What are the dietary recommendations for pediatric athletes to ensure optimal nutrition and hydration?

Management of Athlete's Nutrition in Pediatrics

Pediatric athletes should consume a nutrient-dense diet emphasizing fruits, vegetables, whole grains, low-fat dairy, and lean proteins, with age-appropriate caloric intake (1,000-1,300 kcal/day for ages 1-3 years, increasing with age and activity level), adequate hydration with plain water as the primary beverage, and avoidance of added sugars, caffeine, and restrictive eating practices that could impair growth and performance. 1

Age-Specific Caloric and Macronutrient Requirements

Toddlers and Early Childhood (1-5 years)

• Caloric intake: 1,000-1,300 kcal/day for ages 1-3 years, distributed across 3-4 meals and 1-2 snacks offered every 90-120 minutes 1, 2
• Macronutrient distribution: Carbohydrates 40-50%, protein 8-12%, fat 40-50% of total calories to support growth and development 2
• Emphasis on nutrient-dense foods from all food groups: fruits, vegetables, whole grains, dairy, protein foods, and healthy oils 1
• Fiber intake: Approximately 19g per day for ages 1-3 years 2

Middle Childhood (5-12 years)

• Age-based caloric intake adjusted for activity level, with sedentary children requiring baseline amounts and active athletes needing additional calories 1
• Nutrient-dense foods remain the foundation: fruits, vegetables, whole grains, fat-free or low-fat dairy, lean meats, and healthy proteins 1
• Physical activity increases energy demands: Athletes require ≥60 minutes per day of moderate-to-vigorous physical activity, plus muscle- and bone-strengthening activities at least 3 days per week 1

Adolescence (13-18 years)

• Caloric needs increase substantially with puberty and training demands, requiring individualized assessment based on growth velocity, training volume, and body composition goals 1
• Maintain emphasis on nutrient-dense foods while meeting increased energy requirements 1
• Uninterrupted sleep: 8-10 hours per night is essential for recovery and performance 1

Hydration Strategies

Daily Fluid Requirements

• Plain water should be the primary beverage for hydration in pediatric athletes 1, 3
• Toddlers (1-2 years) should be offered fluids every 90-120 minutes as part of regular meal and snack patterns 1, 3
• Water requirements are calculated at approximately 1 mL per 1 kcal consumed, or 100 mL/kg/day for the first 10 kg plus 50 mL/kg/day for additional weight 3

Exercise-Specific Hydration

• Athletes should be well-hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses 4, 5, 6
• Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to maintain blood glucose, provide muscle fuel, and decrease dehydration risk 4, 5, 6
• For athletes with hypertension, rehydration often requires deliberate intake of additional salt-containing fluids and foods to ensure body-water retention, despite general sodium restriction recommendations 1

Beverages to Limit or Avoid

• Limit 100% fruit juice to no more than 4 ounces per day for toddlers aged 1-3 years 1, 2, 3
• Avoid sugar-sweetened beverages, toddler milk drinks, and caffeine in young children 1
• Adolescents should limit caffeine intake 1

Macronutrient Considerations for Athletic Performance

Carbohydrate Intake

• Carbohydrate needs vary with training demands: 3-5 g/kg body weight for light activity, increasing to 8-12 g/kg for very high activity levels in adult athletes 1
• While specific pediatric carbohydrate loading protocols lack evidence, adequate carbohydrate intake is essential to maintain blood glucose during exercise and replenish glycogen stores 7, 4, 5
• Timing matters: Consume easily digestible, high-carbohydrate foods before, during, and after exercise 8, 5, 6
• High-carbohydrate foods should be eaten soon after exercise to maximize glycogen replacement rates 8

Protein Requirements

• Adequate protein is necessary to build and repair tissue during periods of high physical activity 4, 5, 6
• Current evidence does not support increased protein intake beyond normal dietary recommendations for child athletes 7
• Preservation of protein intake may help maintain immunity despite energy deficiency 1

Fat Intake

• Fat should be sufficient to provide essential fatty acids and fat-soluble vitamins while contributing energy for weight maintenance 4, 5, 6
• Diets should provide moderate fat intake (20-25% of energy), with no performance benefit to consuming less than 15% of energy from fat 6
• Emphasize unsaturated fats and ensure adequate omega-3 fatty acid intake 1
• Limit saturated and trans fats 1

Fiber Considerations

• While fiber offers gastrointestinal and cardiovascular benefits, athletes should choose low-fiber/residue carbohydrate sources before exercise to reduce gastrointestinal complaints 1
• Daily fiber intake should meet age-appropriate recommendations (19g/day for ages 1-3 years) during non-competition periods 2

