ObjectiveThis study aimed to review the quality and content of phosphate educational materials used in pediatric chronic kidney disease. MethodsThe quality of text-based pediatric phosphate educational materials was assessed using validated instruments for health literacy demands (Suitability Assessment of Materials [SAM] and Patient Education Material Assessment Tool [PEMAT-P]) and readability (Flesch Reading Ease [FRE] and Flesch-Kincaid [FK] Grade Level). Codes were inductively derived to analyse format, appearance, target audience, resource type and content, aiming for an intercoder reliability (ICR) >80%. The content was compared to Paediatric Renal Nutrition Taskforce (PRNT) recommendations. ResultsSixty-five phosphate educational materials were obtained, 37 were pediatric-focused including 28 text-based. Thirty-two percent of text-based materials were directed at caregivers, 25% children and 43% unspecified. Most (75%) included a production date with 75% produced >2 years ago. The median FRE test-score was 68.2 (interquartile range [IQR] 61.1-75.3) and FK Grade Level 5.6 (IQR 4.5-7.7). Using SAM, 54% rated “superior” (≥70), 38% “adequate” (40-69) and 8% “not suitable” (≤39). Low scoring materials lacked a summary (12%), cover graphics (35%) or included irrelevant illustrations (50%). PEMAT-P scores were 70% (IQR 50-82) for understandability and 50% (IQR 33-67) for actionability. An ICR of 87% was achieved. Over half limited foods in agreement with PRNT (including 89% suggesting avoiding phosphate additives). Recommendations conflicting with PRNT included reducing legumes and wholegrains. Over a third contained inaccuracies and over two thirds included no practical advice. ConclusionsText-based pediatric phosphate educational materials are pitched at an appropriate level for caregivers, but this may be too high for children under 10 years. The inclusion of relevant illustrations may improve this. Three quarters of materials scored low for actionability. The advice does not always align with the PRNT, which (together with the inaccuracies reported) could result in conflicting messages to patients and their families.