For decades, nurses in pediatric intensive care units have drawn back on feeding tubes every six hours, checking whether the stomach has emptied before continuing enteral feeds. When volumes looked too high, feeds were withheld. A large randomized trial published June 12, 2026 in JAMA suggests that practice is not only unnecessary — it may be costing critically ill children calories they can ill afford to miss.

The GASTRIC-PICU trial enrolled 4,700 children aged 0 to 16 years across 24 pediatric intensive care units — 23 in the United Kingdom and 1 in Switzerland — who were receiving invasive mechanical ventilation and starting enteral feeds. After excluding 240 from the intention-to-treat analysis, 4,460 children were analyzed: 2,352 randomized to the no-routine-assessment group and 2,348 to usual care. The median age was 8 months; 42.6% were female. Recruitment ran from June 2023 through December 2025.

What Each Group Received

Children in the intervention arm had gastric residual volume (GRV) checking removed from their feeding protocol entirely; nurses assessed feed tolerance using clinical signs alone — vomiting, abdominal distension, and similar indicators. Children in the control arm received GRV checks at least every 6 hours, the standard PICU practice, with feeds paused or reduced when volumes were deemed excessive.

Primary Results

The trial had two co-primary endpoints. On the clinical endpoint — a composite of survival and days free from mechanical ventilation at 30 days — the no-GRV group was noninferior to usual care. Both groups achieved a median of 25 ventilator-free days (IQR 21–27). The adjusted odds ratio was 0.95 (95% CI, 0.86–1.05), and the per-protocol analysis was consistent (adjusted OR 1.01; 95% CI, 0.90–1.13).

On the nutritional endpoint, children in the no-GRV group met a mean of 80.3% of their energy requirements by 72 hours, compared with 76.8% in the usual-care group — an adjusted mean difference of 3.2 percentage points (95% CI, 1.3–5.2; P < .001), a statistically significant superiority finding.

The results suggest that routine GRV monitoring does not protect critically ill children from worse ventilator outcomes or reduced survival, while its removal yields a small but significant improvement in early calorie delivery. Whether that nutritional gain translates into longer-term clinical benefit was not established in this trial.

Limitations: The pragmatic design precludes blinding of clinical staff. The study population was drawn from UK and Swiss PICUs, limiting direct generalizability to other settings. The nutritional benefit is a surrogate measure at 72 hours, not a long-term clinical outcome.

This article describes a clinical research finding in critically ill, ventilated children enrolled in a hospital trial. Decisions about feeding protocols in intensive care are made by critical care teams based on individual patient circumstances.