Objectives: To determine the prevalence and spectrum of feeding and gastrointestinal (GI) problems among neurologically impaired children, and to evaluate health-related quality of life (HRQoL) among their primary caregivers. Study Design: A cross-sectional study conducted among 163 children aged 1 to 15 years with neurological impairment attending two tertiary centres in Sri Lanka. Data on demographic characteristics, neurological aetiology , comorbidities, feeding and GI problems, complications, investigations, and management strategies were collected through clinical records and caregiver’s interview . Caregiver's HRQoL was assessed using the Short Form 36 (SF-36) questionnaire. Results: Among participant children, 63.2% were male; cerebral palsy was the predominant neurological diagnosis (62.6%). Feeding and GI Problems were highly prevalent, including drooling (41.1%), constipation (31.3%), refusal to open mouth while feeding (21.5%), cough during feeding (18.4%) and spitting (17 .8%). Failure to thrive (35.0%) and aspiration pneumonia (12.9%) were the most notable complications. Despite the burden of feeding difficulties, only 25.8% underwent formal swallowing assessment, although 76.7% received some form of speech therapy . Caregivers reported moderate impairment across multiple SF-36 domains, with pronounced limitations in physical and emotional role functioning, vitality , and general health perception. Conclusions: Neurologically impaired children experience a substantial burden of feeding and GI problems, with associated nutritional and respiratory complications. Caregivers also face significant reductions in HRQoL. These findings underscore the need for comprehensive multidisciplinary care, including improved access to structured swallowing assessment and familycentred support to address both child feeding difficulties and the well-being of the carer.