Remote Feeding Support in War-Affected Ukraine: When Multidisciplinary Care Is Out of Reach

Even before the full-scale war, many Ukrainian families of children with feeding difficulties had limited access to specialized care. Pediatric feeding is interdisciplinary, yet in Ukraine there are still few multidisciplinary feeding teams, limited formal education in this field, and uneven access to trained specialists across regions. Families may consult different professionals, but these perspectives are not always connected into one coherent plan.

The full-scale invasion has deepened these gaps. Displacement, disrupted routines, financial strain, air alerts, interrupted schooling, family separation, and chronic uncertainty have made regular in-person care difficult or impossible for many families. As a result, feeding difficulties may become more intense, while access to specialized support becomes even more limited.

Recent Ukrainian data confirm that war has affected children’s eating behaviours. In a cross-sectional online survey of 4,854 children aged 5–17 years, 63% had parent-reported changes during the war, most commonly food cravings, food fussiness, aversion to certain foods, and decreased appetite (1). When a child’s world becomes less predictable, eating may also become less flexible: familiar foods, textures, and routines can become one of the few areas where the child still feels some control.

Feeding difficulties, however, are rarely only about food. The consensus definition of Pediatric Feeding Disorder describes feeding problems across medical, nutritional, feeding skill, and psychosocial domains (2). This framework is especially relevant in Ukraine now: a child who refuses food, eats only a few products, gags with textures, or cries at meals may need more than a recipe or advice to “eat better.” The family may need help understanding risks, reducing pressure, rebuilding safe mealtime routines, and knowing when in-person medical or developmental assessment is necessary.

In response to these realities, Ukrainian specialists have increasingly used remote formats to support families when regular in-person care is difficult or unavailable. Remote feeding support is not a replacement for medical examination, swallowing assessment, emergency care, or full multidisciplinary evaluation when serious concerns are present. However, in war-affected and low-resource settings, it may be the only realistic first step for families who would otherwise remain alone with the problem.

The work usually begins with a detailed history: the child’s medical and developmental background, growth, current diet, feeding routine, accepted and refused foods, stressful mealtime situations, and the family’s main concerns. Parents are often asked to record short videos of typical meals. These videos are valuable because they show how the child sits, the pace of the meal, how the child handles textures, and whether there are signs of oral-motor difficulty, sensory discomfort, fatigue, distress, pressure, distraction, or avoidance. They also reveal the emotional atmosphere around the table, which is often impossible to understand from a written description alone. After analyzing the history and videos, the specialist meets with the parents online to discuss what is happening, what can realistically be changed first, and how to build a practical plan.

Whenever possible, remote support does not end after one consultation. Families need follow-up, because feeding recommendations often require adjustment. Parents may send new videos, describe what worked and what did not, ask questions, and receive corrections or encouragement. In a situation where families are tired, frightened, displaced, or far from specialized services, this ongoing contact can be as important as the recommendations themselves.

At the same time, Ukrainian specialists have to keep clear safety limits. Remote support cannot replace direct medical examination, instrumental swallowing assessment, emergency care, or a full multidisciplinary evaluation when the child has choking, coughing during meals, recurrent respiratory symptoms, suspected aspiration, dehydration, faltering growth, significant weight loss, persistent vomiting, pain, severe restriction, or other red flags. In such cases, the remote specialist’s role is to recognize risk early and help the family understand where and how to seek in-person care.

For many families, the first goal is not to expand the child’s diet immediately, but to reduce panic, stop harmful pressure, and return some predictability to meals. In war conditions, a parent who understands what to observe, when to worry, what to change, and when to seek help is no longer completely alone. This support may protect not only nutrition, but also the parent-child relationship and the emotional safety of mealtimes.

Research with Ukrainian mothers affected by the war shows that feeding practices, maternal wellbeing, and support needs are closely connected in emergencies (3). When caregivers are frightened, exhausted, or unsupported, meals may become more pressured, even when this pressure comes from love. Supporting caregivers is therefore central to feeding care.

Telepractice in pediatric feeding and dysphagia may improve access when in-person care is difficult to reach. Online work is not suitable for every child, and safety boundaries are essential, but structured remote support can be clinically meaningful when connected to referral pathways.

Remote feeding support should not be understood as “second-best care.” In war-affected Ukraine, it has become a bridge between isolation and professional support, between parental fear and clearer decision-making, between unsafe pressure and responsive feeding, and between a child in need and the multidisciplinary care that may eventually become available. For other countries affected by war, displacement, poverty, or shortage of specialized services, this experience may also be relevant. Families do not stop needing feeding support when systems are under pressure. In fact, they may need it more.

References

1. Gulich M, Fedorova D, Petrenko O, et al.War exposure and changes in eating behaviours in Ukrainian school-aged children: a cross-sectional online survey. Matern Child Nutr. 2025;21(1):e13729. doi:10.1111/mcn.13729.
2. Goday PS, Huh SY, Silverman A, et al. Pediatric feeding disorder: consensus definition and conceptual framework. J Pediatr Gastroenterol Nutr. 2019;68(1):124-129. doi:10.1097/MPG.0000000000002188.
3. Iellamo A, Wong CM, Bilukha O, et al. “I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula”: a qualitative study on effects of the war on Ukrainian women’s infant feeding. Front Nutr. 2024;11:1225940. doi:10.3389/fnut.2024.1225940.

Conflict of interest: None declared.

This article represents the view of its author and does not necessarily represent the view of the IACAPAP's Bureau or Executive Committee.

IACAPAP Bulletin, Issue 83