Malnutrition is a major problem in children admitted to critical care unit. Enteral nutritional delivery plays an important role in determining the clinical outcomes in this population. As per recent guidelines by ASPEN (American Society of Parenteral and Enteral Nutrition), in critically ill children enteral nutrition should be initiated < 48 hours of admission to PICU and 2/3^rd of energy requirement must be achieved in first week which is beneficial. However due to factors like feed intolerance, disease severity, gut injury and barriers of enteral nutrition, there is a delay in initiation and progression in nutritional delivery. Of the factors mentioned above feed intolerance is the major one delaying the achievement of target calories and protein. One way of improving feed tolerance is changing the mode of delivery from intermittent bolus to continuous.

Studies in critically ill children comparing continuous and intermittent tube feeding are lacking and two earlier studies have controversial results. Studies in critically ill adults have inconsistent results. No clear recommendation has been made for the mode of delivery of enteral nutrition in critically ill children. Given the magnitude of problem of malnutrition in critically ill children and outcome benefits achieved by supplementation of target calorie and protein in them, it necessary to have evidence on mode of delivery of enteral nutrition. Although intermittent feeding is more physiological, continuous feeding which constantly delivers the nutrition without increasing the stress on dysfunctional gut in critically ill may have additional advantages. In view of insufficient evidence and possibility of achieving target nutritional requirement earlier in continuous feeding with better feed tolerance than intermittent feeding, we plan to conduct a study to compare the two modes of tube feeding in critically ill children.