Nutrition is a challenging aspect in acute respiratory failure patients’ treatment. While noninvasive ventilation (NIV) is increasingly used as a tool to prevent endotracheal intubation in both adults and the pediatric population, nutritional support is frequently denied or delayed, given the increased risk of aspiration. Moreover, guidelines on nutrition management in NIV are nonexistent. Challenges in nutrition management in NIV patients included NIV interruption while providing oral nutrition and air leakages due to physical interference of a nasogastric tube (NGT) with the use of an NIV mask. One of the major limitations in pediatric NIV is finding an optimal fitting mask, in particular for younger children and those with facial anomalies. Over the years, clinicians have used different strategies to overcome air-leaks risk when using feeding tubes and NIV concomitantly. The development of special NIV masks with a port for feeding tubes is often complex to set up, costly, and consequently unavailable in all clinical scenarios. A new tube and inhaler adaptor for NIV (TIA-NIV) was developed, creating a NIV mask design aiming to allow simultaneous enteric tube placement and aerosol delivery while on NIV. Initial studies on the prototype tube adaptor have shown that NIV support improves effectiveness by significantly reducing air leaks, in addition to ameliorating patients’ subjective discomfort. Furthermore, this adaptor has shown potential use in difficult airways in post-extubation failure by creating an adequate mask seal while maintaining an airway exchange catheter in place. Moreover, the TIA-NIV could potentially reduce skin lesions and be used as part of the 3D anthropometric masks in pediatrics. This novel adaptor is a low-cost, easy-to-use device that has been shown to solve therapeutic problems in the clinical setting. However, more studies are needed to further evaluate the clinical impact of TIA-NIV.