‘Good food’, I remarked argumentatively ‘should be the occasion and not the topic of good conversation’. I was rounded on by my friends who berated me for such a naïve remark. From antiquity to the present day the experience of good food, the mealtime, has been a major feature of civilization and the cultural importance unimpeachable. Just so. But perhaps my view was biased by having spent time with families with children who have been hard to feed. Preparing the right food for them (good food) and helping the child consume that food over many hours can cause endless distress. When we started our first Feeding Clinic at our Child Development Centre I naïvely imagined that most of the children who came to see us would be there with social and behavioural reasons for the feeding difficulty (and there are such of course). But we soon saw children with all sorts of disabilities and it was distressing to find, as a clinician, that children referred for ‘feeding difficulties’ proved to have a neurological problem and we were telling parents that was the case at the same time as trying to help them with the problems that had brought them to the clinic. It is in these children that alternative feeding methods have to be considered. Already for many of them nasogastric feeding had been a feature of their early lives. Sampson-Fang and her colleagues have reviewed more than a decade of not very robust evidence of the value of gastrostomy feeding in children with cerebral palsy (CP; DMCN 2003, 45: 415–426). But it is important to remember that CP is not the only diagnostic category where we see feeding problems (e.g. cardiac, genetic conditions).