National Institute of Diabetes and Digestive and Kidney Diseases

NATIONAL INSTITUTES OF HEALTH

Nutrition in Children with

Chronic Kidney Disease

Introduction

E very child needs good nutrition.

If your child has been diagnosed

with kidney disease, learning

about nutrition is vital because your

child’s diet can affect how well the kidneys work. Always consult with your

child’s health care team before making

any major changes in your child’s diet.

Our kidneys do many things to help

maintain our health. To keep the body

working properly, the kidneys remove

wastes and extra water from the blood.

They balance the salts—made of sodium,

potassium, calcium, and phosphorus—

that circulate in the blood. And they

control the release of natural chemicals

called hormones that help make red

blood cells, control blood pressure,

and keep bones strong.

In the early stages of chronic kidney

disease (CKD), the kidneys continue to

work. They just don’t do their job as

well as normal kidneys do. Since the

decline in kidney function happens slowly, your child’s body may adapt, and you

may not notice any change in the way

your child looks or feels. Unfortunately,

over time, small changes can build up,

and as the kidney disease worsens (CKD

stages 4 and 5), your child may develop

more symptoms of kidney disease.

As kidney disease progresses, nutritional

needs change as well. When the kidneys don’t work normally, your child’s

health care team may recommend a

change in your child’s diet to protect

the kidneys. Health problems from

CKD can be prevented or delayed by

eating the right foods.

Kidney disease can limit a child’s

growth. Your child’s health care team

will work with you to make sure that

your child’s growth is as normal as possible. As children grow, their nutritional

needs change as well. Work with your

child’s health care team to be certain

your child gets the right amount of all

necessary nutrients. At different times,

the team may suggest changes in both

the amount and the types of food your

child needs to eat. Learning about food

choices will help you understand what

changes need to be made to ensure that

your child is as healthy as possible.

Energy

Everyone needs energy to grow and

be active. We measure the amount of

energy in the diet by counting calories.

Taking in too little energy can lead to

decreased activity, poor growth, and

decreased resistance to infection. As

your child grows, energy needs change

depending on age, height, and weight.

Work with the health care team to

determine your child’s daily calorie

needs. If your child is not growing as

well as possible, your child’s health care

team can provide appropriate ways to

add calories to your child’s diet.

U.S. Department of Health

and Human Services
Health care professionals calculate a child’s

daily energy needs using the child’s weight as

part of the equation. For example, a 3-monthold baby requires 49 calories a day for each

pound of her body weight. If the baby weighs

8 pounds, she would need 392 calories per day.

8 × 49 = 392

As the baby gains weight, she requires more

calories. If she gains 2 pounds, her daily

calorie requirement would increase to 490.

10 × 49 = 490

The following chart shows how energy needs

change as a child grows. A growing child

requires more and more energy, or calories.

But the older child does not need as many

calories per pound of body weight as an

infant needs.

Energy needs will vary and you should discuss

any changing needs with your child’s health

care team.

Protein

Protein is an essential part of any diet. It helps

build and maintain muscle, bone, skin, organs,

and blood. Some proteins help fight disease

and heal wounds. All proteins break down

into waste products that must be cleaned from

the blood by the kidneys.

Doctors sometimes recommend that patients

with CKD eat moderate or reduced amounts

of protein. In some patients, however,

restricting protein can prevent adequate

growth and may lead to malnutrition. For

children with kidney disease, the goal is to eat

enough protein for growth but to stay away

from high protein intake. If your child is

on dialysis, your child’s protein needs will

increase, but the amount of this increase will

be based on the type and frequency of dialysis.

Talk with your child’s health care team about

the amount of protein and the sources of protein in your child’s diet. Animal sources such

as eggs, milk, cheese, chicken, fish, and red

meats contain more of the essential amino

acids the body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your child’s health care team can suggest

ways to make adjustments in eating habits

to help meet your child’s protein needs. The

following table has examples of the protein

content of some common foods, but your

child’s health care team can customize the

list to your family’s diet habits.

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Energy Needs for Children with

Kidney Disease

Age Range Calories / Pound / Day

Infant 0–6 months 49

7–12 months 45

Toddler 1–3 years 46

Child 4–6 years 41

7–10 years 32

Adolescents Girls Boys

11–14 years 21 25

15–18 years 18 20
Source: United States Department of Agriculture (USDA)

National Nutrient Database for Standard Reference, Release

16–1 (www.nal.usda.gov/fnic/foodcomp/Data/SR16-1/wtrank/

16-1w203.pdf; accessed October 13, 2005)

Here is a table with the typical protein needs

for growing children with kidney disease. A

child on hemodialysis needs more protein than

a child who has not started dialysis because

the dialysis process removes protein from the

child’s blood. Peritoneal dialysis removes even

more protein than hemodialysis.

