Protein Adequacy Building block of life

While proteins are essential nutrients for all, they are especially important for the optimal growth and development of children and adolescents. Yet, despite its ‘building block of life’ status, children worldwide are not getting adequate protein. Global research indicates that one in seven school-age children is protein-deficient – Kiran Balimane & Cynthia John

Not for nothing is protein known as the building block of life. Every cell, bone and muscle in the human body contains it. Protein is essential for the growth of muscles, bones, skin and organs of children. Comprising long chains of amino acids, proteins build and repair tissues and cells, produce hormones and enzymes that regulate several bodily processes, including digestion, metabolism, and immune defence, and transport molecules (e.g, haemoglobin) to cells, tissues and the bloodstream.

While proteins are essential nutrients for all, they are especially important for the optimal growth and development of children and adolescents. With their bodies growing constantly and building new tissue, muscles, and organs, proteins provide the necessary building blocks (amino acids) of this process. Proteins ensure that children add height, weight, and enhance body structure through growth of new cells; boost neurotransmitter production, aiding memory, learning, and focus, and produce antibodies that fight infections and diseases while also repairing micro-tears in muscles, the inevitable outcome of play and exercise.

Yet, despite its ‘building block of life’ status, children worldwide are not ingesting adequate protein. Global research indicates that one in seven school-age children is protein-deficient. In India, a 2017 survey by market research firm IMRB (Indian Market Research Bureau) revealed that 51 percent of infants aged one-three years and 40 percent in the age group four-six suffer protein deficiency. A more telling statistic indicating pervasive protein deficiency is that 34.7 percent of children under five years age in India are stunted (low height-for-age) and 17.3 percent wasted (low weight-for-height), according to the Global Nutrition Report 2021 of the World Health Organisation (WHO).

Dr. Deepalakshmi Sriram

“Protein is a critical nutrient for the orderly growth and development of children. It supports the formation and repair of cells, muscles, tissues, and organs, while boosting body immunity, enzyme production and cognitive development. As children grow, their bodies demand increased supply of protein. However, many parents are unaware of the importance of protein intake during the crucial childhood phase and tend to neglect it. Also, with most Indian diets deficient in protein, children are not receiving the protein intake their growing bodies need,” says Deepalakshmi Sriram, paediatric and neonatal nutritionist, The Cleft & Craniofacial Centre, Sree Balaji Medical College & Hospital, Chennai.

According to Sriram, the Indian Council of Medical Research (ICMR) has recommended daily protein intake for children by age through its Recommended Dietary Guidelines (RDA) 2024, with distinct requirements of infants, toddlers, children, and adolescents. The guidelines recommendation:

Infants (0-6 months). Breast (or formula) milk provides the best protein for growth and development of newborns. The recommended protein intake is 1.40 gm per kg of body weight per day.

6 months-1 year. During this growth phase, when infants are introduced to solid foods, protein needs increase. Infants in this age group require 1.2 gm per kg of body weight per day (total protein intake increases as children gain body weight). Protein sources include breast (or formula) milk plus complementary foods such as pureed meats, lentils, and cereals.

Toddlers (1-3 years). The recommended dose is 0.97 gm per kg of body weight per day. At this stage, inclusion of protein-rich foods such as milk, eggs, lentils, and meat becomes more important.

Preschool (4-6 years). The recommended intake is 0.87 gm per kg of body weight per day. A balanced diet of dairy products, legumes, grains, and meat is key to providing adequate protein.

Children (7-9 years). The recommended intake rises to 0.92 gm per kg of body weight per day. During this period, children become more physically active, therefore, they need more protein to support muscle development.

10-12 years. Protein requirement is 0.91 gm per kg of body weight per day for boys and 0.90 gm for girls. During this time, the body undergoes significant growth and requires sufficient protein to support physical development and cognitive growth.

Adolescents (13-15 years). Teenage children who attain puberty experience rapid growth, necessitating adequate protein. Recommended intake is 0.89 gm per kg of body weight per day for boys and 0.87 gm for girls. Protein supports hormonal changes and increased energy demands of adolescents.

Older adolescents (16-18 years). Protein requirement remains high, ranging from 0.86 gm per kg of body weight per day for boys and 0.83 gm for girls.

Dr. Ridhi Kaur

Protein deficiency outcomes. Given its importance for all-round physical and cognitive growth of children, parents need to recognise early warning signs of protein deficiency to ensure timely intervention. “One of the primary indicators of protein deficiency in children is poor growth — they won’t attain normative height, weight and muscle mass. A second manifestation is weakened immunity, as protein plays a vital role in the production of antibodies. Protein deficient children are more susceptible to infections, prolonged illnesses, and recover slowly from common ailments such as colds and flu. Thirdly, lack of protein prompts constant fatigue, weakness, and an overall lack of stamina in children. It can also cause brittle nails, thinning hair, and dry skin,” says Dr. Ridhi Kaur, a Gurgaon-based paediatrician.

