If you work with families, young athletes or parents trying to build healthier habits at home, chances are you have fielded some version of this question: Can kids be healthy on a vegetarian or vegan diet?

It is a fair question, and for a long time it has been answered with more opinion than clarity. Some people treat plant-based eating in kids as automatically healthier. Others talk about it as though it is almost guaranteed to lead to problems. A major new systematic review and meta-analysis suggests the truth is more nuanced and, frankly, more useful than either extreme. Plant-based diets in childhood can support healthy growth and may offer some benefits, but they also require careful planning and attention to several nutrients that are easy to miss.

That is what makes this paper worth your attention. Published in Critical Reviews in Food Science and Nutrition, it is the largest review of its kind to date, covering 59 studies and 48,626 children and adolescents younger than 18. The authors compared lacto-ovo-vegetarian diets and vegan diets with omnivorous diets across nutrient intake, growth, body composition and health markers. In all, the analysis included 7,280 lacto-ovo-vegetarians, 1,289 vegans and 40,059 omnivores.

A Study Worth Paying Attention To

One reason this review stands out is its scope. The researchers pulled data from studies conducted in 18 countries and looked at a wide range of outcomes, from energy and protein intake to ferritin, vitamin D, cholesterol, height, weight and bone mineral content. These were observational studies, not clinical trials, so the review cannot prove cause and effect. But it does offer the clearest broad look yet at what tends to show up when children follow vegetarian or vegan diets.

That matters because childhood is not just a smaller version of adulthood. Kids and teens are growing, developing and, in many cases, training and competing. Their nutrient needs are high, and the margin for error can be smaller. The authors make that point directly, noting that while well-planned plant-based diets have been shown to be appropriate for adults, their suitability for children and adolescents remains an active area of debate.

What the Researchers Found

At a high level, the pattern was pretty clear. Children eating vegetarian diets tended to consume more fiber, iron, folate, vitamin C and magnesium than omnivores. They also consumed fewer calories and less protein, fat, vitamin B12, vitamin D and zinc. Evidence for vegan diets was more limited, but the trend was similar, with one especially notable concern: calcium intake was particularly low in children who followed a vegan diet.

That does not mean these diets were inherently inadequate. In fact, one of the most important points in the paper is that many of the average nutrient and biomarker values still fell within pediatric reference ranges. But averages can hide a lot, especially in a population as varied as children and adolescents. When the researchers looked more closely at deficiency-related outcomes, some important red flags emerged.

Among children following a lacto-ovo-vegetarian diet, the odds of iron deficiency, anemia, vitamin D deficiency, vitamin A deficiency and being underweight were higher than in omnivores. Among children following a vegan diet, data were more limited, but two studies showed significantly higher odds of vitamin B12 deficiency.

That is the piece you should not miss. A plant-based diet can look healthy on the surface and still come up short in a few nutrients that matter a great deal during growth.

The Nutrients Most Likely to Need Attention

If you are looking for the short list, the paper points to vitamin B12, iron, calcium, vitamin D, iodine and zinc as the nutrients most likely to need attention. Vitamin B12 stands out because it is not naturally available in unfortified plant foods. The authors state plainly that adequate vitamin B12 intake cannot be reached without supplementation or fortified foods.

“Notably, vitamin B12 didn’t reach adequate levels without supplementation or fortified foods, and calcium, iodine and zinc intakes were often at the lower end of recommended ranges, making them important nutrients to consider for children on plant-based diets,” explains study coauthor Dr. Jeannette Beasley. “Vegan children, in particular, had especially low calcium intake.”

Iron is another important example of why diet quality is more than a nutrient spreadsheet. The review found that children adhering to a vegan and vegetarian diet often consumed more dietary iron than those following an omnivorous dietary pattern, yet still had lower ferritin and, in some cases, higher odds of iron deficiency and anemia. That makes sense biologically, because plant foods provide non-heme iron, which is less readily absorbed than the heme iron found in animal foods.

For health and exercise professionals, this is a helpful reminder that “high intake” on paper does not always mean “low risk” in real life.

Growth, Body Composition and the “Leaner” Question

It would be easy to oversimplify the study’s growth findings, so they are worth discussing carefully.

