Children with disabilities in nutrition programmes: Thematic analysis of training and guidelines

Children with disabilities are often excluded in nutrition policy, programming and practice. A recently established "Feeding and Disability Resource Bank" collates currently available guidelines and training materials for children with disabilities. Our research aims to evaluate these resources to improve quality of care for children with disabilities in nutrition programming and services. Objectives include analysis of resources, evaluating gaps in resources, and barriers and facilitators to their use. Methods include thematic analysis and semi-structured key-informant interviews to identify priority areas for improvement of the resources and provide context to their use. Data were analysed deductively to identify themes around the study's objectives. Analysis of the Feeding and Disability Resource Bank included 13 training resources, eight programme packages and nine programmatic guidelines which were mapped for coverage and depth of recommendations for 28 key topics. Twelve key informant interviews were conducted. Synthesized key topics were identified by key informants and thematic analysis included identification of disability, feeding difficulties and malnutrition, management of feeding difficulties and malnutrition and integration of care for a child, family and community. Findings indicate there are some high-quality resources to support children with disabilities, but more are needed to provide comprehensive care. Gaps include appropriate assessment of nutritional status (8/30 resources), micronutrient deficiencies (0/30), management of the nutritional quality of a modified diet (6/30) and dehydration (3/30). Resources can be strengthened by filling identified gaps, standardising recommendations and operationalising how these practices can be integrated into programming. The uptake of these recommendations could be maximized by concurrent consideration of the visibility of disability in nutrition agendas, accessibility and dissemination of the resources, and the human and resource capacity of the sector. Unless addressed, children with disabilities will continue to experience systemic exclusion from accessing quality care, treatment and prevention of further disability.