Energy Expenditure Estimation in Pediatric Patients

Introduction to Estimation Methods

The American Academy of Pediatrics recommends using the Schofield equation for calculating resting energy expenditure (REE) in general pediatric ward patients and outpatients, while critically ill children in the PICU should ideally have measured energy expenditure via indirect calorimetry when feasible, with Schofield as a backup when measurement is unavailable 1, 2, 3

The Society of Critical Care Medicine recommends indirect calorimetry as the preferred method for measuring energy expenditure in critically ill children, particularly those who are mechanically ventilated, have suspected metabolic alterations, or severe malnutrition 1, 2, 3, 4
In the acute phase of critical illness, provide 60-85 kcal/kg/day depending on age, which represents approximately REE without additional activity factors 1, 4
In the stable phase, multiply REE by approximately 1.3 to enable growth and catch-up growth 5
Withholding parenteral nutrition for 1 week in critically ill children while providing micronutrients can be considered as an acceptable strategy 5

The American Academy of Pediatrics recommends using the Schofield equation to calculate REE, then add appropriate factors for physical activity and growth needs 1, 2, 3
The Schofield equation using weight and height is least likely to underestimate REE compared to measured values and is therefore the preferred calculation method 1, 2, 3, 4
For healthy outpatients, use a physical activity level (PAL) of 1.5 (light activity) to 1.7 (moderate activity) depending on the child's typical activity level 2, 3, 7

The American Academy of Pediatrics recommends using the Schofield equation as the primary method for calculating REE in outpatient settings 1, 2, 3
Calculate total energy expenditure (TEE) = REE × PAL + growth energy needs 2, 3, 7

For catch-up growth in malnourished children, calculate energy requirements based on ideal weight for height age (not chronological age) plus additional allowance for accelerated growth 6, 8
The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends using the Schofield equation over WHO equations because it was least likely to underestimate REE compared to measured values 1, 2, 3, 4
For pediatric obesity management, calculate REE using the Schofield equation with actual body weight (not ideal body weight) 7
Provide protein at 1.5-2.0 g/kg/day (140-190% of standard requirements) for catch-up growth in children ages 1-3 years 8