Nutrition has long been accepted as playing an important role for critically ill children and increasing evidence links poor nutrition during critical illness with increased morbidity (infections, weakness, prolonged mechanical ventilation and delayed recovery) as well as increased mortality (1). Following the publication of the ESPNIC Metabolism, Endocrine and Nutrition (MEN) section position statement and clinical guidelines in 20201, the challenge is now to implement these into daily PICU practice. These European guidelines complement those from ASPEN (2), providing practical, pragmatic answers and highlighted the scarcity of adequately powered interventional nutrition studies with meaningful clinical outcome measures. Conducting nutrition trials in critical care is challenging due to the heterogeneity of the population in terms of age, pathology, severity of illness, and nutritional status at admission. As a result, clinical practice among PICUs varies significantly (3,4). This hot topic article will focus on a framework to aid the implementation of guidelines; identifying and overcoming barriers to enteral nutrition (EN) in PICU and highlights the priorities for nutrition research.