ASPEN Releases New Comprehensive Nutritional Guidelines for Critically Ill Pediatric Patients

July 10, 2017, Silver Spring, MD:   The American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM) today released Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition . These guidelines were based upon an exhaustive literature review on the importance of nutritional support therapy in cases involving critically ill patients ages one month to 17 years of age.

The research team, chaired by ASPEN President-elect, Dr. Nilesh Mehta of Boston Children’s Hospital, analyzed over 2,032 citations for relevance related to pediatric nutritional support, specifically looking at the data for critically ill pediatric patients with a length of stay greater than two or three days in a pediatric intensive care unit (PICU), admitting medical, surgical, and cardiac patients.

“In 2009, after conducting a comprehensive review, ASPEN issued clinical guidelines for critically ill pediatric patients. Up until that time, healthcare providers had no such assistance when providing nutrition support therapy to their youngest patients,” explained Debra BenAvram, ASPEN’s CEO. “Thanks to Dr. Mehta and his team, we have now updated that information. The strategic pathway indicated in the 2017 guidelines will help to deliver optimal nutrition and better outcomes for this particularly vulnerable population.”

Among the guidelines findings:

  • There is a significant gap in proper nutritional interventions, particularly among malnourished pediatric patients. This is deeply concerning as malnutrition is associated with adverse clinical outcomes including longer periods of ventilation, higher risk of hospital-acquired infection, longer PICU and hospital stays, and increased mortality.

  • Early intervention makes a difference. Patients who receive a nutritional intervention in a timely manner may benefit most from the therapy. The new guidelines recommend that PICU patients undergo a detailed nutritional assessment within 48 hours of being admitted to the hospital.

  • The timing and method of nutrient delivery is important. The new guidelines offer strategies to optimize enteral nutrition (tube feeding) during critical illness. The research also points to the benefits of a delayed approach to parenteral nutrition (intravenous feeding).

  • A skilled nutrition support team is a key differentiator . One that includes a dedicated dietitian should be available in the PICU to facilitate timely nutritional assessment, and optimal nutrient delivery and adjustment to the patient’s nutrition plan as the clinical situations change.

  • Ongoing monitoring is critical to avoid unintended caloric under- or overfeeding. Patients are at risk of nutritional deterioration during hospitalization, which can adversely affect clinical outcomes. The new guidelines, therefore, suggest that the nutritional status of patients be reevaluated at least weekly throughout hospitalization.

  • Determining how much nutrition is needed is an important factor. For example, optimal protein intake is closely related to positive clinical outcomes. The new guidelines provide recommendations on the minimum protein intake. However, it’s important to bear in mind that the use of RDA (recommended daily allowance) values to guide protein prescription in critically ill pediatric patients is not advised; these were developed for healthy children and often underestimate the protein needs during critical illness.


“Children are especially susceptible to malnutrition,” stated Dr. M. Molly McMahon, President of ASPEN and Professor of Medicine in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at the Mayo Clinic in Rochester, MN. “These guidelines addressing the nutrition of critically ill children have never been more needed or relevant. Ultimately, this clinical guidance has the potential to improve medical outcomes and to decrease health care costs in this group of children.“

Please visit to access the full report and complete recommendations.

# # # #

The American Society for Parenteral and Enteral Nutrition (ASPEN) is dedicated to improving patient care by advancing the science and practice of nutrition support therapy and metabolism. Founded in 1976, ASPEN is an interdisciplinary organization whose members are involved in the provision of clinical nutrition therapies, including parenteral and enteral nutrition. With more than 6,500 members from around the world, ASPEN is a community of dietitians, nurses, nurse practitioners, pharmacists, physicians, scientists, students and other health professionals from every facet of nutrition support clinical practice, research and education. For more information about ASPEN, please visit


Media contact:

Amber McCracken  
(703) 599-0134