Achieving Protein Requirements Through Oral Feeding in Children with Congenital Heart Disease: A Narrative Review.

Background/Objectives: Protein-energy malnutrition is common in children with congenital heart disease (CHD) due to increased metabolic demand and limited oral intake capacity. Achieving adequate protein intake in this population through oral feeding remains a critical yet underexplored challenge. This review aims to synthesize the currently available evidence on protein requirements, barriers to oral intake, and strategies for optimization of protein delivery in children with CHD. Methods: A narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Relevant observational studies, randomized trials, guidelines, and recent reviews addressing nutritional management and oral feeding in pediatric CHD were included. Evidence was synthesized across metabolic, clinical, and practical domains. Results: Children with CHD exhibit increased protein requirements driven by hypermetabolism, inflammation, and perioperative stress, often reaching a requirement of 3-4 g/kg/day in high-risk settings. However, feeding limitations-including fatigue, gastrointestinal dysfunction, and oral motor impairment-restrict intake capacity and contribute to protein inadequacy in this population. Evidence supports the use of nutrient-dense feeding, optimized feeding frequency, food fortification, oral nutritional supplementation, and multidisciplinary care to improve protein delivery efficiency and nutritional status. Conclusions: Achieving adequate protein delivery through oral feeding requires a shift toward targeted, protein-focused strategies that address intake limitations. Early attention to protein adequacy may support nutritional recovery and growth, although its independent effects on postoperative and long-term outcomes remain uncertain. Further research is needed to establish standardized, evidence-based protocols tailored to this population.