For example, a 10-year-old boy who weighs

60 pounds would need 27 grams of protein a

day before starting dialysis.

60 × 0.45 = 27

Limiting a child to this amount may be difficult

because some foods contain that much protein

in a single serving. You may need to cut sandwiches in half or serve smaller portions of

soups and vegetables.

If this same boy started hemodialysis, his daily

protein needs would increase to 36 grams.

60 × 0.6 = 36

On peritoneal dialysis, the boy would need 48

grams of protein a day.

60 × 0.8 = 48

Your child’s protein needs may vary—discuss

them with your child’s health care team.

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Protein Content of Foods

Food Serving Size

Turkey breast 41 grams/cup

Large hamburger with

vegetables and condiments

34 grams/8-oz sandwich

Tuna sub 30 grams/6-inch sub

Cottage cheese 26 grams/cup

Chili con carne 24 grams/cup

Cold-cut sub 21 grams/6-inch sub

Fast food taco 20 grams/6-oz taco

Fish sandwich with tartar sauce

and cheese

20 grams/6.5-oz sandwich

Baked beans 17 grams/cup

Chicken nuggets 16 grams/6 nuggets

Yogurt 13 grams/8-oz container

Beef stew 12 grams/cup

Fast food burrito with meat and

beans

11 grams/4-oz burrito

Cooked peas 8 grams/cup

Chicken noodle soup 6 grams/cup

Protein Needs for Children 

with Kidney Disease

Age Range

Grams / Pound / Day

PreDialysisHemodialysisPeritoneal

Dialysis

Infant 0–6 months 1 1.2 1.3–1.4

7–12 months 0.73 1.1 1.0–1.1

Toddler 1–3 years 0.5 0.7 0.9

Child 4–6 years 0.5 0.7 0.9

7–10 years 0.45 0.6 0.8

Adolescents 11–14 years 0.45 0.6 0.8

15–18 years 0.4 Girls Boys 0.6–0.7

0.5 0.6
Sodium

Sodium is a mineral that is important for many

body functions. Sodium is found in ordinary

table salt and many seasonings like soy and

teriyaki sauces. One teaspoon of table salt

contains 2,300 milligrams of sodium. Canned

foods, some frozen foods, and most processed

foods have large amounts of table salt. Some

snack foods like chips and crackers are also

high in salt. Too much sodium can increase

thirst, raise blood pressure, and cause water

retention that may lead to excess weight gain

or fluid buildup in the lungs. On the other

hand, in some patients, too little sodium can

lead to dehydration and poor weight gain.

Figuring out how much sodium your child

needs is complicated by the kind of kidney

problem your child has, your child’s age, and

sometimes other factors. Depending on your

child’s own special needs, your health care

team may ask you to either limit or add

sodium to your child’s diet.

Talk with your child’s health care team about

how much sodium your child needs. Look

at the sodium content on the nutrition labels

of the foods you buy. Choose “sodium-free”

or “low-sodium” food products if you need

to reduce sodium in your child’s diet. Nearly

all fresh vegetables and fresh, unprocessed

meat are preferable to processed foods. Try

alternative seasonings like lemon juice or hot

pepper sauce. But avoid salt substitutes that

use potassium.

Source: American Dietetic Association, Complete Food and

Nutrition Guide, RL Duyff, 1998.

4

Sodium Claims on Food Labels

Claim Explanation

“Sodium-free” Less than 5 mg sodium per serving

“Salt-free” Meets requirements for “sodium-free”

“Low-sodium” 140 mg sodium or less per serving

“Very low sodium” 35 mg sodium or less per serving

“Reduced sodium” At least 25 percent less sodium when

compared with the regular version

“Light in sodium” 50 percent less sodium per serving;

restricted to foods with more than

40 calories per serving

“Unsalted, no

added salt”

No salt is added during processing; the

product it resembles and substitutes

for is normally processed with salt;

the label bears the statement “not a

sodium-free food” or “not for control

of sodium in the diet”
Potassium

Potassium is a mineral found in many fruits and

vegetables like bananas, potatoes, avocados,

and melons. It keeps the heart beating regularly and muscles working right. Your child’s

health care team will routinely check your

child’s blood tests to make sure that the potassium level stays in the normal range. If your

child’s potassium begins to rise, talk with your

child’s health care team about ways to limit

the amount of potassium in your child’s diet.

