Introduction

Cerebral palsy (CP) is a leading cause of childhood physical disability and is consistently associated with an elevated risk of malnutrition (Aggarwal et al. 2015; Vova 2022). Children with CP frequently experience feeding and swallowing difficulties, gastrointestinal complications and motor impairments that limit their ability to chew, swallow and safely consume food (Da Silva et al. 2022; Calderone et al. 2025; Dalpatadu et al. 2025). Oropharyngeal dysphagia, reported in a substantial proportion of this population, contributes to prolonged mealtimes, reduced dietary intake and increased risk of aspiration, while conditions such as gastro‐oesophageal reflux and constipation further compromise nutritional status. These clinical and functional challenges mean that adequate nutrition for children with CP depends not only on the presence of food but also on its texture, preparation, feeding support, posture, mouth control and safety during consumption.

The Fundamental Right to Be Free From Hunger

In response to persistent global food insecurity, the United Nations introduced Sustainable Development Goal (SDG) 2: Zero Hunger, which aims to eliminate hunger, achieve food security, improve nutrition and promote sustainable agriculture by 2030 (Arora and Mishra 2022). Despite global progress, food insecurity and malnutrition remain ongoing public health concerns across many settings (Viana et al. 2021). Although SDG 2 is universal in scope, emerging scholarship suggests that disability considerations are not consistently foregrounded within food security initiatives, raising questions about the extent to which children with disabilities, including those with CP, are represented within policy and program responses.

Within low‐and middle‐income contexts (LMICs) such as South Africa, these feeding complexities intersect with broader socioeconomic constraints. Households caring for children with CP often incur additional costs related to specialized feeding equipment, modified diets, nutritional supplements, healthcare utilization and transport (Snik et al. 2019; Kibrom et al. 2024; Melak et al. 2025; Naidoo et al. 2024). As a result, children with CP may experience functional hunger, defined as the inability to effectively ingest or utilize adequate nutrition despite food being present within the household (Kuperminc et al. 2013; Sleigh 2005). Hunger in this context reflects barriers to accessing food that is nutritionally dense, appropriately textured and safely consumable, highlighting the multidimensional nature of food insecurity for this population.

Food security provides a useful framework for understanding these challenges. Conceptualized across four interrelated pillars: availability, accessibility, utilization and stability. Food security extends beyond food supply to encompass the ability to obtain, prepare, consume and consistently access adequate nutrition (Ingram 2020; Xie et al. 2021). For children with CP, the utilization dimension is particularly salient, as nutritional adequacy depends on caregiver capacity, caregiver knowledge regarding safe feeding management affected by specific dysphagia‐related disorders, feeding skills, time, adaptive equipment and clinical support to ensure safe and effective feeding (Mbhenyane and Tambe 2024; Nyman et al. 2025; Parkes et al. 2010). Disruptions across these pillars therefore shape not only household food security but also children's nutritional wellbeing and health. These concerns must be understood within a human rights framework. The right to food, protected within national and international legal instruments, requires that food be available, accessible, acceptable and adequate for all individuals without discrimination. For children with CP, realization of this right is often constrained by feeding impairments, resource limitations and health system gaps that restrict meaningful access to safe and nutritionally appropriate food (Makhoul et al. 2026). Despite growing recognition of disability‐related nutritional vulnerability, there remains limited empirical evidence describing how caregivers of children with CP in South Africa experience food insecurity and negotiate feeding within constrained environments.

A Disability‐Inclusive and Rights‐Based Perspective on Food Security

Limited research has examined the forms of support required by caregivers to meet the feeding and nutritional needs of children with CP within contexts of food insecurity (Jahan et al. 2022; Ostojic et al. 2025). This gap is particularly notable in Sub‐Saharan Africa, where there is a paucity of evidence describing caregiver experiences related to food procurement, dietary modification and feeding practices for children with CP (Melak et al. 2025). Within South Africa, social protection mechanisms such as the disability grant are intended to support households caring for children with disabilities; however, little empirical work has explored how such support intersects with the specialized feeding and nutritional needs associated with CP (Adams et al. 2024; Mbhenyane and Tambe 2024). Consequently, the extent to which existing food security strategies and social supports adequately respond to disability‐related nutritional requirements remains unclear. These knowledge gaps highlight the need for research that examines food security and feeding through a disability‐inclusive and rights‐oriented lens. Understanding caregiver experiences is essential for informing policies and services that aim to support equitable access to adequate and appropriate nutrition for children with CP. Without contextually grounded evidence, it is difficult to determine how global commitments such as SDG 2 translate into meaningful nutritional inclusion for this population.

Ensuring freedom from hunger for children with CP therefore requires a rights‐based, disability‐inclusive approach that recognizes their complex feeding needs, addresses economic and physical barriers to food access and strengthens caregiver support systems. Without such targeted strategies, the global commitment to zero hunger will continue to overlook one of the most nutritionally vulnerable child populations. Therefore, this study explores caregiver experiences of feeding children with CP in South Africa through a food security lens, examining how intersecting challenges related to availability, access, utilization and stability shape the realization of the right to food for this population.