Patients with traumatic brain injury display disruption in their metabolic balance, with a resulting hypermetabolic state. Nutritional intervention must be implemented early in the acute course to offset ensuing malnutrition. This article discusses these issues and the importance of a multidisciplinary team approach to address complicating factors, including aspiration, gastric dysfunction, swallowing disorders, and cognitive- behavioral problems. The advantages, disadvantages, and implications of parenteral and enteral nutrition are reviewed, as well as factors affecting the early initiation of oral feeding in the acute hospital course.