A prospective controlled study with repeated measures before and after surgery examined the medical, surgical, and health outcomes of gastrostomy for children with disabilities at a tertiary paediatric referral centre in the North Thames area, UK. Anthropometric measures included weight, mid‐upperarm and head circumference. Five‐day prospective food diaries were completed and data on physical health and surgical outcomes recorded. Seventy‐six children participated and underwent gastrostomy (44 males, 32 females; median age 3y 4mo, range 4mo–17y 5mo), and 35/76 required an anti‐reflux procedure. Categories of disability were: cerebral palsy (32/76), syndrome of chromosomal or other genetic origin (25/76), slowly progressive degenerative disease (11/76), and unconfirmed diagnosis (8/76). Most children had gross motor difficulties (99%) and were non‐ambulant (83%). Oromotor problems were identified in 78% of children, 69% aspirated, and 65% were fed nasogastrically before surgery. The mean weight before surgery was –2.84 standard deviation score (SDS; SD 2.21, range –9.8 to 3.4). Two‐thirds of children achieved catchup growth postoperatively: weight‐for‐age (mean difference 0.51 SDS, 95% CI 0.23–0.79, p=0.001) and mid‐upper arm circumference (mean difference 1.12cm, 95% confidence interval 0.50–1.75, p=0.001). Health gains included a reduction in drooling, secretions, vomiting, and constipation. Major surgical complications were found in 13/74 children. The study provides evidence that catch‐up growth and health gains are possible following gastrostomy.