PedsCrit Nutrition in Critical Illness with Dr. Enid Martinez, 2/2
Dec 8, 2025
Dr. Enid Martinez, a leading expert in pediatric critical care and nutrition at Boston Children's Hospital, shares her insights on the vital role of nutrition in critically ill children. She discusses when to use trophic feeds and the pitfalls of Pedialyte. Monitoring for feeding intolerance is crucial, and she explains preferring post-pyloric feeds over prokinetics. Enid also emphasizes the impact of opioid-induced constipation on feeding and the importance of early parenteral nutrition for malnourished patients. Prepare for an enlightening discussion on optimizing pediatric care!
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When To Use Trophic Feeds
- Define trophic feeds as very low-volume enteral feeds, generally <25% of goal, not meant to meet caloric needs.
- Reserve prolonged trophic feeds for patients with long prior gut rest or persistent PN dependence and advance feeds when tolerated.
Don't Feed During Active Resuscitation
- Avoid feeding during active resuscitation and escalating vasoactive boluses.
- Begin enteral feeds once patients are convalescing and pressors are weaning, watching closely for intolerance.
Use Multiple Signs To Judge Tolerance
- Monitor abdominal distension, vomiting, diarrhea and gastric residuals together rather than relying on residuals alone.
- Use concerning combinations of signs to stop or adjust feeding and watch patients closely when on pressors.