{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:52:14Z","timestamp":1776682334855,"version":"3.51.2"},"reference-count":37,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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\u201318 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 \u00b1 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 \u00b1 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 \u00b1 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% \u2192 9.9%); oral acceptance improved (62% \u2192 95%); and mouth clearance improved (59% \u2192 96%). Malnutrition prevalence decreased (20% \u2192 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.<\/jats:p>","DOI":"10.3390\/nu18081291","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:37:42Z","timestamp":1776677862000},"page":"1291","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feeding Recovery in Post-PICU Patients: A Case Series in an Intensive Feeding Program"],"prefix":"10.3390","volume":"18","author":[{"given":"Tariq","family":"Almanaseer","sequence":"first","affiliation":[{"name":"College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Hayhurst","sequence":"additional","affiliation":[{"name":"College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica B.","family":"Doorn","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Helen DeVos Children\u2019s Hospital, Corewell Health, Grand Rapids, MI 49503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Bonebrake","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Helen DeVos Children\u2019s Hospital, Corewell Health, Grand Rapids, MI 49503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3696-8336","authenticated-orcid":false,"given":"Brooke","family":"Dudick","sequence":"additional","affiliation":[{"name":"Corewell Health Research Institute, Corewell Health, Grand Rapids, MI 49503, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Rosner","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Helen DeVos Children\u2019s Hospital, Corewell Health, Grand Rapids, MI 49503, USA"},{"name":"Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy F.","family":"Bandstra","sequence":"additional","affiliation":[{"name":"Intensive Feeding Program, Helen DeVos Children\u2019s Hospital, Corewell Health, Grand Rapids, MI 49503, USA"},{"name":"Departments of Psychiatry and Pediatrics & Human Development, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0595-4578","authenticated-orcid":false,"given":"Mara L.","family":"Leimanis-Laurens","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Helen DeVos Children\u2019s Hospital, Corewell Health, Grand Rapids, MI 49503, USA"},{"name":"Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/24694193.2018.1520323","article-title":"The Post-Intensive Care Syndrome in Children","volume":"43","author":"Ekim","year":"2020","journal-title":"Compr. Child Adolesc. Nurs."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Quadir, A., Festa, M., Gilchrist, M., Thompson, K., Pride, N., and Basu, S. (2024). Long-term follow-up in pediatric intensive care\u2014A narrative review. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1430581"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/PCC.0000000000001476","article-title":"Conceptualizing Post Intensive Care Syndrome in Children-The PICS-p Framework","volume":"19","author":"Manning","year":"2018","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e076023","DOI":"10.1136\/bmjopen-2023-076023","article-title":"Post Intensive Care Syndrome in Swiss Paediatric survivors and their Families (PICSS-PF): A national, multicentre, longitudinal study protocol","volume":"13","author":"Rahmaty","year":"2023","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e084445","DOI":"10.1136\/bmjopen-2024-084445","article-title":"Design and rationale of the Post-Intensive Care Syndrome\u2014Paediatrics (PICS-p) Longitudinal Cohort Study","volume":"14","author":"Curley","year":"2024","journal-title":"BMJ Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1542\/peds.2014-2174","article-title":"Redefining success in the PICU: New patient populations shift targets of care","volume":"135","author":"Rennick","year":"2015","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2019.01.013","article-title":"Feeding difficulties in young paediatric intensive care survivors: A scoping review","volume":"30","author":"Morton","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e041234","DOI":"10.1136\/bmjopen-2020-041234","article-title":"Protocol for a multicentre longitudinal mixed-methods study: Feeding and survivorship outcomes in previously healthy young paediatric Intensive care survivors (the PIES Study)","volume":"10","author":"Morton","year":"2020","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jpeds.2019.02.019","article-title":"Postextubation Dysphagia in Pediatric Populations: Incidence, Risk Factors, and Outcomes","volume":"211","author":"Hoffmeister","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, Y., Fu, C.H., Ju, M.J., Liu, J., Yang, X.Y., and Xu, T.T. (2024). Measurements of enteral feeding intolerance in critically ill children: A scoping review. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1441171"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1177\/0148607117711387","article-title":"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","volume":"41","author":"Mehta","year":"2017","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1038\/ejcn.2010.43","article-title":"Gastrostomy tube feeding: When to start, what to feed and how to stop","volume":"64","author":"Gottrand","year":"2010","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1044\/2020_JSLHR-19-00038","article-title":"Outcomes for Feeding Tube-Dependent Children With Oral Aversion in an Intensive Interdisciplinary Treatment Program","volume":"63","author":"Bandstra","year":"2020","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Abera, E.G., and Sime, H. (2023). The prevalence of malnutrition among critically ill children: A systematic review and meta-analysis. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-04419-x"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.clnu.2025.06.002","article-title":"Impact of nutritional status on the mortality and clinical outcomes of children admitted to the pediatric intensive care unit: A systematic review and meta-analysis","volume":"51","author":"Agrawal","year":"2025","journal-title":"Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kratochvil, M., Klucka, J., Klabusayova, E., Musilova, T., Vafek, V., Skrisovska, T., Djakow, J., Havrankova, P., Osinova, D., and Stourac, P. (2022). Nutrition in Pediatric Intensive Care: A Narrative Review. Children, 9.","DOI":"10.3390\/children9071031"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"MacDonald, S., Du Pont-Thibodeau, G., Thibault, C., Jutras, C., Roumeliotis, N., Farrell, C., and Ducharme-Crevier, L. (2024). Outcomes of patients supported by mechanical ventilation and their families two months after discharge from pediatric intensive care unit. