Table 3.

Summary of recommendations

	Category	Recommendation	Grade
1	Energy requirements	1.1 We suggest that the initial prescription for energy intake in children with CKD2–5D should approximate that of healthy children of the same chronological age.	Level B; moderate recommendation
		1.2 To promote optimal growth in those with suboptimal weight gain and linear growth, we suggest that energy intake should be adjusted towards the higher end of the suggested dietary intake (SDI).	Level D; weak recommendation
		1.3 In overweight or obese children, adjust energy intake to achieve appropriate weight gain, without compromising nutrition.	Level X; strong recommendation
2	Protein requirements	2.1 We suggest that the target protein intake in children with CKD2–5D is at the upper end of the SDI to promote optimal growth. The protein intake at the lowest end of the range is considered the minimum safe amount and protein intake should not be reduced below this level. 2.2 We suggest that the protein intake in children on dialysis may need to be higher than the SDI for non-dialysis patients to account for dialysate protein losses. 2.3 In children with persistently high blood urea levels, we suggest that protein intake may be adjusted towards the lower end of the SDI, after excluding other causes of high blood urea levels.	Level C; moderate recommendation Level X; strong recommendation Level C; weak recommendation Level C; moderate recommendation
3	Nutritional prescription	3.1 Breastfeeding is the preferred method for feeding an infant with CKD. 3.2 When breastfeeding is not possible or expressed breastmilk is not available in adequate amounts for the infant with CKD, we suggest that whey-dominant infant formulas be used. 3.3 We suggest that breastmilk and infant formulas should be fortified when there is a prescribed fluid restriction or when a more energy or nutrient dense feed is required to meet nutritional requirements 3.4 We suggest that the concentration of feeds and addition of dietary supplements are prescribed in a gradual manner in order to maximize acceptance and tolerance. 3.5 Solid foods should be introduced as recommended for healthy infants, with progression to varied textures and content according to the infant’s cues and oral motor skills. We suggest that all children eat a healthy, balanced diet with a wide variety of food choices, as for the general population, taking into account possible dietary limitations. 3.6 Oral feeding is the preferred route whenever possible. Oral stimulation is desirable, even if oral intake is limited, to prevent the development of food aversion. 3.7 We suggest prompt intervention once deterioration in weight centile is noted. Oral nutritional supplementation should be started in children with inadequate dietary intake, after consideration of medical management of correctable causes of reduced intake. 3.8 We suggest that supplemental or exclusive enteral tube feeding should be commenced in children who are unable to meet their nutritional requirements orally, in order to improve nutritional status.	Level X; strong recommendation Level A; strong recommendation Level A; strong recommendation Level D; weak recommendation Level D; weak recommendation Level C, weak recommendation Level B, moderate recommendation Level B, moderate recommendation