Children with cognitive and adaptive disabilities are at increased risk for developing feeding difficulties and secondary nutritional deficiencies. Problems such as poor oral-motor coordination, swallowing dysfunction, gastroesophageal reflux, and aversive feeding behaviors comprise significant obstacles to growth, prevent the achievement of developmental potential, and threaten clinical stability. Feeding and nutritional problems in patients with developmental disabilities have been well documented, and malnutrition has been reported in up to 90% of nonambulatory children with cerebral palsy. Although diverse factors certainly contribute to this startling and disturbing observation, feeding disorders have been observed in a high percentage of children with major motor and cognitive disabilities. Failure to assess and treat these problems in a timely fashion not only hastens the onset of significant nutrient deficits, but also heightens the incidence of complications, increases hospitalization rates, and results in impaired quality of life. This article describes an approach to evaluating and managing feeding disorders in children with developmental disabilities; and it examines effects of these management strategies on growth and clinical outcomes. The importance of a structured approach to these problems is discussed, and a diagnostic and treatment algorithm for addressing common feeding disorders is presented. Utilizing this approach in a group of 79 children with moderate-severe neurodevelopmental disabilities, 2-year follow-up data demonstrate that diagnosis-specific interventions significantly improve nutritional status and reduce clinical morbidity in these patients.