Which method of estimating energy requirements in critically ill children is LEAST accurate when compared to indirect calorimetry?

• A. World Health Organization equations
• B. RDA for energy
• C. White Equation
• D. Schofield Equation

Answer: (B)

Estimating energy needs in critically ill children hinges on how illness alters metabolism. Indirect calorimetry directly measures energy expenditure, so it’s the reference standard. Using the general RDA for energy is least accurate in this setting because RDAs are designed for healthy growth and development and don’t account for the substantial and fluctuating metabolic changes of critical illness—fever, inflammation, organ dysfunction, sedation, and shifts in body composition can markedly raise or lower energy needs. A fixed RDA value tends to misestimate true requirements. In contrast, predictive equations like the WHO, Schofield, and White models use age and body size to tailor estimates to the child, offering a closer reflection of energy needs than a generic RDA, even though they’re not perfect in the critically ill.