Protein seems to be a common nutrition concern in pediatric feeding. Parents commonly worry that their child doesn’t get enough. Most parents greatly overestimate how much protein a child needs. One mother offered a perfect example. After a workshop, she approached Katja and asked about her 15 month-old:
“I give my son chicken nuggets every night because I know he’ll eat them and he doesn’t eat enough protein. Is that okay?”
After asking a few questions, it was clear that she greatly overestimated how much he needed. He was not unusually selective, nor did he have any delays or other need for accommodations. Mom described him as “underweight” though he was growing steadily at about the 25th percentile. (He was smaller than average, but likely healthy, just as his mom and older brother were.)
Only offering his favorites, out of her misguided protein (and growth) worry, made it more likely that he would refuse other protein sources moving forward. He was missing out on learning experiences and opportunities to explore and expand variety.
Offering different sources of protein — even if he doesn’t reliably eat them — will help.
Commonly, when we see intake analyses for even selective or “underweight” children, the amount of protein the child eats is far more than the minimum recommended. For example, a toddler drinking a cup or two of milk throughout the day, part of an egg, and a slice or two of deli meat gets more than enough protein. When parents understand how relatively easy it is to get enough protein, they can relax and not pressure.
The following are some general formulas for protein needs for kids:
(source: Nutrition Through the Life Cycle, Cengage. Copyright 2020, 2017 Cengage Learning, Inc.)
There is a DRI table and this includes information about g of protein/kg of body weight for healthy children:
- 0-6 mo = 1.52 g/kg of body weight/day
- 6 mo- 1yr = 1.2 g/kg of body weight/day
- 1-3 yr = 1.05 g/kg of body weight/day
- 4-8 y r= 0.95 g/kg of body weight/day
- 9-13 = 0.95 g/kg of body weight/day
- 14-18 = 0.85 g/kg of body weight/day
These are numbers pediatric dietitians use as a minimum level to estimate protein needs in healthy children without increased metabolic needs. Divide grams by 2.2 for protein grams per pound. so for example, thus 0-5 months would need about .7 grams/pound of body weight…) If your child gets above this amount and is doing well, that is reassuring. However, always check with your healthcare team.
Non-meat protein sources (amounts given to show how it adds up):
- Milk: 1 cup = 8 grams
- Cheese: 1 ounce = 6–8 grams
- Yogurt: 1 cup = 8 grams
- Greek-style yogurt: 1 cup = up to 18 grams (check labels; protein varies)
- Nuts or nut butters: 2 tablespoons = 7 grams
- Eggs: 1 egg = 7 grams
- Fish and shellfish, like shrimp: 1 ounce = 7 grams
- Beans and lentils: ½ cup cooked = 7–10 grams
- Edamame soybeans: ½ cup = 14 grams (edamame, which the child can shell, is a fun snack)
- Tofu: ½ cup = 20 grams
- Veggies: ½ cup cooked = 1–3 grams
- Grains: ½ cup cooked pasta, 1 slice of bread, ½ cup oats = 2–4 grams
Dairy is high in protein. The Canadian Food Guide now includes dairy in the protein category, with beans and meats.
A different unfounded protein worry
Another mom emailed Katja about protein: “I want to feed my son meat lasagna tonight, but I heard that too much protein is bad for his kidneys.” If children are otherwise healthy, it would take massive amounts of meat lasagna to affect their kidneys, amounts they’d have an almost impossible time-consuming. The only time in Katja’s medical practice where a healthy young person got into trouble with protein was when a teen took protein powder supplements (to “bulk up”) and severely dehydrated himself on purpose (to make his weight category) for a weekend wrestling tournament. The combination of excessive protein load, dehydration, and extreme exertion with muscle breakdown over several wrestling matches, led to temporary kidney problems—avoidable with common sense.
This was another case where an unfounded protein worry interfered with joyful feeding.
Sometimes parents can clearly state their worries, sometimes it becomes clear some weeks or months into working with a family. It can help to ask, “I notice you mention protein in particular. Is there anything you worry about with how much protein they eat? What it is that you observe or worry will happen if he doesn’t eat protein?” You may be in a position where you can take this particular worry… off their plate.
*This is the first in the “Nutrition Note” series where one of the main goals will be to offer a reassuring voice to counteract the widespread fear-mongering around food and nutrition. We can help parents avoid unnecessary anxiety and pressure. This series will also aim to offer practical support for nutrition with feeding challenges.
Katja and Natalia