Dr. Kaur adds that protein-deficient children are also likely to show signs of mood swings, irritability, and experience focusing difficulty because protein is necessary for neurotransmitter production, which aids brain functioning and mental health. Therefore, she believes it should be accorded high importance by parents (see box, p.12).

Dr. Akshta Malhotra

According to Dr. Akshta Malhotra, a Bengaluru-based physiotherapist and ergonomist, protein-deficient children also experience slow healing of cuts, wounds, and bruises and slow injury recovery. “Protein is crucial for cell regeneration and tissue repair. After a surgery or injury, the body breaks down muscle protein to provide amino acids for healing. Children with low protein intake lose muscle mass, making recovery slower and more painful. Bone healing is also delayed because of deficiency of collagen and essential amino acids. Therefore, it’s critical that parents provide children with protein-rich diets to boost their immunity and accelerate cell/muscle regeneration necessary for recovery of injured children,” says Malhotra.

Sneha Arora

Best protein sources. Protein-rich diets are especially important for children with affinity for sports, athletics and field games. Sneha Arora, a Bengaluru-based sports nutritionist and fitness trainer, recommends that parents provide sports and games-loving children protein-rich snacks and meals throughout the day to support growth and build muscle. “Parents who encourage children to participate in sports and physical activity should develop the habit of adequate protein intake in children from early age and include protein-rich foods such as eggs, fish, chicken, soya, sprouts, milk, paneer (cottage cheese), cheese, pulses and legumes into their meals and snacks,” says Arora who recommends a protein shake recipe loved by celeb sportspersons (see box).

Many globally admired sports champs and athletes swear by protein-rich diets. Among them: football star Cristiano Ronaldo (lean meats, fish, eggs, and protein shakes); tennis champ Serena Williams (lean chicken, fish, and plant-based proteins, especially for recovery-focused nutrition); India’s cricket icon Virat Kohli (quinoa, tofu, and plant-based proteins for muscle maintenance and endurance); 23 Olympic gold medals winner Michael Phelps (eggs, lean meats, and poultry to sustain intense training regime) and India’s sweetheart and former Olympics and world badminton champ P.V. Sindhu (eggs, grilled chicken, and lentils as staples to support muscle recovery and agility).

However, Arora strongly advises parents against self-prescribing children off-the-shelf protein supplements. “Ready-made protein supplements are inadvisable for children unless medically prescribed. Kidneys have to work harder to digest additional protein and could result in damage. A protein-enriched diet is sufficient to meet children’s needs. Also, since protein induces satiety, children will be less inclined to binge eat,” she says.

Addressing protein deficiency in children

Gurugram-based paediatrician Dr. Ridhi Kaur lists symptoms and suggests strategies to prevent and manage protein deficiency in children:

Symptoms

Growth and development delays including height and low weight challenges.
Weak immunity leading to frequent infections (cold, flu, respiratory illnesses).
Slow wound healing and increased recovery time from injuries.
Wasted muscle and poor strength.
Low energy levels and fatigue.
Brittle hair and hair fall, skin rashes and/or dry, flaky skin, and weak nails.
Behavioural and cognitive problems, including irritability, mood swings, and poor focus. Impaired cognitive growth which could prompt learning difficulties

Preventive strategies

Diversify protein sources. A well-balanced diet includes animal and plant-based protein sources. Eggs, dairy products (milk, yogurt, cheese), poultry, and fish are excellent animal-based proteins. Vegetarian options include beans, tofu, paneer, yogurt, nuts, and seeds.

Encourage protein-rich breakfast. Breakfast is an important meal that sets the tone for the day. Parents should ensure their children consume protein-rich breakfasts including boiled eggs, paneer parathas made with sattu, sprouted moong dal, peanut butter sandwiches, smoothies with yogurt and nuts.

Legumes and pulses. Indigenous legumes such as dal, rajma (kidney beans), chana (chickpeas), and soybeans are rich in protein. Combine them with whole grains (rice/millets) to enhance absorption.

Dairy. Dairy products such as yogurt, paneer, milk, and cheese are excellent sources of high-quality protein and calcium, crucial for bone development in childhood.

Protein snacks. Substitute high-carbohydrate snacks (burgers, potato chips) with protein-rich alternatives such as roasted chana, peanuts, nuts, seeds, Greek yogurt, protein-enriched laddoos.

Supplements. In cases of extreme deficiency, paediatricians may recommend protein supplements. Fortified foods such as protein-enriched flour or milk usually bridge the gap.

Parental education and awareness. Too many parents are unaware of daily protein needs of children. Consult your paediatrician to understand children’s nutritional requirements according to age. Schools can also help by arranging parenting workshops on the subject.

Arora Protein Shake

Ingredients