially if you lean plant-based. The study included over 1 million infants in Israel, a relatively homogeneous country compared with places like the United States. Studies of vegetarian babies in more heterogeneous countries may have a harder time distinguishing genetic from dietary impacts on growth parameters. On to the findings and thoughts to mull over:
- While low birth weight was lowest in the omnivore group, high birth weight was highest in the omnivore group. Something to chew over given risk for metabolic disorders is higher for newborns at both ends of the weight spectrum.
- Mothers in the vegan group had the oldest mean age at birth (33.0 years), followed by the vegetarian moms (31.9 years) and omnivorous moms (30.0 years).
- Vegans had the longest duration of breastfeeding. Omnivores had the lowest duration.
- Vegan mothers had fewer prior children compared to the other groups.
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References:
Avital K, Fliss-Isakov N, Shahar DR, et al. Growth Trajectories in Infants From Families With Plant-Based or Omnivorous Dietary Patterns. JAMA Netw Open. 2026;9(2):e2557798. doi:10.1001/jamanetworkopen.2025.57798
Watanabe, Fumio, and Tomohiro Bito. “Vitamin B12 sources and microbial interaction.” Experimental biology and medicine (Maywood, N.J.) vol. 243,2 (2018): 148-158. doi:10.1177/1535370217746612
Rizzoli, René. “Dairy products and bone health.” Aging clinical and experimental research vol. 34,1 (2022): 9-24. doi:10.1007/s40520-021-01970-4
