**Background:** One billion people worldwide have a disability, 80% of whom live in low- and middle-income countries (LMICs). The prevalence of feeding difficulties ranges from 25–45% in non-disabled children and 33–80% in children with disabilities. Children with disabilities are three times more likely to be underweight and twice as likely to be stunted or wasted than non-disabled children, and twice as likely to die from malnutrition. Despite these numbers, no global reviews of systems and programs for improving nutritional care for these children existed prior to this work.
**Methods:** The U.S. Agency for International Development's (USAID) flagship multi-sectoral nutrition project, USAID Advancing Nutrition, conducted a non-systematic scoping review including a desk review of peer-reviewed and gray literature and key informant interviews. The desk review identified 127 documents (published 2003–2022) through keyword searches and snowballing, with 76% published since 2015. Of these, 66.1% were research articles or published books, 8.7% were non-peer-reviewed reports, and 15.7% were program resources such as training materials. Twenty-two percent of resources were related to programs or specific interventions. The study team also interviewed 42 experts (86% female) from diverse professional backgrounds: 19% nutrition, 31% medicine, 7% public health, and 43% disability or rehabilitation. Interviewees worked across multiple regions including Sub-Saharan Africa (31%), Europe and Central Asia (26%), North America (17%), South Asia (14%), and others. Findings were organized using structured matrices of challenges and opportunities across the universal progressive model of care framework.
**Key Results:** The review found that while some tools for identifying and managing feeding difficulties exist (e.g., EDACS for cerebral palsy, MAITS training packages, Ubuntu caregiver support groups, SPOON's Feeding and Nutrition Training Package), they are not standardized or universally used. Health workers often lack training to identify and support feeding difficulties, and funding for capacity strengthening is limited. Children with disabilities are frequently excluded from universal nutrition services—one review of 100 clinical trials of early childhood development interventions found that 50% excluded children with disabilities. A review of 71 national and international malnutrition guidelines found that while most mention disability, only three had specific sections providing guidance on disability. Key informants reported that health workers often accept malnutrition as the norm for children with disabilities or miss feeding issues because they are attributed to the disability. Rehabilitation services are often unavailable, of poor quality, disconnected from health systems, or concentrated in urban areas. Families face high care demands—one study found that feeding children with cerebral palsy can take caregivers up to seven hours daily—along with financial strain, stigma, and lack of access to appropriate foods and assistive products. Some positive outcomes were noted: SPOON's program showed a 44% reduction in anemia and 25% reduction in wasting among 224 children; Holt International's program found that 33% of children with disabilities and 54% without disabilities who had a feeding difficulty at baseline no longer had one after one year; and the MAITS Working with Infants with Feeding Difficulties package significantly increased early breastfeeding and exclusive breastfeeding at discharge in Rwanda. However, many evaluations did not find improvements in child growth.
**Clinical Implications:** The review identifies critical gaps across all six WHO health systems building blocks for children with feeding difficulties and disabilities. Four areas of recommendations emerged: (1) Build the evidence base on effective interventions, including formative research with caregivers and intentional inclusion of children with disabilities in research and data systems; (2) Strengthen health systems to improve identification and service provision, including capacity strengthening, addressing health worker biases, and revising guidelines to include feeding difficulty support; (3) Provide direct support to families through peer support groups, assistive products, and inclusion in social protection schemes; and (4) Conduct advocacy to raise awareness and address stigma at community, health system, and policy levels. The authors note that feeding-related interventions for children with disabilities have not consistently shown improvements in growth and nutritional status, despite benefits in chewing, swallowing, and caregiver stress reduction, highlighting the need for further research.