sick childI was inundated this past week with people sending me links to articles about a French family who was charged with child endangerment for, what articles reported, being vegan.  The way most outlets had it, the vegan couple were exclusively breastfeeding their 11-month-old daughter when she fell ill and died.  The conclusion?  Being vegan isn’t safe if you’re breastfeeding.  But there is more to this story and an examination of the myths surrounding this case is clearly needed.

What Really Happened?

It seems, based on more complete news stories (as I wasn’t there), this 11-month-old girl was exclusively breastfed and her parents were vegan.  But her death was due to untreated bronchitis which progressively got worse until she got so sick her parents called an ambulance but it was too late.

So how did the whole vegan thing come up?  According to news sites, when the ambulance drivers arrived, they noticed the little girl looked incredibly undernourished.  She weighed 5.7 kg (12.56 lbs; unbelievably low, even by breastfeeding standards[1]) and an autopsy revealed she was deficient in vitamins A and B12.  Doctors determined that the mother’s “dietary imbalance” (i.e., being vegan) was to blame and heightened the risk of the child contracting an illness.  Which she did – bronchitis.  But here is where the parents were truly negligent and seems to be the crux of the case against them: When their daughter contracted bronchitis, they avoided medical treatment opting instead to treat her with “cabbage and clay poultices and massages with camphor and garlic oil”.  It took until their daughter was truly on death’s doorstep to reach out for medical care.

So we have three issues here to discuss: exclusive breastfeeding for a year, vegan diets and breastfeeding, and a parent’s right to refuse medical treatment for their child.  Let’s go…

Exclusive Breastfeeding for a Year

Unfortunately a lot of people have commented on this story claiming to not give a child solids at six months should be equivalent to child abuse.  First, let me say that information on the dietary implications of exclusive breastfeeding for a year is absent.  It’s done so infrequently that we just have no real idea if there are any problems associated with it.  There does not seem to be reason to believe there is an issue though given that any solids prior to a year are really there for filling or to allow a child to adapt to the taste of different foods.  Even in children who receive solids earlier than a year, the vast majority of calories continue to come from breastmilk (or formula).

The only potential issue, as I see it, is whether or not a parent is forcing a child to nurse exclusively for a year or if this is a child-led decision.  Without research, we can’t say a parent who makes the decision about exclusive breastfeeding for the child is doing any harm at all, and depending on the food available, breastmilk alone may continue to be superior, but it can be seen as denying a child food (potentially).  In the case of the child-led exclusive breastfeeding, some would say the child knows his/her own body and what is appealing or not, and as long as one is offering solids, force-feeding a child is also dangerous so exclusive breastfeeding is a-okay.  If a child is reaching and asking for food past six months, it may be a sign that they require more calories or a more varied diet or are simply curious.  On average, it seems that humans (as far back as the Neanderthals[2]) have been exclusively breastfeeding for approximately six months and then (slowly) introducing solids.  For whatever reason, that is when human babies seem to want to expand their palate and when we oblige.  However, it certainly isn’t unheard of to exclusively breastfeed for longer.  The bigger issue seems to be about the nutritional status of the breastmilk and what it offers the child, which brings us to…

Vegan Diets and Breastfeeding

To me, the fact that the “vegan” diet is getting the bulk of the criticism is silly.  It should really have raised awareness about diets in general (especially in North America) and breastfeeding.  It’s very simple, if you aren’t getting proper nutrition, your body doesn’t (always) magically make it for your breastmilk.  Your diet is your breastfed child’s diet.  And deficiencies in several of the key vitamins for development are linked to maternal diets that are lacking in these vitamins.  For example, there is research on Vitamin D deficiencies in breast-fed babies due to maternal deficiencies[3] as well as Vitamin B12 and folate deficiencies due to maternal underconsumption both during pregnancy and lactation[4][5].  Some research has found that areas in which there are extreme deficiencies in the mother’s diet have higher likelihoods of resulting Vitamin A deficiency in infancy (which can be fixed via supplementation)[6].  However, this is rare because even in poorly nourished areas, breastfeeding has found to be protective of Vitamin A deficiency, suggesting that the level of deprivation needed to reach this is more extreme than in many of the poorest regions of the world[7].

The child in question was deficient in Vitamin A and B12.  Well, B12 is a vitamin we get from animal sources and is key to an infant’s neurological development.  Infants who are deficient present with many symptoms of developmental delays and regressions (including anorexia and failure to thrive)[8].  Notable to the case at hand, vegans are notoriously low in B12 as they don’t consume any animal by-products, but not because they can’t reach their recommended daily intake.  Vegans DO have options, including certain nutritional yeasts that provide a full daily amount and fortified items or even plain supplements.  And most vegetarian and vegan sites and books are very clear on the importance of ensuring you receive adequate B12, especially when lactating.

The deficiency in Vitamin A is a little harder to understand.  As previously said, the fact that the child was notably deficient despite being breastfed suggests levels of deficiency seen in some of the most impoverished areas of the world.  Although even in one study out of a poorer region of Ethiopia, none of the breastfed children (many were in preschool and still nursing – yeah!) were deficient despite many becoming deficient as soon as they weaned[7].  And as many of the sources of Vitamin A are vegetables, I can honestly say I fail to understand how a vegan could be deficient at all.

