Doctors studied 98 children with a serious lung infection called bronchiolitis who were receiving extra oxygen through special nose tubes. The children were normally kept from eating because doctors worried they might choke or need a breathing machine. Researchers created a simple plan to start feeding these kids earlier through a small tube in their nose. When they used this plan, children started eating 6 times faster (within 4 hours instead of 24 hours), and nobody got sick from it. Kids also left the hospital sooner. This shows that feeding very sick children earlier, when done carefully, is safe and helps them get better faster.

The Quick Take

  • What they studied: Whether children with severe bronchiolitis (a serious lung infection) who are getting extra oxygen support can safely start eating sooner through a feeding tube, and if doing so helps them recover faster.
  • Who participated: 98 children in a pediatric intensive care unit (PICU) with bronchiolitis who were receiving humidified high-flow oxygen through nose tubes. The study compared two groups: 45 children treated before a new feeding plan was created, and 53 children treated after the plan was put in place.
  • Key finding: Children started receiving nutrition through a nose tube in just 4 hours after the new feeding plan was introduced, compared to 24 hours before. This is a 6-fold improvement. No children experienced choking or other serious problems, and they spent less time in the hospital overall.
  • What it means for you: If your child has severe bronchiolitis and needs oxygen support in the hospital, doctors may now be able to start feeding them sooner, which could help them recover faster and go home earlier. However, this approach should only be used in hospitals with proper medical supervision and should be tailored to each child’s specific condition.

The Research Details

This was a quality improvement project that compared how children with bronchiolitis were treated before and after a new feeding plan was introduced. The researchers looked at two groups of children treated at different times in the same pediatric intensive care unit. Group 1 (45 children) was treated from October 2022 to May 2023 without the new feeding plan. Group 2 (53 children) was treated from October 2023 to May 2024 after the new feeding plan was put into place. All children had severe bronchiolitis and were receiving humidified high-flow oxygen through special nose tubes. The main goal was to see if they could start feeding children through nose tubes much faster—at least 50% faster—after the new plan was introduced.

The researchers created a step-by-step algorithm (a set of clear instructions) that helped doctors decide when and how to start feeding these very sick children. Instead of keeping all children from eating because of worry about choking, the new plan allowed doctors to safely start nutrition earlier. Children received nutrition through naso-gastric tubes, which are small, flexible tubes placed through the nose into the stomach.

The study measured several important things: how quickly children started eating, how long it took to reach their full calorie needs, how many days they needed the oxygen support, how long they stayed in the intensive care unit, and how long they stayed in the hospital overall. The researchers also carefully watched for any problems like choking or other harmful effects.

This research approach is important because it tests a real-world solution to a common problem in pediatric intensive care. Many doctors have been hesitant to feed children with severe bronchiolitis because they worry about aspiration (food going into the lungs instead of the stomach). However, not eating enough can slow down recovery and weaken the immune system. By comparing what happened before and after the new plan, researchers could see if the plan actually worked in real hospital conditions and whether it was safe. This type of study is valuable because it shows what actually happens when hospitals change their practices, not just what might happen in a controlled experiment.

This study has several strengths: it involved a reasonable number of children (98 total), it was conducted in a real hospital setting, and it carefully tracked whether any harmful effects occurred. The fact that no choking or other serious problems happened in either group is reassuring. However, the study has some limitations to keep in mind. It was conducted at a single hospital, so results might be different at other hospitals. The two groups were treated at different times, which means other changes in hospital practices or patient characteristics could have affected the results. The study didn’t randomly assign children to the two groups, so we can’t be completely certain the new plan caused the improvements. Despite these limitations, the results are encouraging and suggest the approach is worth trying at other hospitals.

What the Results Show

The main finding was dramatic: children started receiving nutrition through their feeding tubes much faster after the new plan was introduced. Before the plan, the typical time to start feeding was 24 hours (with most children starting between 16-24 hours). After the plan, the typical time dropped to just 4 hours (with most children starting between 2-6 hours). This represents a 6-fold improvement and far exceeded the goal of 50% faster initiation.

Another important finding was that children reached their full calorie goals much faster with the new plan in place. This is significant because adequate nutrition is essential for healing and fighting infection. The faster children received proper nutrition, the sooner their bodies could focus on recovery.

Perhaps most importantly, the safety record was excellent. Not a single child experienced aspiration (choking) or any other serious harmful effect in either group. This completely contradicts the fear that earlier feeding would cause problems. The new plan appeared to be just as safe as the old approach, but much more effective at getting nutrition into sick children.

Additionally, children in the group with the new feeding plan spent fewer days needing the oxygen support, spent less time in the pediatric intensive care unit, and spent less time in the hospital overall. These shorter hospital stays suggest children recovered faster and could go home to their families sooner.

