Bronchiolitis is an acute viral lower respiratory tract infection that affects infants and young children worldwide [1]. In the United States, bronchiolitis accounts for over 100,000 annual hospitalizations at a cost of $734 million, burdening both families and the health care system [2,3]. Current recommendations from the American Academy of Pediatrics (AAP) focus primarily on providing respiratory and nutritional support in hospitalized patients [4].

The use of non-invasive mechanical ventilation for the management of bronchiolitis has increased 1450% since 2000, largely driven by the expanded use of humidified high flow nasal cannula (HHFNC) [2,5]. Initially used in critical care, HHFNC has gained popularity and is now used in the emergency department (ED) and on inpatient floors, even in institutions without intensive care unit (ICU) support [[5], [6], [7]]. With many physiological advantages, HHFNC is a safe approach to respiratory support [8], but substantial practice variability exists in nutritional support for children managed with HHFNC [6].

Children on HHFNC may be kept nil per os (NPO) because of concern for aspiration and worsening respiratory distress, even though enteral nutrition is optimal for hospitalized children [[9], [10], [11], [12]], and exclusive oral feeding while on HHFNC is associated with the shortest time to hospital discharge [13]. Prior studies have reported that enteral nutrition is safe and well tolerated by children irrespective of the degree of HHFNC support, but most studies focus on the ICU population, with enteral nutrition initiated 12–24 h after hospital admission [9,14,15]. A single retrospective study examined the initiation of oral nutrition upon inpatient pediatric floor admission [16], but there is no available data to guide nutritional practices for the ED physician initiating HHFNC for children with bronchiolitis. As the use of HHFNC in the ED for children with bronchiolitis continues to increase [7], additional studies are warranted to optimize approaches to enteral nutrition for children started on HHFNC in the ED. Therefore, our aim was to determine whether oral enteral nutrition initiated in the ED for patients admitted to the general pediatric floor with viral bronchiolitis on HHFNC was associated with a shorter hospital LOS without an increase in return ED visits or hospital readmissions.