[Update: I got a good nutritional lesson from some EP readers informing me that the reason many vegetables are listed as being sources of Vitamin A is that they can, under optimal conditions, convert to Vitamin A but do not actually contain Vitamin A, but rather beta-carotene.  Unfortunately some people actually cannot do this conversion and need to get their sources from animal sources.  Thus, this mother may have been completely deficient herself if she was one of the people who CANNOT convert beta-carotene to Vitamin A.  Thank you EP readers!]

What does this mean?  In this case, it seems the parents’ diet was woefully inadequate.  In the case of B12, it was clearly due to their vegan diet and a refusal or ignorance about supplementation.  In the case of vitamin A, who knows?!  However, does this mean we condemn vegan diets?  I say no.  We know they can be quite healthy, even though it may require more work on behalf of those partaking in them.  Furthermore, an unhealthy diet seems to be an issue in today’s world regardless of whether you’re vegan or not.  In one study, it was found that the average diet in the United States is deficient in vitamins A, C, D, and E, calcium, and magnesium[9].  Other research has found that most North Americans are also deficient in Omega-3 Fatty Acids, also key for infant neurological development[10].

So it seems that many parents could be found guilty of not providing the nutrients their children need for development and yet we wouldn’t think to charge them if they were eating a more mainstream diet.  Even though children who are lacking in these vitamins are, as pointed out in the original case, at a higher risk of getting sick.  This means we need more information and education on proper diet, and what signs to look for in terms of deficiencies in ourselves and our children.  No one wants their child to get sick, which is what happened here, and which brings us to the final issue…

Can or Should Parents be Able to Refuse Medical Treatments for their Children?

This seems to be the real crux of the issue.  Had these parents brought their daughter in for treatment when she got sick, a whole host of issues would have been found and hopefully dealt with.  Nutritional deficiencies would be noted and I would hope, she’d have started on supplements immediately.  She’d have received treatment for her bronchitis.  Chances are, she’d be here today.

The question becomes, should parents have the right to refuse these treatments with no repercussions?  In North America, it’s much harder to prosecute (though certainly not impossible), especially as many people refuse under religious grounds.  In France, there are far fewer protections on religion (not that it was brought up here anyway) meaning they can and did charge these parents.  On the surface it’s easy to say that parents should not be able to, that the child’s rights supersede that of the parent’s.  But then we have to consider what it means when parents have no rights to refuse treatment.  Imagine a doctor saying your child needed a circumcision or medicine you felt would actually harm your child.  How would you feel if you had no rights?  If your failure to agree with a doctor meant risking jail time or loss of custody?

It’s a very difficult discussion and yet one that does affect us as parents.  And while I wholeheartedly disagree with what this family did – after all, a child that is clearly underweight (by a lot), failing to thrive, and sick needs to be seen by someone – and personally find them to be either remarkably stupid or morally lacking, I don’t know that it should be illegal.  At the very least jail time seems the last thing that would help, though I agree with the court’s decision to remove the other child from the home (that’s a consequence I can get on board with).

What happened is a tragedy for that little girl.  But let’s at least make sure that the real issues come to light and not a vilification of veganism or extended breastfeeding.  We need parents to be aware of the nutritional issues around breastfeeding and the signs to look for when something isn’t quite right.  That, and that alone, should be the take-home message.

[Image Credit: The Telegraph.co.uk]



[1] http://kellymom.com/wp-content/uploads/WHOgrowthcht_wfa_girls_p_0_2.jpg

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[3] Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C.  Implications of vitamin D deficiency in pregnancy and lactation.  Am J Obstet Gynecol 2010; 202: 429.e1-429.e9.

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[5] Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL.  Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development.  Food & Nutrition Bulletin 2008; 29: S101-S111.

[6] Stoltzfus RJ, Hakimi M, Miller KW, Rasmussen KM, Dawiesah S, Habicht J-P, Dibley MJ.  High does vitamin A supplementation of breast-feeding Indonesian mothers: effects on the vitamin A status of mother and infant.  Community and International Nutrition 1993; 123: 666-75.

[7] Asrat YT, Omwega AM, Muita JWG.  Prevalence of vitamin A deficiency among pre-school and school-aged children in Arssi Zone, Ethiopia.  East African Medical Journal 2002; 79: 355-60.

[8] Dror DK, Allen LH.  Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms.  Nutritional Reviews 2008; 66: 250-5.

[9] Fulgoni VL, Keast DR, Bailey RL, Dwyer J.  Foods, fortificants, and supplements: where do Americans get their nutrients?  J of Nutrition 2011; doi: 10.3945/jn.111.142257.

[10] Child & Family Research Institute (2008, March 11). Typical North American Diet Is Deficient In Omega-3 Fatty Acids. ScienceDaily. Retrieved May 27, 2013, from http://www.sciencedaily.com­ /releases/2008/03/080307133659.htm