When doctors and nurses in a children’s intensive care unit started writing down specific feeding goals for critically ill patients, something important happened: kids got better faster. Researchers looked at 1,510 children admitted to the hospital before and after this change. They found that when feeding goals were documented early, children were more likely to receive nutrition support quickly, and they spent less time in the hospital overall. This simple change in how medical teams communicate about nutrition appears to make a real difference in helping critically ill children recover.

The Quick Take

  • What they studied: Whether writing down feeding goals early in a child’s hospital stay helps doctors start nutrition support faster and improves recovery
  • Who participated: 1,510 children admitted to a pediatric intensive care unit (PICU) over two years—702 before the hospital made changes to how they document feeding goals, and 808 after the changes were made
  • Key finding: After the hospital improved how they documented feeding goals (from 30% to 97% of children), more children received early nutrition support, and they spent about 1.3 fewer days in the hospital on average and 1.3 fewer days in the intensive care unit
  • What it means for you: If your child is admitted to a pediatric intensive care unit, asking the medical team about feeding goals and making sure they’re written down may help your child recover faster. However, this finding is specific to critically ill children and may not apply to other situations.

The Research Details

Researchers compared two groups of children: those admitted to the pediatric intensive care unit before the hospital made changes (May 2020 to April 2021) and those admitted after the changes were made (May 2021 to April 2022). They looked at medical records and hospital computer systems to find information about when feeding goals were documented, when children started receiving nutrition through feeding tubes, and how long children stayed in the hospital. The researchers focused on the first 96 hours (4 days) after admission, which is a critical time for starting nutrition support in very sick children.

The hospital’s change was straightforward: they improved how they documented energy goals—essentially making sure doctors and nurses wrote down exactly how many calories each child needed each day. Before the change, only 30% of children had these goals documented early. After the change, 97% of children had documented goals.

The researchers used statistical tests to compare the two groups and account for differences between children, such as age, sex, and how sick they were when admitted. This helps ensure that improvements weren’t just due to chance or differences in the types of children admitted.

This research approach is important because it shows what happens in real hospitals with real patients, not just in controlled laboratory settings. By comparing the same hospital before and after a change, researchers can see if the change actually made a difference. The large number of children studied (1,510) makes the findings more reliable than if they had only looked at a small group.

This study has several strengths: it included a large number of patients, compared two similar groups of children, and adjusted for factors that could affect the results. However, because it’s a retrospective study (looking back at what already happened), researchers couldn’t control all the variables like they could in an experiment. The study was conducted at one hospital, so results might be different at other hospitals with different practices. The researchers had access to detailed medical records, which is good, but some information might have been missing or recorded differently before and after the change.

What the Results Show

The main finding was that children admitted after the hospital improved their documentation of feeding goals were significantly more likely to receive early nutrition support. Specifically, more children in the second group received at least 25% of their daily calorie goal within the first 48 hours of admission.

Children in the group after the change also spent less time in the hospital overall. The median hospital stay decreased from 8.25 days to 6.99 days—a reduction of about 1.3 days. Similarly, time spent in the intensive care unit decreased from 4.05 days to 3.64 days, also about 1.3 days shorter.

When researchers adjusted their analysis to account for differences between children (like age and how sick they were), the connection between documented feeding goals and early nutrition remained strong and statistically significant. This means the improvement wasn’t just due to chance or because different types of children were admitted in the two time periods.

The improvement in documentation itself was dramatic: the percentage of children with early documented energy goals increased from 30% to 97%, showing that the hospital’s quality improvement project was very successful in changing how staff documented feeding plans.

The study found that the improvement in early nutrition support was consistent across different groups of children, even when accounting for age, sex, race, ethnicity, and how critically ill children were at admission. This suggests the benefit of documenting feeding goals wasn’t limited to just one type of child but appeared to help broadly. The fact that both intensive care unit stay and total hospital stay were shorter suggests that better nutrition planning may have broader effects on recovery.

Previous research has suggested that early nutrition support in critically ill children is important for recovery, but this study provides evidence that simply improving how feeding goals are documented and communicated can make a practical difference. The findings support the idea that nutrition planning isn’t just about what doctors decide—it’s also about clearly communicating those decisions to the entire medical team so everyone works toward the same goal.

This study looked back at what happened rather than randomly assigning children to different approaches, so we can’t be completely certain that documenting goals caused the improvements. Other changes at the hospital during this time period might have contributed to better outcomes. The study was conducted at one hospital, so results might be different elsewhere. The researchers couldn’t track all possible factors that might affect nutrition and recovery. Additionally, the study doesn’t explain exactly why documented goals led to faster nutrition initiation—it just shows that they’re connected.

The Bottom Line

For hospitals and medical teams: Implementing a system to document feeding goals early in a child’s intensive care unit stay appears to be a practical way to improve nutrition support and potentially shorten hospital stays. This recommendation has moderate-to-strong evidence from this study. For families: If your child is admitted to a pediatric intensive care unit, ask the medical team about feeding plans and goals. Make sure these are documented and communicated clearly among all staff members.

This research is most relevant to hospitals with pediatric intensive care units, doctors and nurses who care for critically ill children, and families with children in intensive care. The findings may not apply to children in regular hospital rooms or outpatient settings. Parents of children with chronic conditions who might need intensive care should be aware that nutrition planning is an important part of care.

The improvements in hospital stay length were observed during the hospital stay itself—children went home about 1-1.5 days sooner on average. However, this is an average, and individual children’s recovery times vary based on their specific condition and how sick they were when admitted.

Want to Apply This Research?

  • If a family member is in intensive care, track the date feeding goals were documented and the date nutrition support began. Note the percentage of goal calories being delivered each day. This creates a record to discuss with the medical team.
  • Parents and caregivers can advocate for clear documentation by asking the medical team: ‘What are the feeding goals for my child?’ and ‘When will nutrition support begin?’ Request written summaries of these goals and ask to be updated daily on progress toward meeting them.
  • Keep a simple log of daily calorie intake percentage and hospital stay length. After discharge, review this with your child’s doctor to understand how nutrition support contributed to recovery. This information can be valuable if your child needs future hospital care.

This research applies specifically to critically ill children in pediatric intensive care units and should not be used to make decisions about nutrition for healthy children or children with other medical conditions. The findings come from one hospital and may not apply universally. Parents and caregivers should always follow the specific recommendations of their child’s medical team. This information is educational and not a substitute for professional medical advice. If your child is in intensive care, discuss nutrition planning and goals directly with the treating physicians and registered dietitians.