Nutritional Strategies for Intestinal Rehabilitation in Children with Short Bowel Syndrome: A Narrative Review.

Background/Objectives: Nutritional management is fundamental to intestinal rehabilitation in children with short bowel syndrome (SBS), yet clinical practice remains heterogeneous and largely guided by expert opinion. Enteral nutrition (EN) is the main driver of intestinal adaptation and progression toward enteral autonomy, but optimal strategies vary according to residual bowel anatomy, postoperative phase, and feeding tolerance. This review aimed to synthesize available evidence on nutritional strategies for pediatric SBS, with a focus on EN initiation, advancement, composition, and outcomes. Methods: A structured literature search was conducted in MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), SciELO, and Google Scholar for studies published between January 1975 and October 2025. Pediatric clinical studies addressing nutritional management in SBS were eligible. Study selection followed predefined PICO criteria, with independent screening and quality appraisal by two reviewers, in accordance with PRISMA-ScR reporting standards. Results: One hundred and thirty pediatric clinical studies were included, the majority of which were observational, with few randomized controlled trials. EN consistently emerged as a key determinant of intestinal adaptation and progression toward enteral autonomy across all phases of SBS. Outcomes were strongly influenced by residual bowel anatomy, presence of the ileocecal valve and colon, and feeding tolerance. Substantial variability was observed in feeding routes, modalities, diet composition, and advancement strategies. Conclusions: EN is a cornerstone of intestinal rehabilitation in pediatric SBS; however, current recommendations rely mainly on observational evidence. Prospective multicenter studies are needed to define optimal nutritional strategies and strengthen evidence-based practice.