100+ Free CSP Practice Questions

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A 6-year-old post-bone marrow transplant develops graft-versus-host disease of the gut. Which is MOST appropriate?

High-fiber diet immediately

Resume full regular diet immediately

Strict fasting for 6 weeks

Low-fiber, low-lactose, low-fat trial; possibly elemental EN or PN if severe; advance per tolerance

to track

Same family resources

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2026 Statistics

Key Facts: CSP Exam

150

Total Items

125 scored + 25 pretest

3 hrs

Time Limit

CDR

37%

Largest Domain Weight

Nutrition Assessment & Diagnosis

2,000 hrs

Required Experience

Pediatric nutrition within 5 years

$350

US Exam Fee

$475 international

5 years

Certification Validity

CDR

The CSP (Board Certified Specialist in Pediatric Nutrition) exam is administered by CDR. The exam consists of 150 multiple-choice items (125 scored + 25 pretest) over 3 hours. The fee is $350 US / $475 international. Eligibility requires an active RD/RDN credential plus 2,000 hours of pediatric nutrition practice within the past 5 years. Nutrition Assessment and Diagnosis is the largest domain at 37%. Year-round computer-based testing through PSI. Credential valid 5 years.

Sample CSP Practice Questions

Try these sample questions to test your CSP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which growth chart should be used for a 14-month-old infant in routine well-child clinic?

A.CDC growth chart for ages 0-20 years

B.WHO growth standards for ages 0-24 months

C.Fenton preterm growth chart

D.Olsen preterm growth chart

Explanation: The CDC and AAP recommend the WHO growth standards for all children from birth to 24 months because they are based on optimally fed (breastfed) populations and represent how children should grow under ideal conditions. The CDC charts are used for children 2-20 years.

2A 30-week gestation preterm infant on full enteral feeds is gaining 12 g/kg/day. What is the MOST appropriate response?

A.Continue current feeds; growth is appropriate

B.Increase calories to target 15-20 g/kg/day weight gain

C.Decrease feeds because gain exceeds intrauterine rate

D.Switch from human milk to standard term formula

Explanation: Recommended postnatal weight gain for preterm infants is 15-20 g/kg/day to approximate intrauterine growth. A gain of 12 g/kg/day is suboptimal and warrants increased energy and protein, typically through human milk fortification or higher-calorie preterm formula.

3An ELBW infant on parenteral nutrition should receive how much protein per day to support optimal growth?

A.1.5-2.0 g/kg/day

B.2.0-2.5 g/kg/day

C.3.5-4.0 g/kg/day

D.5.0-6.0 g/kg/day

Explanation: ASPEN and ESPGHAN recommend 3.5-4.0 g/kg/day of amino acids for extremely low birth weight (ELBW, <1000 g) infants on parenteral nutrition to match in-utero accretion rates and prevent postnatal growth failure.

4Which formula is MOST appropriate for an infant with confirmed IgE-mediated cow's milk protein allergy who failed an extensively hydrolyzed formula?

A.Standard cow's-milk-based formula

B.Soy-based formula

C.Amino acid-based (elemental) formula

D.Partially hydrolyzed (HA) formula

Explanation: When an infant with IgE-mediated cow's milk allergy continues to react to extensively hydrolyzed formula (about 10% of CMA infants), an amino acid-based formula (e.g., Neocate, EleCare, PurAmino) is indicated because the protein is fully broken down into individual amino acids with no antigenic peptide chains.

5A 10-year-old with cystic fibrosis weighs 28 kg. What is the appropriate dose range of pancreatic enzyme replacement therapy (PERT) per meal?

A.100-500 units lipase/kg/meal

B.500-2,500 units lipase/kg/meal

C.3,000-5,000 units lipase/kg/meal

D.10,000 units lipase/kg/meal fixed dose

Explanation: The Cystic Fibrosis Foundation recommends PERT dosing of 500-2,500 lipase units/kg/meal (max 10,000 units lipase/kg/day or 4,000 units/g of dietary fat) to avoid fibrosing colonopathy associated with high-dose enzymes.