Your child may need to avoid some fruits and

vegetables. The number and portion sizes of

fruits and vegetables may need to be reduced

as well. You can reduce the potassium content

of potatoes and beans by soaking them in

water for several hours before cooking.

Source: United States Department of Agriculture (USDA)

National Nutrient Database for Standard Reference, Release

17–1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/

sr17a306.pdf; accessed October 13, 2005)

Phosphorus

Phosphorus is a mineral found in many foods,

particularly those high in protein. When your

child’s blood phosphorus level is too high, it

pulls calcium from the bones, making them

weaker and more likely to break. Too much

phosphorus may also make your child’s skin

itch and cause redness of the eyes. High protein foods such as dairy products, meat, dried

beans, peas, colas, nuts, and peanut butter are

high in phosphorus. Talk with your child’s

health care team about how much phosphorus

your child should have in his or her diet.

As kidney disease progresses, it may be necessary to take a phosphate binder with meals

such as calcium acetate (PhosLo), calcium

carbonate (Caltrate, Children’s Maalox tablets,

Oscal, Tums), or sevalemer hydrochloride

(Renagel) to lower the concentration of phosphorus in the blood. These medications act

like sponges to soak up, or bind, phosphorus

while it is in the stomach. Because it is bound,

not all of the phosphorus gets into the blood.

Instead, some of it is passed out of the body

in the stool.

Source: United States Department of Agriculture (USDA)

National Nutrient Database for Standard Reference, Release

17–1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/

sr17a305.pdf; accessed October 13, 2005)

5

Potassium Content of Foods

High-Potassium Foods

Lower-Potassium

Alternatives

Oranges and orange juice

Melons

Apricots

Banana

Kiwi

Potatoes

Tomatoes

Sweet potatoes

Cooked spinach

Beans (baked, kidney, lima,

pinto)

Apples and apple juice

Cranberry juice

Canned fruit

Strawberries, blueberries,

raspberries

Plums

Pineapple

Cabbage

Cauliflower

Mustard greens

Broccoli

Phosphorus Content of Foods

High-Phosphorus Foods

Lower-Phosphorus

Alternatives

Dairy foods (milk, cheese,

yogurt)

Beans (baked, kidney, lima,

pinto)

Nuts and peanut butter

Processed meats (hot dogs,

canned meat)

Cola

Canned iced teas and lemonade

Bran cereals

Egg yolks

Liquid non-dairy creamer

Sorbet

Pasta, rice

Rice and corn cereals

Popcorn

Green beans

Lemon-lime soda

Root beer

Powdered iced tea and

lemonade mixes
Fluids

Early in kidney disease, your child’s damaged

kidneys may produce either more or less urine

than normal. If your child makes only a small

amount of urine, swelling or high blood pressure may develop. If the kidneys produce too

much urine, your child is at risk of dehydration. Tell your child’s health care team if you

notice that your child is making either more or

less urine or if you notice any swelling in the

face, legs, arms, or abdomen.

Once your child’s kidneys fail and your child

begins dialysis, you may need to limit how

much your child drinks. The amount people

drink is often related to the amount of sodium

they eat. If thirst is a problem, you need to

speak with your child’s health care team about

ways to control excess thirst.

Special Problems in the First Year

of Life

Because infants grow so quickly, your child’s

health care team will need to follow your child

more closely during this critical time. Often a

child will need special formulas with extra

supplements (calorie enhancers) to be sure that

your child gets the right amount of fluid and

nutrients. Sometimes an infant can’t drink the

amount of formula he needs to grow, and your

physician may suggest that he be fed by tube.

While this may sound drastic, experience has

shown that tube feeding is often the best way

to be sure that your child gets the full supply

of fluid and nutrients he needs to promote

growth and development. While feeding

tubes are most often used in infants, there are

situations when older children and adolescents

benefit from them as well.

Keep Track of Test Results

If your child has CKD, your child’s health care

team will order regular blood tests. Many

patients find that keeping track of test results

helps them see how well they are doing. Ask

your child’s doctor for copies of the laboratory reports and ask to have them explained.

Note any results that are out of the normal

range. When you learn how to read your

child’s reports, you will see how the foods

your child eats can affect laboratory results.

Talk with your child’s health care team about

making healthier food choices. You may ask

for a laboratory report card from your child’s

health care team on a regular basis.

6

The U.S. Government does not endorse or favor

any specific commercial product or company.

Trade, proprietary, or company names appearing

in this document are used only because they are

considered necessary in the context of the

information provided. If a product is not

mentioned, the omission does not mean or

imply that the product is unsatisfactory.
Additional Reading

The following fact sheets and brochures, as

well as other information, are available on

request from the organizations listed. Most

of them can also be found online at the web

address given.