Micronutrient and Supplement Guidance

Vitamin and Mineral Intake

• Vitamin and mineral supplements are not needed if adequate energy is consumed from a variety of foods 4, 5, 6
• Supplements may be required for athletes who restrict energy intake, use severe weight-loss practices, eliminate food groups, or consume unbalanced diets with low micronutrient density 4, 5, 6

Iron Considerations

• Consumption of iron-rich foods should be encouraged, as depleted iron stores are common in young athletes 7
• Iron-rich or fortified foods should be introduced first when beginning complementary feeding in infants 1

Sodium and Potassium

• Sodium intake typically exceeds recommended levels in children, while calcium and potassium intakes fall below recommendations 1
• Daily recommended intakes should be monitored and adjusted based on age-specific guidelines 1

Ergogenic Aids and Supplements

• Creatine use is not recommended in youth athletes despite being common 7
• Nutritional ergogenic aids should be used with caution and only after careful product evaluation for safety, efficacy, potency, and legality 4, 5, 6
• Regulations specific to nutritional ergogenic aids are poorly enforced 4, 5

Special Considerations and Common Pitfalls

Energy Availability and RED-S (Relative Energy Deficiency in Sport)

• Low energy availability can cause serious health consequences including menstrual dysfunction, bone loss, decreased resting metabolic rate, gastrointestinal changes, and impaired performance 1
• In female athletes, nutritional deficiencies can lead to athletic amenorrhea and bone loss; resolution of energy deficits can restore normal bone formation and return of menses 7
• Athletes at risk for low energy availability may experience decreased training response, impaired judgment, decreased coordination and concentration, increased irritability, depression, decreased glycogen stores, muscle strength, and endurance performance 1

Weight Management Concerns

• Daily weigh-ins are discouraged as body weight and composition should not be the sole criterion for sports performance 4, 5, 6
• Overestimating caloric needs can contribute to childhood obesity, while excessive restriction can impair growth and development 2
• Obese athletes require careful monitoring as they are at higher risk for hypertension 1

Meal Timing and Structure

• Regular meal timing helps establish healthy eating patterns and prevents excessive snacking 2
• Adequate food and fluid should be consumed before, during, and after exercise to maintain blood glucose, maximize performance, and improve recovery 4, 5, 6
• Test any food plan before competition to determine how well it works for the individual athlete 8

Foods to Emphasize

• Fruits and vegetables (though fried potatoes should not constitute the majority of vegetable intake) 1
• Whole grains (at least half of all grain intake) 2
• Low-fat dairy products (fat-free and low-fat milk, not full-fat which is a major source of saturated fat) 1
• Fish, poultry, and lean meats in appropriate portion sizes 1
• Beans and legumes 1

Foods and Practices to Avoid

• Added sugars and sugar-sweetened beverages 1
• High sodium foods 1
• Saturated and trans fats 1
• Using food as rewards or punishment, which establishes unhealthy relationships with eating 2
• Relying on calorie-dense but nutrient-poor foods 2
• Bottle propping in infants and only breastmilk or formula in bottles 1

Lifestyle Modifications

• Daily physical activity and a well-balanced diet should be discussed and encouraged at all well-child visits regardless of blood pressure status 1
• Parents and caregivers should serve as role models and lead by example with "do as I do" rather than "do as I say" 1
• Family meals provide important social context for eating behavior 1
• Regular monitoring of weight, height, and BMI is essential to ensure adequate nutrition 2

Medication and Substance Review

• Medication, caffeine, drug, tobacco, and stimulant use should be reviewed with any athlete, particularly those with hypertension 1

Practical Implementation

For Healthcare Providers

• Provide nutrition advice only after comprehensive assessment of the athlete's health, diet, supplement and drug use, and energy requirements 6
• Qualified sports dietitians (Board Certified Specialist in Sports Dietetics in the United States) should provide individualized nutrition direction after comprehensive nutrition assessment 4, 5
• Age-specific research is needed as most knowledge in pediatric sports nutrition is extrapolated from adult literature 7

For Parents and Caregivers

• Control when food is available, nutrient quality, portion size, and snacking patterns 1
• Provide social context for eating behavior through family meals 1
• Teach children about food and nutrition at the grocery store and when cooking meals 1
• Counteract inaccurate information from media and other influences 1
• Choose breastfeeding for first nutrition and try to maintain for 12 months 1