Physician diet orders written for pediatric burned patients frequently differ from the diets patients actually receive. At Shriners Burns Institute in Boston, such deviations from the diet order were generally not recognized for at least two days. In order to increase compliance with physician diet orders, changes in the nutritional support program were implemented which included physician diet orders containing specific macronutrient requirements in addition to the caloric goal, which was changed in response to recent research demonstrating that the previously used formula provided excessive calories; introduction of modular diets for parenteral and enteral feedings; institution of daily nutrition flow sheets; and a change of the time at which daily caloric intake records were calculated. In order to assess the benefits of the new measures, the average deviation from the caloric goal was calculated for patients who did not receive the new assessment tools (control group, N = 51), compared with those who did (study group, N = 50). Least squares regression analysis indicated a trend toward improved compliance and less deviation from the calculated caloric goal following implementation of the four measures.