Feeding difficulties, such as poor attachment or ineffective sucking during breastfeeding, picky eating, or difficulty chewing or swallowing, can negatively affect a child’s nutritional status and health outcomes when left unaddressed. Among typically developing children, 25 to 45 percent have difficulty during feeding, but among the 100 million children worldwide with a disability, 33 to 80 percent experience difficulty feeding. Feeding difficulties contribute to the risk of malnutrition: children with disabilities are up to three times more likely to be malnourished than non-disabled children, twice as likely to be stunted, twice as likely to be wasted, and twice as likely to die from malnutrition. Prioritizing children with feeding difficulties and disabilities is vital to helping them thrive, but they are routinely excluded from nutrition programs, services, and policies, and stigma can often stand in the way of creating a more inclusive space.

In recognition of the importance of improving the nutrition of children with feeding difficulties and disabilities, USAID Advancing Nutrition reviewed over 100 documents and interviewed more than 40 experts working in nutrition, health, and disability to identify the following key gaps and subsequent recommendations to improve nutrition among children with feeding difficulties and disabilities:

1. Strengthen systems to improve identification, early intervention, and inclusion of children with complex needs in primary health care services and expand the availability of specialized services for children with indicated needs and their families.

Major gaps exist in every building block of the health system, which prevents children with feeding difficulties and disabilities from receiving the proper care, resources, and services to address their feeding and nutritional needs. For example, nutrition programs and services are often not designed in accessible ways and may exclude children with disabilities as a result. They may have physical barriers that prevent children with disabilities from reaching them, or they may not train their workforce or provide the proper assistive devices that are required to address their specific needs. Strengthening the capacity of the workforce, addressing biases and misconceptions among health workers, and revising guidelines and care protocols related to health and nutrition to include guidance on caring for children with feeding difficulties and disabilities would all contribute to strengthening systems.