Feeding Recovery in Post-PICU Patients: A Case Series in an Intensive Feeding Program

BACKGROUND/OBJECTIVES: Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral treatment (IIBT), reduces tube dependence and improves oral intake; however, outcomes in PICU survivors remain understudied. This study aimed to evaluate feeding outcomes in children with prior PICU admission who completed IIBT. METHODS: This study was a retrospective case series of children (0-18 years) admitted to the HDVCH, Corewell Health, Grand Rapids, Michigan, who subsequently completed IIBT (from 2007 to 2024). Variables included demographics, PICU course (admission indication, complications, length of stay, ventilation, and nutrition status) and IIBT outcomes (feeding modality, oral skills, and malnutrition status). Feeding outcomes were compared pre- and post-IIBT. RESULTS: Sixteen patients were included (62.5% female; mean age 1.44 ± 1.21 years). Primary PICU admission causes were post-operative recovery (68.8%) and acute respiratory failure (25%). PICU complications included acute respiratory failure (43.8%) and the need for respiratory support beyond baseline (62.5%). At PICU discharge, 75% remained tube-fed and 18.8% were malnourished. The mean time from PICU discharge to IIBT initiation was 641 ± 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 ± 0.9 weeks), 58% of tube-fed patients achieved tube removal eligibility; 44% transitioned to partial or full self-feeding; problematic mealtime behaviors decreased (45.7% → 9.9%); oral acceptance improved (62% → 95%); and mouth clearance improved (59% → 96%). Malnutrition prevalence decreased (20% → 12%). CONCLUSIONS: Children with prior PICU admission demonstrated substantial feeding and behavioral improvement during IIBT participation, with over half achieving tube-weaning eligibility. The time from referral to program start reflects barriers that delay intervention.