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1333634"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1177\/0145445519865170","article-title":"Improvements in Children\u2019s Feeding Behavior after Intensive Interdisciplinary Behavioral Treatment: Comparisons by Developmental and Medical Status","volume":"44","author":"Seiverling","year":"2020","journal-title":"Behav. Modif."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114126","DOI":"10.1016\/j.jpeds.2024.114126","article-title":"Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape","volume":"272","author":"Sharp","year":"2024","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jpeds.2016.10.002","article-title":"A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?","volume":"181","author":"Sharp","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Briassoulis, G., Ilia, S., and Briassouli, E. (2024). Personalized Nutrition in the Pediatric ICU: Steering the Shift from Acute Stress to Metabolic Recovery and Rehabilitation. Nutrients, 16.","DOI":"10.3390\/nu16203523"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Brackmann, M., Lintvedt, A., Kogelschatz, B., Heinze, E., Parker, J.L., Ferguson, K., Rosner, E., Boville, B., and Leimanis-Laurens, M.L. (2023). Daily Nutritional Intake of Pediatric Patients (N = 64) on Extracorporeal Membrane Oxygenation from 2018 to 2022: A Single-Center Report. Nutrients, 15.","DOI":"10.3390\/nu15143221"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1055\/s-0040-1712920","article-title":"Preadmission Diet and Zip Code Influences the Pediatric Critical Care Clinical Course for Infants with Severe Respiratory Illness (N\u2009=\u2009187)","volume":"9","author":"Jaji","year":"2020","journal-title":"J. Pediatr. Intensive Care"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Leimanis-Laurens, M.L., Ferguson, K., Wolfrum, E., Boville, B., Sanfilippo, D., Lydic, T.A., Prokop, J.W., and Rajasekaran, S. (2021). Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted \u201cShotgun\u201d Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study. Nutrients, 13.","DOI":"10.3390\/nu13030774"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lintvedt, A., Purosky, I., Kogelschatz, B., Brackmann, M., Heinze, E., Parker, J., Dudick, B., McDiarmid, J., Rosner, E., and Boville, B. (2024). Nutritional Intake in Venovenous ECMO Patients: A Single-Center Study in a North American PICU. Nutrients, 16.","DOI":"10.3390\/nu16223813"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Russell, M.M., Leimanis-Laurens, M.L., Bu, S., Kinney, G.A., Teoh, S.T., McKee, R.L., Ferguson, K., Winters, J.W., Lunt, S.Y., and Prokop, J.W. (2022). Loss of Health Promoting Bacteria in the Gastrointestinal Microbiome of PICU Infants with Bronchiolitis: A Single-Center Feasibility Study. Children, 9.","DOI":"10.3390\/children9010114"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1097\/CCM.0000000000004660","article-title":"A Core Outcome Set for Pediatric Critical Care","volume":"48","author":"Fink","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1313","DOI":"10.1097\/CCM.0000000000004595","article-title":"Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review","volume":"48","author":"Maddux","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/PCC.0000000000002971","article-title":"Physical, Emotional\/Behavioral, and Neurocognitive Developmental Outcomes From 2 to 4 Years After PICU Admission: A Secondary Analysis of the Early Versus Late Parenteral Nutrition Randomized Controlled Trial Cohort","volume":"23","author":"Verlinden","year":"2022","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/S2352-4642(20)30104-8","article-title":"Long-term developmental effect of withholding parenteral nutrition in paediatric intensive care units: A 4-year follow-up of the PEPaNIC randomised controlled trial","volume":"4","author":"Jacobs","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/jpc.15286","article-title":"Paediatric tube-feeding: An agenda for care improvement and research","volume":"57","author":"Hopwood","year":"2021","journal-title":"J. Paediatr. Child Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1002\/jpn3.12387","article-title":"Nutrition support in children discharged from the pediatric intensive care unit: A bi-national prospective cohort study (ePICUre)","volume":"80","author":"Winderlich","year":"2025","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e569","DOI":"10.1097\/DBP.0000000000001310","article-title":"Intensive Outpatient Programs for Pediatric Feeding Disorder: A Qualitative Study of Current Challenges and Future Directions","volume":"45","author":"Baranwal","year":"2024","journal-title":"J. Dev. Behav. Pediatr. JDBP"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s10880-023-09948-2","article-title":"Pediatric Tube Weaning: A Meta-Analysis of Factors Contributing to Success","volume":"30","author":"Killian","year":"2023","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/MPG.0000000000002330","article-title":"Variables Impacting the Time Taken to Wean Children From Enteral Tube Feeding to Oral Intake","volume":"68","author":"Lively","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kampfschulte, A., Oram, M., Escobar Vasco, A.M., Essenmacher, B., Herbig, A., Behere, A., Leimanis-Laurens, M.L., and Rajasekaran, S. (2021). Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011\u20132017) of One Midwestern City in the US. Children, 8.","DOI":"10.3390\/children8020059"},{"key":"ref_37","unstructured":"United States Census Bureau (2026, April 03). QuickFacts Michigan, Available online: https:\/\/www.census.gov\/quickfacts\/fact\/table\/MI\/PST045224."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/8\/1291\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:59:28Z","timestamp":1776679168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/8\/1291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":37,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nu18081291"],"URL":"https:\/\/doi.org\/10.3390\/nu18081291","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}