Strategies to optimize enteral feeding and nutrition in the critically ill child

The provision of nutrition therapy is an integral component of care for the critically ill child. Essential factors to consider include a child’s evolving metabolic needs accounting for age, underlying disease, co-morbidities and the severity of illness. This includes the implications that the stress response has on concurrent energy requirements during hospital admission. To ameliorate the impact of the stress response nutrition therapy is a crucial aspect of this care. Scientific support for early enteral nutrition is strong yet application in clinical practice remains challenging. Enteral nutrition for children who require vasoactive medications is a long-standing question despite evidence suggesting it can be well-tolerated and beneficial in pediatric critical illness. Studies suggest improved clinical outcomes, decreased length of hospitalization and decreased mortality in certain populations. The aim of this narrative review is to discuss the physiology of metabolic derangements that occur during critical illness, outline how to determine optimal nutrition prescription, and discuss benefits of early enteral nutrition. Considerations of particular populations, such as the postoperative surgical patient, and the patient requiring vasoactive medications will also be discussed.