Although pediatricians are increasingly aware of the problem of undernutrition in children with neurologic disabilities, many of these children remain poorly nourished despite prolonged attempts at oral feedings. We studied the effects of tube feeding on such children, using either nasogastric (NG) or gastrostomy (GT) feedings. Twenty-six patients (16 male, mean age at first visit 40.7 months) were followed while receiving tube feedings for a mean of 23 months. Thirteen children in the NG group were tube fed by nasogastric tube. The GT group consisted of two groups of children: 10 who began with nasogastric feedings and then changed to gastrostomy because of intolerance or need for reflux surgery, and three who were always tube fed via gastrostomy. Mean percent ideal body weight for height age (%IBWH) for the whole group improved from 73.2% to 94.2% (P < .0001), for the NG group from 72.1% to 89.3% (P < .002), and for the GT group from 74.2% to 98.8% (P < .0001). One patient died of unrelated severe upper airway obstruction. No patients reported hospitalization due to tube-feeding complications. Seventeen of the parents perceived that their child's mood was improved and that they spent less time in child care after NG or GT feedings were begun. We conclude that (1) both nasogastric and gastrostomy feedings safely improved nutrition in these children and (2) this objective improvement was often accompanied by subjective improvement. We suggest aggressive use of tube feedings in selected patients.