Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Pediatric sports nutrition: an update Dan Nemet a,b and Alon Eliakim a,b Introduction Although most children today are less active and increas- ingly overweight, there is also a growing number of children who are engaged in competitive sports involving high training loads [1]. Although nutritional issues in the young athlete are thought to parallel those of the adult athlete, it is now known that growing children have several physiologic and metabolic characteristics that distinguish them from adults and require specific nutri- tional considerations. Sports nutrition is a key factor in an athlete’s growth, development and performance [2  ]. This review will focus on short-term and long-term nutritional considerations in the young growing athlete. We will discuss the short-term effects of carbohydrates (CHOs), protein and fluid intake on the exercising child. The review will also discuss the possible long-term medical consequences of inappropriate nutrition in the young athlete. Carbohydrates The daily recommended intake of CHOs in children is based on the amount needed to provide glucose for brain metabolism and does not consider muscle needs for gly- cogen repletion. In adult athletes, CHOs are the major fuel for maintaining work rate. Children are believed to be different in their CHO metabolism; they lack the full development of glycolytic capacity and utilize different nutrient oxidation routes compared with adults. Moreover, children have a higher risk of heat-related illness, and during puberty, because of the natural increase in sex steroids and growth hormone secretion, they become relatively insulin resistant (insulin sensitivity appears to a Child Health and Sports Center, Pediatric Department, Meir General Hospital, Kfar-Saba and b Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Correspondence to Alon Eliakim, MD, Child Health and Sports Center, Department of Pediatrics, Meir General Hospital, Kfar-Saba 44281, Israel Tel: +972 9 7472134; fax: +972 9 7471303; e-mail: Eliakim.alon@clalit.org.il Current Opinion in Clinical Nutrition and Metabolic Care 2009, 12:304–309 Purpose of review There is a growing interest in the field of pediatric sports nutrition because of the will to lead the child athlete to high achievements, with minimal impairment of growth and development. In this article, we review some of the new data concerning the possible short-term and long-term effects of nutrition on children’s performance, current and future health. Recent findings Growing children engaged in strenuous exercise have several physiologic and metabolic characteristics that distinguish them from adults and require specific nutritional considerations. There is currently not enough evidence to support either carbohydrate loading or increased protein intake in the diet of the child athlete. Creatine use, although common among youth, is not recommended. Adequate hydration is essential to optimal performance. Consumption of iron-rich foods should be encouraged, as depleted iron stores are common in young athletes. In female athletes, nutritional deficiencies could lead to athletic amenorrhea and bone loss, and the resolution of energy deficits can restore normal bone formation and the return of menses. Summary In the highly competitive world of the child athlete, proper nutrition is of essence. Unfortunately, most of the knowledge in this field is based on adult literature. Age-specific research would lead to a better understanding of what constitutes ‘a healthy diet’ in the context of the growing athlete and may be a first step toward achieving these necessary insights. Keywords amenorrhea, anemia, exercise, hydration, protein Curr Opin Clin Nutr Metab Care 12:304–309 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 1363-1950 1363-1950 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/MCO.0b013e32832a215b