Nutritional support of the critically ill child.

There is a growing awareness that the nutrition an individual receives as a child may exert significant consequences later in life. The successful treatment of critically ill children influences their potential for full recovery and optimal outcome. This requires an understanding of how the child responds to stress and starvation. Daily energy needs of the child in the intensive care unit are highly variable. Specific knowledge of the nutritional assessment of these children, whether sustaining an acute or chronic illness, is required, as is an understanding of how the disease process affects the child. Further work needs to be done to evaluate how chronic illness affects the growth, development, and maturation of the child. Assessment parameters remain somewhat controversial, and recent studies indicate that, indeed, critically ill children may be overfed if standard equations are used to calculate needs. Poor clinical outcomes can occur if the child is underfed or overfed. The long-term results of specific diets, micronutrients, glutamine, and new access routes into the infant are not yet known. Research in these areas is rapidly growing, and the new knowledge will provide a greater ability to meet the individual needs of the critically ill child. Perhaps in the future the treatment of choice in patients with organ failure will involve specific micronutrients that influence the immune status and cellular degradation. In the meantime, critically ill children deserve to have their basic nutritional needs met, and nurses can do much to individualize the nutritional support required to produce optimal patient outcomes.