A. More families than ever are raising their kids as vegans, the kind of vegetarians who don’t eat any animal-related products, including dairy and eggs. Raising your baby as vegan is certainly a more challenging road, but one you can take with careful planning that may need to include supplements. Making sure your baby gets enough of certain nutrients, such as vitamin D, calcium, iron, zinc, vitamin B12, omega-3s, will take some extra effort, particularly with vitamin B12, the red blood cell building nutrient that’s hardest to get from vegan foods alone. Many experts advise taking a vitamin B12 supplement of 5 to 10 micrograms per day, which, if you’re breastfeeding, will provide your baby with enough of the vitamin. Formula-fed babies should be given formula containing B12, and older babies can have a powder form of the vitamin (available at health food stores) added to food or drink, for more information on which foods contain the essential nutrients your vegan baby needs, check out The Vegetarian Resource Group, vrg.org.
Q. Are chickenpox parties a good idea?
A. Chickenpox, caused by the varicella zoster virus, used to be a childhood rite of passage. In the 1990s, vaccines were given only to kids at high risk for severe varicella, like those with weakened immune systems, but it was thought to be unnecessary for generally healthy kids. The rationale to expand to all kids was primarily economic—parents missing work to care for sick kids resulted in too much lost revenue. Today, given that the vaccine prevents up to 90 percent of all cases and almost all severe ones, most states require it before starting kindergarten. While rare, some kids do get a rash and fever from the vaccine, whereas getting chickenpox naturally usually involves mild itching and low-grade fever (though it can be life-threatening for kids with compromised immune systems). My biggest concern is how long immunity from the vaccine lasts. Varicella is a much more severe disease for adults—what if the immunity doesn’t take (up to 20 percent of kids aren’t fully immune after the vaccine) or doesn’t last more than a few years? Many states have instituted a second dose of the vaccine at age 5 to address this issue, but we still don’t have long-term studies to show how long the vaccine lasts. Personally—and this is not the mainstream answer—I’d rather wait until children are 12, check their immunity with a blood test, and then immunize those who aren’t yet immune. As for the chickenpox party, I’m hesitant to recommend unnecessary exposure, but I wouldn’t worry if your child ends up being accidentally exposed at school.
Q. My child’s doctor said her BMI is too high, but she’s already an active kid!
A. BMI, or body mass index, is one way to assess weight by comparing it to a person’s height, but it’s not the final say. BMI is a calculation that divides weight in kilograms by height in meters, squared, and it’s usually a better gauge of health than weight alone. For example, picture two kids who weigh 50 pounds. Imagine that one is 4 feet tall while the other is 3 feet tall—adding height to the equation gives a much better picture of overall fitness. But while it’s important to compare weight and height versus simply looking at weight, it’s not clear what “too high” of a BMI is for kids. For adults, a BMI of 23 and above is thought to raise the risk of obesity-related diseases, but in children the story is much less clear and widely debated.—kids with higher muscle mass may have higher BMIs but in fact be quite healthy. Our society does need to focus more on healthy eating and exercise, but we shouldn’t over-focus on one measurement like BMI. If a clinical assessment determines that your child is indeed overweight, focus on her nutritional balance and aerobic fitness, and not just one number.
Lawrence D. Rosen, M.D., is the founder of the Whole Child Center in Oradell, New Jersey, one of the first green, integrative primary care practices in the U.S.
Have a question for Dr. Rosen? E-mail him at firstname.lastname@example.org.