Beyond the main findings, the study revealed several other positive outcomes. The reduction in days requiring humidified high-flow oxygen support suggests that better nutrition may have helped children’s lungs heal faster. The shorter pediatric intensive care unit stays mean fewer children needed the most intensive level of hospital care for as long. The shorter overall hospital stays have important implications for families, who can have their children home sooner, and for hospitals, which can care for more patients with the same resources. These secondary findings all point in the same direction: the new feeding plan improved outcomes across multiple measures.

This research builds on growing evidence that children with severe respiratory infections can often tolerate feeding earlier than doctors traditionally thought. Previous studies have suggested that keeping children from eating for long periods can actually slow recovery and increase the risk of complications. This study is one of the first to show that a structured, systematic approach to earlier feeding in children with bronchiolitis on high-flow oxygen is both safe and effective. The findings align with newer thinking in pediatric critical care that emphasizes getting nutrition started as soon as safely possible, rather than waiting until children are completely stable. However, this study is specific to bronchiolitis and high-flow oxygen support, so the results may not apply to all critically ill children.

Several important limitations should be considered when interpreting these results. First, this study was conducted at a single hospital, so the results might not apply to all hospitals or all patient populations. Different hospitals have different staff, equipment, and patient characteristics that could affect outcomes. Second, the two groups of children were treated at different times (one year apart), which means other changes in hospital practices, staffing, or patient care could have contributed to the improvements, not just the new feeding plan. Third, children were not randomly assigned to receive the old or new approach—they received whichever approach was in place during their hospital stay. This means we cannot be completely certain that the new plan caused the improvements. Fourth, the study did not include a detailed analysis of which specific parts of the new feeding plan were most important. Finally, the study did not examine long-term outcomes beyond hospital discharge, so we don’t know if the benefits persist after children go home.

The Bottom Line

Based on this research, pediatric intensive care units should consider developing and implementing structured feeding protocols for children with bronchiolitis who are receiving high-flow oxygen support. The evidence suggests this approach is safe and leads to faster recovery. However, these protocols should be developed by hospital teams that include doctors, nurses, and nutrition specialists who understand the specific needs of their patient population. Parents of children with bronchiolitis should discuss feeding options with their medical team—earlier feeding may be possible and beneficial, but decisions should be individualized based on each child’s condition. Confidence level: Moderate. This is one study from one hospital, so more research at other hospitals would strengthen the evidence.

This research is most relevant to parents of children hospitalized with severe bronchiolitis who are receiving high-flow oxygen support. It’s also important for pediatric intensive care doctors, nurses, and nutrition specialists who care for these children. Hospital administrators and quality improvement teams should pay attention because the new approach may reduce hospital stays and improve outcomes. This research is less relevant to families dealing with mild bronchiolitis or other types of respiratory infections, as the findings are specific to children on high-flow oxygen support. Children with other serious illnesses may or may not benefit from similar approaches—their doctors would need to make individual decisions.

If a hospital implements a similar feeding protocol, improvements should be visible relatively quickly. Children should start receiving nutrition within hours rather than a full day, and they should reach their full calorie goals within days rather than weeks. Shorter hospital stays could mean children go home within days to a week or two sooner than they would have with the old approach. However, the full benefits of better nutrition on long-term health and development may take weeks or months to become apparent. Parents should not expect overnight miracles, but should see steady improvement in their child’s condition once proper nutrition is established.

Want to Apply This Research?

  • If your child is hospitalized with bronchiolitis, track the time from admission to first feeding, daily calorie intake, and length of hospital stay. Record these dates and amounts in your health app to monitor progress and share with your medical team.
  • Work with your hospital care team to understand the feeding plan for your child. Ask specific questions about when feeding will start and what signs the doctors are watching for. If your child is discharged, continue tracking their nutrition intake and growth at home using your app to ensure they’re catching up on any nutrition they missed during hospitalization.
  • Long-term, track your child’s growth (weight and height), energy levels, and overall recovery progress for several months after discharge. This helps ensure that earlier hospital feeding led to better long-term outcomes. Share this information with your pediatrician at follow-up visits to monitor your child’s full recovery from bronchiolitis.

This research describes a hospital-based feeding protocol for children with severe bronchiolitis receiving specialized oxygen support. These findings apply specifically to hospitalized children under medical supervision and should not be used to make decisions about feeding children at home. If your child has bronchiolitis or respiratory symptoms, consult with your pediatrician or hospital care team before making any changes to feeding or nutrition. This study was conducted at one hospital and represents one approach to care; individual hospitals and doctors may have different protocols based on their experience and patient population. Always follow the specific recommendations of your child’s medical team, as they understand your child’s unique medical situation.