Extracorporeal life support is an accepted treatment modality for children with severe cardiac and/or respiratory dysfunction. However, after a period of inadequate gut perfusion clinicians are often reluctant to initiate enteral nutrition. A retrospective cohort study in a single large pediatric intensive care unit in Northwest England over 5.5 years (2017 - 2022). 156 children were included with a median age of two months (IQR 0.3 - 15) and a mean weight for age score of -1.50 (SD 1.7). Indications for extracorporeal life support were respiratory failure (31%); cardiac arrest (28%); low cardiac output state (27%) and unable to separate from cardiopulmonary bypass (12%). Most (75%) children were fed during extracorporeal life support, with the median time to initiate feeding 24 hours (IQR 12.2 - 42.7). More Gastrointestinal complications were associated with being enterally fed 86% vs 14% (p=<0.001), but these were predominantly feed intolerance (46%), and this was associated with receiving formula feeds compared to maternal (breast) milk (p=<0.001). Overall children's median energy target achievement by 72 hours was 38% (IQR 10.7 -76%) but this varied by support indication. Our findings suggest most children tolerated enteral feeding within 24 hours after extracorporeal life support initiation, with only mild gastrointestinal complications. This article is protected by copyright. All rights reserved.