Dining Out With Confidence: 

A Guide for Patients with Kidney Disease

Nutrition for Children with Chronic Kidney

Disease

National Kidney Foundation

30 East 33rd Street

New York, NY 10016

Phone: 1–800–622–9010 or 212–889–2210

Email: info@kidney.org

Internet: www.kidney.org

A Healthy Food Guide for People with

Chronic Kidney Disease

American Dietetic Association

120 South Riverside Plaza

Suite 2000

Chicago, IL 60606-6995

Phone: 1–800–366–1655

Internet: www.eatright.org

“Solving the Diet Dilemma for Children”

aakpRENALIFE, vol. 17, no. 5 (March 2002)

http://www.aakp.org/AAKP/RenalifeArt/2002/

dietdilemma.htm

American Association of Kidney Patients

3505 East Frontage Road

Suite 315

Tampa, FL 33607

Phone: 1–800–749–2257 or 813–636–8100

Email: info@aakp.org

Internet: www.aakp.org

For More Information

American Kidney Fund

6110 Executive Boulevard

Suite 1010

Rockville, MD 20852

Phone: 1–800–638–8299 or 301–881–3052

Email: helpline@akfinc.org

Internet: www.kidneyfund.org

American Society of Pediatric Nephrology

Northwestern University

The Feinberg School of Medicine

Pediatrics W140

303 East Chicago Avenue

Chicago, IL 60611–3008

Phone: 312–503–4000

Fax: 312–503–1181

Email: aspn@northwestern.edu

Internet: www.aspneph.com

Food and Nutrition Information Center

National Agricultural Library/USDA

10301 Baltimore Avenue, Room 304

Beltsville, MD 20705–2351

Phone: 301–504–5719

Email: fnic@nal.usda.gov

Internet: www.nal.usda.gov/fnic

Life Options Rehabilitation Resource Center

c/o Medical Education Institute, Inc.

414 D’Onofrio Drive

Suite 200

Madison, WI 53719

Phone: 1–800–468–7777

Email: lifeoptions@MEIresearch.org

Internet: www.lifeoptions.org

National Kidney Disease Education Program

3 Kidney Information Way

Bethesda, MD 20892

Phone: 1–866–4–KIDNEY (454–3639)

Email: nkdep@info.niddk.gov

Internet: www.nkdep.nih.gov

7
About the Nutrition for 

Chronic Kidney Disease Series

The NIDDK Nutrition for Chronic

Kidney Disease Series includes three

fact sheets:

■ Nutrition for Early Chronic Kidney

Disease in Adults

■ Nutrition for Later Chronic Kidney

Disease in Adults

■ Nutrition in Children with Chronic

Kidney Disease

For free single printed copies of this

series, please contact the National Kidney and Urologic Diseases Information

Clearinghouse.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 06–5752

March 2006

National Kidney and Urologic

Diseases Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov

Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases

Information Clearinghouse (NKUDIC) is a

service of the National Institute of Diabetes

and Digestive and Kidney Diseases (NIDDK).

The NIDDK is part of the National Institutes

of Health under the U.S. Department of Health

and Human Services. Established in 1987,

the Clearinghouse provides information about

diseases of the kidneys and urologic system to

people with kidney and urologic disorders and

to their families, health care professionals, and

the public. The NKUDIC answers inquiries,

develops and distributes publications, and

works closely with professional and patient

organizations and Government agencies to

coordinate resources about kidney and

urologic diseases.

Publications produced by the Clearinghouse are

carefully reviewed by both NIDDK scientists

and outside experts. The NKUDIC would like

to thank Joseph Flynn, M.D., of the American

Society of Pediatric Nephrology (ASPN), for

coordinating the review of this fact sheet by the

ASPN’s Clinical Affairs Committee: Barbara

Fivush, M.D. (co-chair), Steve Wassner, M.D.

(co-chair), John Brandt, M.D., Deepa Chand,

M.D., Ira Davis, M.D., Stuart Goldstein, M.D.,

Ann Guillot, M.D., Deborah Kees-Folts, M.D.,

Juan Kupferman, M.D., Gary Lerner, M.D., Tej

Mattoo, M.D., Alicia Neu, M.D., Cynthia Pan,

M.D., William Primack, M.D., and Michael

Somers, M.D.

This publication is not copyrighted. The

Clearinghouse encourages users of this fact

sheet to duplicate and distribute as many

copies as desired.

This fact sheet is also available at 

www.kidney.niddk.nih.gov.