The inflammatory state that often accompanies critical illness poses a challenge for the provision of nutrition support. The magnitude of this systemic response is greatest following severe burn injury. Pediatric burn patients are at the highest risk for malnutrition due to minimal lean body mass reserves relative to their metabolic rate. Nutrition support for this population consists of immediate provision of feedings characterized by a low Calorie:Nitrogen ratio in order to minimize the breakdown of protein and promote wound healing. Many patients, even those with moderate burns, are capable of tolerating enteral tube feedings within 24 hours post burn (1). It is known that enteral nutrition therapy is preferred over the parenteral route due to its ability to maintain gut mucosal integrity, preserve barrier functions, and maintain gut-associated lymphoid tissues (2,3). Post-pyloric feedings tubes are an effective way to administer nutrition. However, their disadvantage is tube displacement, which can increase the need for additional radiologic procedures and delay the advancement of feedings. At this pediatric burn hospital, gastric feeding is our preferred method of delivery due to the ease of access, minimization of tube displacement, improved overall tolerance (minimal incidence of diarrhea), and the benefit of stimulating important gastric hormones. However, because we use gastric feedings, our most difficult hurdle is the initial delay in gastric emptying, resulting in high gastric residuals. Previous approaches, including post-pyloric feeding tubes and elevating the head of the bead by 30 degrees, have been unsuccessful in overcoming this problem. However by using Peptamen or Peptamen VHP we are now transitioning our patients onto full gastric feedings in a timely manner, thereby minimizing their need for parenteral support. Current research shows that whey formulas increase gastric emptying and consequently decrease the potential for aspiration (4,5). The beneficial effects of whey protein on gastric emptying appear to apply to critically burned children as well. According to our dietary intake records in 2003, acute burn patients (> 25% Total Body Service Area) who received enteral nutrition via a naso-gastric feeding tube experienced a 50% reduction in time to transition to enteral feedings. A significant reduction in TPN usage was associated with a decrease in cost. Due to the heightened success of the whey-based formulas at our institution, it is now our standard of care to initiate enteral nutrition support with Peptamen for all acute burn patients greater than 1 year of age and less than 20 kilograms, and Peptamen VHP for patients who weigh 20 kilograms or greater. Using these formulas we are able to provide 100 percent of protein and Calorie needs. In conclusion, delayed gastric emptying is a major complication of pediatric burn patients that can be overcome by utilizing a whey-based formula, such as Peptamen or Peptamen VHP.