6According to AAP 2023 obesity guidelines, intensive health behavior and lifestyle treatment (IHBLT) for children with obesity should include at least how many contact hours over what time frame?

A.10 contact hours over 6 months

B.15 contact hours over 6 months

C.26 contact hours over 3-12 months

D.52 contact hours over 2 years

Explanation: The AAP 2023 Clinical Practice Guideline recommends at least 26 hours of face-to-face, family-based, multicomponent IHBLT delivered over 3-12 months as the most effective behavioral intervention for children ≥6 years with overweight or obesity.

7A 4-year-old with refractory epilepsy is started on the classic ketogenic diet. What is the standard ratio of fat to (protein + carbohydrate) by weight?

A.1:1

B.2:1

C.3:1

D.4:1

Explanation: The classic ketogenic diet uses a 4:1 ratio of grams of fat to grams of protein plus carbohydrate combined, providing about 90% of calories from fat. Modified versions (3:1 or MCT-based) are used when the strict 4:1 is not tolerated.

8A 7-year-old with classic PKU has a phenylalanine level of 600 μmol/L. What is the BEST nutrition recommendation?

A.Increase intact protein from natural foods

B.Restrict phenylalanine and provide medical food (Phe-free formula)

C.Provide a high-tyrosine, low-leucine diet

D.Eliminate all dietary protein for 48 hours

Explanation: Treatment of PKU requires lifelong phenylalanine restriction with use of a Phe-free amino acid medical food to provide adequate protein, tyrosine, and micronutrients. Target Phe is typically 120-360 μmol/L; 600 μmol/L is above target.

9Which classification reflects severe acute malnutrition in a 3-year-old per WHO criteria?

A.Weight-for-height Z-score between -1 and -2

B.Weight-for-height Z-score < -3 OR MUAC < 11.5 cm OR bilateral edema

C.BMI-for-age 5th to 15th percentile

D.Height-for-age Z-score < -1

Explanation: WHO defines severe acute malnutrition (SAM) in children 6-59 months as weight-for-height Z-score < -3, mid-upper arm circumference (MUAC) < 11.5 cm, or presence of bilateral pitting edema. Any one criterion is sufficient.

10Per the 2014 ASPEN/AND consensus statement, which combination identifies pediatric malnutrition based on a single data point?

A.Weight-for-height Z-score, BMI-for-age Z-score, length/height-for-age Z-score, MUAC Z-score

B.Serum albumin and prealbumin

C.Caloric intake percent of estimated needs only

D.Triceps skinfold percentile only

Explanation: The 2014 ASPEN/AND pediatric malnutrition indicators using a single data point include weight-for-height, BMI-for-age, length/height-for-age, and MUAC Z-scores. Mild = -1 to -1.9, moderate = -2 to -2.9, severe = ≤-3.

About the CSP Exam

Specialty certification for Registered Dietitians practicing in pediatric clinical nutrition. The CSP validates expertise across the pediatric patient population (preterm, infant, toddler, school-age, adolescent), comprehensive nutrition assessment using ASPEN/AND pediatric malnutrition criteria, and evidence-based nutrition intervention for both common conditions (food allergy, obesity, eating disorders) and complex pediatric specialties (CF, IBD, oncology, cardiac, renal, IEM, ketogenic diet for refractory epilepsy).

