This article covers the fundamentals of infant, childhood, and adolescent growth and nutritional assessment, including determining macro and micronutrient intake associated with age appropriate growth and body function. It examines common cultural and lifestyle dietary practices, such as omnivorous, vegetarian, Mediterranean, pescatarian, ketogenic, and gluten-free diets, along with their potential nutrient deficiencies. Additionally, it highlights the common clinical signs of imbalanced nutrition in childhood and presents the recommended physical activity levels and sleep hygiene that promote overall health.

All children should be screened for malnutrition risk at hospital admission using the STRONGkids tool. Children at risk should undergo detailed nutrition assessment (subjective global nutrition assessment) by a pediatric dietitian. Children who are not at risk should undergo repeated re-screening at pre-determined intervals. Children identified as malnourished should be treated initially by oral nutrition supplementation. Some children with malnutrition may need enteral nutrition or parenteral nutrition. The use of nutrition pathways to identify and treat hospitalized children with malnutrition is likely to lead to improved overall outcomes.

Pediatric formula selection for children greater than a year of age has become complex. Formulas vary based on macronutrient content, protein source, protein type, and special ingredients or functional additives. This article aims to provide a general overview of main formula types, their indications and common uses, and characteristics that may aid in formula choice by medical providers. We will also review disease-specific considerations when considering formula options in specific patient populations. Our goal is to make pediatric formula feel less like a role of the roulette wheel, and more an educated decision based on nutritional knowledge and patient-specific factors.

Both temporary nasogastric tubes and durable enteral feeding tubes provide critical means of nutrition support for a variety of pediatric patient phenotypes. It is often difficult for families and clinicians to navigate the care for these tubes across complex medical systems. The build of an interdisciplinary program designed to take care of patients' tubes, throughout the life of the tube, has improved processes and outcomes at a pediatric medical center. Reimagining the best and safest care for these patients has resulted in the development of clinical pathways to navigate this system, resulting in several improved outcomes.

This article summarizes the pathophysiology of obesity and focuses on certain pharmacotherapeytic agents that are currently available for the treatment of pediatric and adult obesity. Medications in earlier stages of development are briefly mentioned, and future directions are discussed.

This article provides a comprehensive overview of culinary interventions, like food as medicine, which can potentially transform health care. It explores the integration of evidence-based nutritional science with the culinary arts, to help patients maintain health, prevent disease, and manage chronic conditions. This article highlights the impact of bioactive compounds in food on metabolic pathways, inflammation reduction, and gut microbiome modulation.

There is an increased risk of malnutrition in pediatric pancreatic disorders. Acute pancreatitis results in a hypermetabolic and hypercatabolic state and enteral nutrition (EN) may improve patient outcomes. In pediatric pancreatitis, EN should be introduced early and advanced as tolerated. EN is preferred over parental nutrition. Chronic pancreatitis is associated with malnutrition, impaired growth and development, and pancreatic insufficiency. Children with chronic pancreatitis should be routinely screened for exocrine and endocrine pancreatic insufficiency and growth and nutritional deficiencies.

This article explores the diagnosis and management of small intestinal bacterial overgrowth in children with short bowel syndrome, a population affected by altered anatomy, dysmotility, and medication-related risk factors. Diagnostic accuracy is limited by the feasibility, and specificity of breath testing and small bowel aspirates. While antibiotics are commonly used, concerns about recurrence and antibiotic resistance remain significant. Emerging nutritional strategies and precision-based, microbiome-targeted therapies offer promising adjunctive treatment options.

The management of pediatric intestinal failure (IF) has evolved over the last 2 decades, transforming it from a bleak diagnosis with high morbidity and mortality, to one of hope and survival with good long-term outcomes. The overarching goal of intestinal rehabilitation is to allow patients to achieve enteral autonomy, namely, freedom from dependence on parenteral nutrition. The following article describes the epidemiology and definitions in pediatric IF, highlights the role of the intestinal rehabilitation programs, and provides an overview of management strategies with a focus on medical management including the prevention and treatment of complications.

Disorders of gut-brain interaction (DGBI) in pediatrics such as irritable bowel syndrome, functional abdominal pain, and functional dyspepsia pose a challenging set of syndromes that limit patient quality of life and may impair optimal nutritional intake. Nutrition plays a key role in management of DGBI by promoting gut motility and modulating visceral sensations. Therapeutic diets can be safely implemented toward the treatment of pediatric DGBI, but it is essential that providers understand the roles and limitations of various diets and assess for restrictive patterns of eating.

This article highlights the evolving role of dietary strategies in the management of pediatric inflammatory bowel disease (IBD). Advances in understanding diet's influence on IBD pathogenesis and disease progression have renewed interest in the role of diet in the treatment of IBD. Exclusive enteral nutrition remains the gold standard, but whole food diets that mimic the composition of EEN or eliminate foods that negatively impact the intestinal microbiome and immune response have shown promise. Additional research that includes larger patient populations and objective data is needed to expand applicability and develop patient-centered recommendations.

Childhood is an essential period for growth and development during which time chronic liver disease can have compounding negative effects on patient health. Aggressive screening and nutritional intervention strategies are key for improving patient outcomes and should involve a multidisciplinary approach with support from a skilled dietitian.

Pediatric allergic bowel diseases are caused by mucosal immune dysregulation elicited by food antigens. These disorders can impact intake, absorption, and utilization of nutrients. Nutritional therapies that eliminate potential food antigen triggers are an important management tool. Used effectively with a multidisciplinary and patient-centered approach, nutritional therapy can induce remission of mucosal inflammation to improve symptoms and support healthy growth.

Under-five years of age is a critical period for child growth and psychomotor development with lifelong influence. Nutritional status assessment by anthropometry indicates millions of children at extreme vulnerability. Characterization of wasting as moderate or severe determines morbidity and mortality risk and therapeutic interventions. Stunting has distinct adverse sequelae and is more difficult to ameliorate. Causal mechanisms of malnutrition are complex but essential components have been identified and guide preventive and therapeutic interventions. Micronutrient deficiencies also remain a public health problem. Steep declines in global nutrition funding for programs, research, and multisectoral capacities are expected to reverse decades long gains.

Feeding disorders, including avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD), are complex conditions that can occur in isolation or together. Feeding disorders have detrimental effects on children's physical, mental, and social well-being and contribute to significant family stress. Ideally, multidisciplinary assessment and treatment is used for proper diagnosis and management. This article compares and contrasts ARFID and PFD, discusses best practices with an emphasis on the role of the medical provider, and provides future directions to address barriers affecting care.

The use of neurostimulation to treat children with disorders of gut-brain interaction and gastrointestinal motility disorders has grown tremendously over the past 2 decades. Gastric electrical stimulation and sacral nerve stimulation delivered by implanted stimulators can lead to long-term improvement for children with refractory symptoms. However, newer noninvasive neurostimulation treatments like auricular neurostimulation and posterior tibial nerve stimulation offer hope to a much larger patient population and have the potential to transform our care for children with even common gastrointestinal complaints.

Digital technology development is accelerating, with extended reality, artificial intelligence, and methods for information sharing leading the charge in broad medical specialties including pediatric neurogastroenterology. This rapid advancement must be acknowledged by clinicians given the potential for improved quality and experience by health care stakeholders, and decisions about when and how to use novel digital technology must consider practical and ethical implementation challenges. Growing evidence of technology acceptance and favorable health outcomes exists, and best practice for using these digital tools in clinical practice remains to be determined.