Nurses in Pediatric Intensive Care Lack Nutrition Training, Study Finds

In the high-stakes environment of a pediatric intensive care unit, where critically ill children fight for survival on ventilators and infusion pumps, one of the most powerful therapies is also one of the most overlooked: nutrition. A new study from the Hospital General Universitario Gregorio Marañón in Madrid has revealed just how unprepared many of the nurses and nursing assistants responsible for delivering that therapy actually are, and it offers a blueprint for fixing the problem. The research, published in BMC Medical Education, describes the development of a structured, competency-based training program in pediatric enteral nutrition, built directly on an honest audit of what frontline staff did not know.

The numbers from the needs assessment are striking. Among 72 professionals surveyed in the pediatric intensive care unit, 73.6 percent had never received prior training in enteral nutrition, and 65.3 percent had no previous training in pediatric nutrition at all. These are the very people who prepare, administer, and monitor feeding in children whose bodies are under extreme metabolic stress. When the researchers probed specific knowledge domains, the gaps widened further: 77.8 percent showed deficiencies in selecting appropriate nutritional formulas, 70.8 percent in managing complications, and 65.3 percent in handling special clinical conditions such as organ dysfunction or metabolic derangement. More than a third lacked confidence in medication–nutrition interactions, a domain where a single error can render a drug ineffective or a feeding regimen dangerous.

What makes these findings particularly compelling is that they were not collected from inexperienced staff. The survey covered 58.3 percent nurses and 41.7 percent nursing assistants working in one of Spain’s leading pediatric intensive care units, professionals who routinely perform complex technical procedures as part of daily practice. Yet 90.3 percent of them reported that they needed specific training in nutrition. This paradox, familiarity with hands-on procedures but insecurity about the underlying nutritional science, reflects a broader structural failure in how critical care staff are educated. Nutrition is often treated as an afterthought in nursing curricula, delegated to dietitians or physicians, even though nurses are the ones executing the feeding plan hour by hour.

The clinical stakes are far from theoretical. In critically ill children, malnutrition can develop rapidly, and inadequate or inappropriate nutritional support is associated with worse outcomes, prolonged ventilation, increased infection risk, and longer hospital stays. Enteral nutrition, delivering liquid formula through a nasogastric or gastrostomy tube, is the preferred route whenever the gut can be used, but it demands precision: the right formula for the child’s age, weight, and condition; correct infusion rates; vigilant monitoring for intolerance, aspiration, and tube complications; and awareness of how drugs given through the same tube can interact with the feeding. Errors or inconsistencies at any of these steps translate directly into patient harm, which is why the study’s authors frame the knowledge gaps they identified as a patient safety issue rather than a mere educational inconvenience.

To understand the scale of the problem, the research team designed their study as a pre-implementation investigation with a structured, multi-phase approach. Phase 1 was an anonymous online survey that assessed knowledge gaps, self-perceived competence, and preferred learning modalities among the unit’s nurses and nursing assistants. This diagnostic step is what distinguishes the Madrid project from generic training packages: instead of assuming what staff needed to learn, the team measured it. The survey revealed not only where knowledge was weakest but also how the staff wanted to learn, an insight that would shape everything that followed.

Phase 2 turned those findings into an educational program. A multidisciplinary team, drawing on expertise from intensive care medicine, nursing, and nutrition, built a competency-based curriculum grounded in adult learning principles and tailored to real-world clinical needs. The program integrates theoretical modules with hands-on workshops and case-based learning, so that participants move from understanding why a particular formula suits a particular child to actually managing the practical scenarios they face on shift. Competency-based design means the goal is not attendance but demonstrable ability: staff must show they can apply the knowledge, not merely sit through a lecture about it.

The delivery format reflects another key finding of the survey. Staff preferred blended learning, a combination of online modules that can be completed flexibly around demanding shift schedules, together with face-to-face sessions and practical workshops where skills can be rehearsed and corrected in real time. This preference matters because training programs fail when they ignore the realities of clinical work. Nurses in an intensive care unit cannot simply disappear into a classroom for a week; education has to fit around twelve-hour shifts, emergencies, and staffing constraints. By designing the program around the learners’ stated preferences, the team increased the odds of genuine engagement and completion.

The study’s published results cover the first two phases, but the full roadmap extends further. Phases 3 through 5, planned as the program moves into operation, include post-training knowledge assessment, evaluation of participant satisfaction, and a pilot implementation with iterative refinement. This staged architecture treats the training program itself as a quality improvement intervention: measure the baseline, intervene, then measure again and adjust. It is the same plan-do-study-act logic that underpins modern patient safety science, applied to professional education. The authors argue that this model has the potential to improve professional competence, standardize clinical practice, reduce variability in care, and enhance the safety and effectiveness of nutritional therapy across pediatric intensive care settings.

The broader significance of the study lies in what it says about hidden gaps in critical care. Intensive care medicine has made spectacular advances in ventilators, dialysis machines, and precision drugs, yet the humble feeding pump can be the weak link in the chain of care. International guidelines increasingly emphasize early enteral nutrition in critically ill children, but guidelines are only as good as the execution on the ground. If nearly three-quarters of experienced nursing staff in a major unit have never been formally trained in enteral nutrition, the same is likely true in many units elsewhere, and the Madrid findings offer other hospitals a ready-made template for diagnosing and addressing their own deficiencies. The survey instrument, the identified knowledge domains, and the blended learning design can all be adapted to different institutional contexts.

There is also a cultural lesson embedded in the research. The fact that more than 90 percent of staff acknowledged their own need for training suggests a workforce ready and willing to learn, provided education is made accessible and relevant. Structured, multidisciplinary training programs like the one developed in Madrid represent a practical, low-cost strategy to close the gap between what critical care teams are expected to do and what they have actually been taught to do. As the program proceeds through its pilot and refinement phases, the unit will generate data on whether improved knowledge translates into safer feeding practices and better outcomes for the children in its beds. For a field where every percentage point of survival matters, ensuring that the people who deliver nutrition actually understand it may prove to be one of the simplest and most impactful interventions available.

Subject of Research: Development of a structured enteral nutrition training program for nursing staff in pediatric intensive care

Article Title: Addressing a critical gap in pediatric intensive care: development of a structured nutrition training program for nursing staff

Article References: Solana, M. J., Trigo, A., Barroso, M., Vilchez, B., García, I. M., López, J., Cerna, J., Garde, L., Manrique, G., & López-Herce, J. (2026). Addressing a critical gap in pediatric intensive care: development of a structured nutrition training program for nursing staff. BMC Medical Education. https://doi.org/10.1186/s12909-026-10478-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10478-2

Keywords: pediatric intensive care, enteral nutrition, nursing education, clinical nutrition, patient safety, competency-based education, training program, malnutrition, nutrition therapy, medical education, Addressing, critical