Children and adolescents

Evidence quality

The evidence is moderate to low. The 2025 ESPGHAN position paper identified ten eligible articles covering approximately 1,500 vegan children, while a 2024 meta-analysis found that 17 of 18 included studies were cross-sectional and rated the certainty of most pooled results as low or very low (Verduci et al., 2025; Koller et al., 2024). These data permit identification of recurring nutritional concerns but provide limited evidence about long-term causal effects.

Growth

ESPGHAN concluded that current evidence is inconclusive as to whether a strictly vegan diet supports normal childhood growth. Across the reviewed studies, height and body-mass-index z-scores did not differ significantly from omnivorous peers, but the evidence base was small and heterogeneous. ESPGHAN therefore recommends regular assessment of intake, growth, and nutritional status rather than assuming adequacy from the diet label alone (Verduci et al., 2025).

Individual studies illustrate the range of findings. In the German VeChi Diet Study, 430 children aged one to three years showed no significant group differences in reported energy intake, energy density, or anthropometric measures among vegan, vegetarian, and omnivorous groups. Vegan children consumed more fiber and less fat on average, showing that comparable growth was observed in this cohort when energy intake was maintained (Weder et al., 2019).

A cross-sectional Polish study of children aged five to ten years reported that vegan participants were shorter on average and had lower bone mineral content than matched omnivorous participants. It also reported lower LDL cholesterol and adiposity measures, alongside lower iron status and lower unsupplemented vitamin B12 and vitamin D concentrations. Supplementation resolved the observed low vitamin B12 and vitamin D concentrations, but the cross-sectional design could not determine whether diet caused the group differences (Desmond et al., 2021).

Nutritional adequacy

A systematic review of 30 studies found potential inadequacies in every diet group. Children consuming plant-based diets were at risk of inadequate vitamin B12, iron, and zinc intake, while low vitamin D and calcium intake occurred across dietary groups. Plant-based groups generally had higher fiber, folate, vitamin C, vitamin E, magnesium, and iron intakes, although higher iron intake did not necessarily imply higher iron stores because non-haem iron has lower and more variable absorption (Neufingerl and Eilander, 2023).

The 2024 meta-analysis of vegan children and adolescents likewise found lower mean protein, calcium, riboflavin, saturated fat, and cholesterol intakes, and lower ferritin, HDL, LDL, and height, while carbohydrate, polyunsaturated fat, fiber, folate, vitamins C and E, magnesium, iron, and potassium intakes were higher. Vitamin B12 blood concentrations were higher among vegan participants in the pooled studies because of supplement use, demonstrating that supplement practice materially affected status (Koller et al., 2024).

Planning considerations

The inherited stub emphasizes adequate calories, nutrient density, and supplementation or fortification. ESPGHAN specifically recommends attention to protein, omega-3 fatty acids, calcium, iron, and vitamin B12, together with regular monitoring. For infants and small children, very bulky, high-fiber, low-fat patterns can make adequate energy intake more difficult; this concern supports selecting age-appropriate energy-dense foods rather than applying an adult weight-loss pattern to a growing child (Verduci et al., 2025).

The available evidence therefore documents vegan children with growth measures comparable to omnivorous peers in some cohorts, while also documenting lower growth or bone measures and nutrient shortfalls in others. Normal growth can be supported in individual children when energy and nutrient requirements are met, but present research does not justify treating planning or monitoring as optional (Weder et al., 2019; Verduci et al., 2025).