Children following a vegetarian diet tended to have lower height, weight, body mass index (BMI) z-scores (standardized scores showing how a child’s BMI compares with age- and sex-based norms), fat mass and bone mineral content than those consuming an omnivorous diet. Children following vegan diets also showed shorter stature and lower BMI z-scores. But the authors were careful with their interpretation: Most values remained within normal pediatric reference ranges, which suggests a leaner growth profile rather than obvious growth failure.

That distinction is important in the kinds of conversations you may have with parents. “Leaner” is not automatically better, especially in kids, but neither does slightly lower body weight or BMI mean a child is unhealthy. The paper also found lower odds of overweight among children adhering to a lacto-ovo-vegetarian style of eating, alongside slightly higher odds of underweight. In other words, the shift seems to be toward lower adiposity overall, not necessarily toward a clinical concern, though some children may need closer attention.

The authors also note that some differences, while statistically significant, may not be clinically meaningful in isolation. That is a useful perspective to carry into practice. Do not overreact to a headline. Do not dismiss a concern, either. Keep the whole picture in mind.

There Were Some Meaningful Upsides, Too

This review was not all caution flags. In fact, one of the strongest positive findings was that children and adolescents following either vegetarian or vegan diets showed more favorable lipid profiles than those adhering to omnivorous diets, including lower total and LDL cholesterol. That likely reflects higher fiber intake and lower intake of saturated fat and cholesterol.

The authors note that plant-based diets “may offer additional health benefits for children—including improved cardiovascular risk profiles.” That does not mean every child should be put on a plant-based diet for cardiometabolic reasons. It does mean the conversation should be more balanced than it often is. These diets may confer some advantages, especially when they are thoughtfully planned. The problem is not the presence of plant foods. The problem is assuming that “plant-based” automatically means “nutritionally complete.”

What the Research Means for Your Work With Clients

This is where the study becomes especially useful for health and exercise professionals. Your role is not to judge a family’s dietary choices. It is to stay within your scope, share general evidence-based guidance and, when appropriate, encourage families to consult a qualified healthcare professional for individualized nutrition advice. This review supports a practical middle ground. You do not need to discourage vegetarian or vegan diets across the board, and you do not need to endorse them uncritically, either. What you can do is help families understand that these diets require thoughtful planning.

In practice, that may mean keeping the conversation general and within scope. You can reinforce the importance of thoughtful meal planning, ask whether the family has access to reliable nutrition guidance and encourage parents to discuss a child’s diet with a pediatrician or registered dietitian nutritionist, especially when they want individualized advice. That is not about assessing or diagnosing. It is about helping families connect with the right support.

The study also gives you a few evidence-based talking points you can reinforce without stepping outside scope. For example, the authors note that families may reduce iron-related risk by pairing iron-rich plant foods with vitamin C-rich foods to enhance absorption. They also identify iodized salt as a simple and effective strategy for iodine intake. And they emphasize that calcium and vitamin D deserve particular attention during growth.

What you should not do is diagnose deficiencies, prescribe supplements as treatment or present yourself as the person deciding whether a child needs lab work. That is where referral matters. If a parent raises concerns about anemia, nutrient deficiency, slowed growth, persistent fatigue or supplement use beyond general education, that is your cue to bring in the appropriate healthcare professional. The study’s authors recommend obtaining clear, evidence-based guidance and support from clinicians such as dietitians and pediatric health professionals.

“Our analysis of current evidence suggests that well-planned and appropriately supplemented vegetarian and vegan diets can meet nutritional requirements and support healthy growth in children,” says lead author Dr. Monica. In other words, these diets can work, but “well-planned” and “appropriately supplemented” can’t be overemphasized.

The Bottom Line

When a client asks whether kids can thrive on vegetarian or vegan diets, you do not need a dramatic answer. You need a credible one.

This review suggests that plant-based diets in children can support healthy growth and may come with some meaningful benefits, including better fiber intake and a healthier lipid profile. It also makes clear that several nutrients deserve careful attention, particularly vitamin B12, iron, calcium, vitamin D, iodine and zinc.

For you, the practical takeaway is simple: Stay curious, stay balanced and stay in your lane. Help clients see that a dietary label does not guarantee nutritional adequacy. Reinforce broadly healthy eating habits and encourage parents to watch for signs that their child may need more support. And when the conversation moves into diagnosis, supplementation or medical nutrition therapy, collaborate and refer.