Questions

150 scored questions

Time Limit

3 hours

Passing Score

Scaled

Exam Fee

$350 US / $475 international (CDR)

CSP Exam Content Outline

32%

Characteristics of the Pediatric Patient Population

Development, age-band physiology, disease-related considerations

37%

Nutrition Assessment and Diagnosis

Clinical status, anthropometric/biochemical assessment, NCP/PES, ASPEN/AND criteria

31%

Nutrition Intervention, Monitoring, and Evaluation

Nutrition prescription, EN/PN, care planning, advancement, transitions

How to Pass the CSP Exam

What You Need to Know

Passing score: Scaled
Exam length: 150 questions
Time limit: 3 hours
Exam fee: $350 US / $475 international

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CSP Study Tips from Top Performers

1Use WHO growth charts for ages 0-24 months (recommended for breastfed infants) and CDC charts for ages 2-20 years. Calculate Z-scores; -1 to -1.9 = mild malnutrition, -2 to -2.9 = moderate, ≤-3 = severe per AND/ASPEN 2014

2Memorize preterm PN advancement: protein start day 1 at 2-3 g/kg/d, advance to 3.5-4 g/kg/d for ELBW; lipids start day 1 at 1 g/kg/d, advance to 2-3 g/kg/d. Glucose advance to GIR ~12 mg/kg/min

3Know CF nutrition: pancreatic enzyme replacement therapy (PERT) 500-2,500 units lipase/kg/meal (max 10,000 U/kg/d), high-fat 35-40% kcal, ADEK fat-soluble vitamin supplementation, salt supplementation in heat stress

4Master AAP 2023 pediatric obesity CPG: intensive health behavior and lifestyle treatment (IHBLT) ≥26 contact hours over 1 year for ≥6 yr with BMI ≥85th; pharmacotherapy as adjunct ≥12 yr with BMI ≥95th; bariatric surgery referral ≥13 yr with BMI ≥120% of 95th + comorbidity

5Complete at least 100 practice questions before scheduling your exam

Frequently Asked Questions

Who is eligible for the CSP exam?

You need an active CDR Registered Dietitian (RD or RDN) credential held for at least 2 years plus a minimum of 2,000 hours of documented pediatric nutrition practice within the past 5 years. The exam is offered year-round through PSI test centers and via online proctoring.

What is the most heavily weighted CSP domain?

Nutrition Assessment and Diagnosis carries the largest weight at 37%. This domain covers comprehensive pediatric assessment (anthropometric, biochemical, clinical, dietary, social), use of WHO growth charts (0-2y) vs CDC charts (2-20y), Z-score interpretation, MUAC, and the AND/ASPEN 2014 pediatric malnutrition consensus criteria for diagnosing acute and chronic malnutrition.

What pediatric malnutrition criteria are tested?

The 2014 AND/ASPEN Pediatric Malnutrition Consensus Indicators are central. Use Z-scores for primary indicators (weight-for-length <2y, BMI-for-age ≥2y, length-for-age, MUAC) and growth velocity for serial assessment. Mild malnutrition = Z-score -1 to -1.9, moderate = -2 to -2.9, severe = ≤-3. Combine with etiology (illness-related vs non-illness, acute <3 months vs chronic ≥3 months) for full diagnosis.

What disease-specific content should I prioritize?

Master CF (high-cal/high-fat with PERT 500-2,500 U lipase/kg/meal, ADEK supplementation), DKA management, IgE-mediated food allergy vs FPIES, IBD (EN as primary therapy in pediatric Crohn), pediatric oncology (mucositis, neutropenia, drug-nutrient interactions), ketogenic diet for refractory epilepsy (4:1 ratio, ketone monitoring), IEM (PKU low-phe, urea cycle disorders, MSUD), pediatric CKD/dialysis, and the AAP 2023 pediatric obesity guideline (intensive lifestyle ≥26 hr over 1 yr; pharmacotherapy ≥12 yr; bariatric ≥13 yr with criteria).

How should I study for the CSP exam?

Plan 60-100 hours over 8-12 weeks. Focus heavily on the two largest domains together (Assessment + Intervention = 68% of exam). Master pediatric anthropometric assessment (Z-scores, growth chart selection by age), AND/ASPEN malnutrition criteria, energy/protein needs by age band (especially preterm advancement), EN formula selection, PN composition with IFALD prevention, and the major pediatric disease states. Reference ASPEN, AAP, AND, and ESPGHAN guidelines.