Paeds · gastroenterology-hepatology-and-nutrition
Normal nutritional requirements across childhood
Also known as Paediatric nutritional requirements · Energy and protein needs in childhood · Micronutrient requirements in children · Dietary reference intakes in childhood
Fellowship guide to normal nutritional requirements across childhood, covering the age-specific energy, protein, fat and micronutrient needs that sustain growth, with the ESPGHAN, WHO and AAP reference values and how to deliver them.
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- Weight or length crossing centile lines downward signals that intake is failing to meet requirements and demands prompt assessment
- Cow's milk as a main drink before twelve months causes iron-deficiency anaemia through occult gastrointestinal blood loss
- Restarting full feeding in a starved child can trigger refeeding syndrome with hypophosphataemia, hypokalaemia and fluid overload
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- General Paediatrics
- Nutrition and growth across infancy, childhood and adolescence
- Current 2026 PREP curriculum — normal nutrition and dietary reference intakes
- Renewed curriculum for first-year trainees from 2027 — growth and nutrition
- Growth, nutrition and development
- Clinical Applications
- Medical Sciences
- Long case: a child with growth faltering and dietary assessment
- Short case: nutritional requirements and feeding advice across childhood
- Nutrition: normal requirements and growth
- Patient management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Communication: age-appropriate feeding and weaning advice
- General Pediatrics Content Outline — Domain 1: Growth and Nutrition
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care: nutritional assessment and counselling
- Medical Knowledge: paediatric nutrition and growth physiology
- Medical Expert
- Nutrition across infancy, childhood and adolescence
Overview & Definition
Normal nutritional requirements are the amounts of energy, protein, fat and micronutrients that a healthy child must absorb to sustain growth, maintain body functions and support physical activity at each age. They are not a single number but a trajectory that is highest per kilogram in early infancy, when the brain and body are growing fastest, and that falls steadily relative to weight as the child matures. [1]
The practical framework combines the estimated energy and protein needs derived from total energy expenditure and growth, with recommended micronutrient intakes set by bodies such as the World Health Organization, the United States Institute of Medicine and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Together these form the dietary reference intakes that clinicians use to judge whether a child is being adequately fed. [1]
Energy is the master requirement because it gates everything else. A child who meets energy needs will generally use protein for growth, whereas an energy-deficient child burns protein for fuel and stops growing. The landmark measurement study of energy expenditure in the first two years of life established that healthy infants require about 80 to 100 kilocalories per kilogram per day, derived from total energy expenditure plus the energy deposited in new tissue. [1]
References11ShowHide
- [1]Butte NF, Wong WW, Hopkinson JM, Heinz CJ, Mehta NR, Smith EO Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. Am J Clin Nutr, 2000.PMID 11101486
- [2]Torun B, Davies PS, Livingstone MB, Paolisso M, Sackett R, Spurr GB Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Eur J Clin Nutr, 1996.PMID 8641267
- [3]Butte NF Fat intake of children in relation to energy requirements. Am J Clin Nutr, 2000.PMID 11063466
- [4]Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2008.PMID 18162844
- [5]Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2017.PMID 28027215
- [6]Wagner CL, Greer FR Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 2008.PMID 18977996
- [7]Baker RD, Greer FR Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 2010.PMID 20923825
- [8]Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S, Hernell O, et al Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. J Pediatr Gastroenterol Nutr, 2005.PMID 16254515
- [9]Mihatsch WA, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, et al ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clin Nutr, 2018.PMID 30471662
- [10]Michaelsen KF Cows' milk in complementary feeding. Pediatrics, 2000.PMID 11061845
- [11]Ziegler EE Adverse effects of cow's milk in infants. Nestle Nutr Workshop Ser Pediatr Program, 2007.PMID 17664905