Nutritional care for children with feeding difficulties and disabilities

Malnutrition can cause disability in the short and long term, while disability can also lead to malnutrition. Children with disabilities are three times more likely to be underweight and twice as likely to be stunted or wasted than non-disabled children. Feeding difficulties are over twice as frequent in children with disabilities, compared to children without disabilities, and 80% of the one billion people with a disability live in low- and middle-income countries. These numbers demonstrate the importance of providing adequate nutritional care and support for children with feeding difficulties and disabilities. However, there are no global reviews of systems, initiatives, and programmes for improving nutritional care for these children. To address this gap, the authors conducted a non-systematic scoping review of programmes and evidence focused on supporting the nutritional care of children with feeding difficulties, related to disability or not.

In total, 127 documents, peer-reviewed or not, published between 2003 to 2022 and identified through keyword searches and snowballing, were reviewed. Interviews were conducted with 42 key informant experts in nutrition and disability. Detailed document review and interview notes were organised into two structured matrices based on challenges and opportunities. The universal progressive model of care framework for services, outlined in the Nurturing Care Framework (WHO et al., 2018), was then used to analyse the findings. In addition, authors also specifically considered the enabling environment in communities and families for accessing and benefiting from services.

The review found insufficient policies, programmes, and evidence to support children with feeding difficulties and disabilities and their families. While some resources and promising approaches exist, they are not standardised or universally used, staff are not trained to use them, and there is insufficient funding to implement them.

“The combination of challenges in identifying feeding difficulties, a lack of understanding of the link between disabilities and feeding, and weak or non-existent referral pathways or specialised services puts these children at risk of malnutrition.”

Additionally, their families face challenges providing the care they need, including coping with high care demands, accessing support, obtaining appropriate foods, and managing stigma. This review also revealed challenges related to knowledge, attitudes, and practices of health workers toward children with disabilities, in general, and to addressing feeding difficulties more specifically.

Addressing these needs requires systems strengthening and quality improvement at all levels of service and – more holistically – including children with disabilities in nutrition services, programmes, and policies to help them thrive. Specific interventions needed include capacity strengthening and addressing misperceptions and biases among health workers and revising relevant nutrition and health guidelines and care protocols to include appropriate guidance and support for children with feeding difficulties.

WHO, UNICEF, World Bank (2018) Nurturing care for early childhood development a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization.