Daily Protein and Energy Requirements for Pediatric Patients
The daily protein and energy requirements for pediatric patients vary by age, with infants and young children requiring higher amounts per kilogram to support growth, ranging from 1.5-2.1 g/kg/day of protein and 90-120 kcal/kg/day of energy for infants to 0.85-1.2 g/kg/day of protein and lower energy needs for adolescents. 1
Age-Specific Requirements
Energy Requirements
Energy requirements decrease with age as growth velocity slows:
- Infants (0-6 months): 90-120 kcal/kg/day 1
- Infants (7-12 months): 80-100 kcal/kg/day
- Children (1-3 years): 70-90 kcal/kg/day
- Children (4-13 years): 60-75 kcal/kg/day
- Adolescents (14-18 years): 30-60 kcal/kg/day (varies by activity level)
Protein Requirements
Protein requirements also decrease with age:
| Age | DRI (g/kg/day) | Recommended for Healthy Children (g/kg/day) |
|---|---|---|
| 0-6 months | 1.5 | 1.5-2.1 |
| 7-12 months | 1.2 | 1.2-1.7 |
| 1-3 years | 1.05 | 1.05-1.5 |
| 4-13 years | 0.95 | 0.95-1.35 |
| 14-18 years | 0.85 | 0.85-1.2 |
Factors Affecting Requirements
Several factors influence energy and protein requirements:
- Growth velocity: Higher requirements during rapid growth periods
- Physical activity: Increased needs with higher activity levels
- Illness/stress: Critical illness can increase protein needs up to 2.0-2.8 g/kg/day 3
- Route of administration: Enteral requirements are typically 10-20% higher than parenteral due to splanchnic metabolism and stool losses 1
- Nutritional status: Malnourished children may require higher intakes for catch-up growth
Special Considerations
Critical Illness
In critically ill children:
- Initial phase: Energy requirements may be lower than predicted
- Recovery phase: Energy requirements increase to 1.3-1.5 times REE 1
- Protein requirements: Higher protein intake (>1.5 g/kg/day) is associated with positive protein balance and improved outcomes 3
- Recent evidence suggests withholding parenteral nutrition for 1 week in critically ill children while providing micronutrients may be beneficial 1
Chronic Kidney Disease
For children with CKD:
- CKD Stage 3: Protein 100-140% of DRI
- CKD Stages 4-5: Protein 100-120% of DRI
- Hemodialysis: DRI + 0.1 g/kg/day to compensate for dialytic losses
- Peritoneal dialysis: DRI + 0.15-0.3 g/kg/day depending on age 1
Practical Implications
- Underfeeding is common: Studies show that critically ill children often receive only 47% of predicted energy expenditure and 49% of estimated protein requirements 4
- Implementation of nutrition support guidelines can improve energy and protein delivery in hospitalized children 5
- Energy-to-protein ratio is important for optimal utilization of protein for growth rather than as an energy source
Common Pitfalls
- Overestimating requirements in obesity: Use adjusted body weight rather than actual weight
- Underestimating needs in stunted children: Consider using height age rather than chronological age
- Inadequate energy provision: When energy intake is insufficient, protein is used as an energy source rather than for growth and tissue repair
- Failure to account for increased needs during recovery: Requirements increase during the recovery phase of illness
- Interruptions in feeding: Frequent interruptions for procedures can lead to significant nutritional deficits 4
The most recent evidence suggests that providing adequate protein (>1.1 g/kg/day) is particularly important for positive clinical outcomes in critically ill children, with even greater benefits seen at intakes >1.5 g/kg/day 3. However, energy provision must be balanced to avoid overfeeding, which can lead to complications such as hyperglycemia, hepatic steatosis, and metabolic programming issues 1.