Objective To evaluate the efficacy and safety of percutaneous endoscopic gastrostomy (PEG) in children with methylmalonic acidemia (MMA) or propionic acidemia (PA) complicated by feeding difficulties. Methods Clinical data of seven children with MMA/PA and feeding difficulty who underwent PEG at Shenzhen Maternity and Child Healthcare Hospital from June 2021 to April 2025 were retrospectively analyzed. Preoperative assessment, perioperative management, and postoperative follow-up were summarized. Results The median age at PEG placement was 20 months. All PEG placements were successfully completed in a single attempt. The mean operative time was (21.0 ± 2.2) minutes, intraoperative blood loss was 1-2 mL, and the mean postoperative hospital stay was (5.7 ± 1.1) days. At 6 months postoperatively, compared with preoperative values, body weight and length increased, the frequency of acidosis episodes decreased, daily feeding time was shortened, time spent on outdoor activities increased, and serum prealbumin levels rose (all P<0.05). During 6-12 months of follow-up, the most common complication was peristomal hypergranulation (five cases). One case developed gastrostomy-site perforation 7 months postoperatively. Conclusions PEG effectively improves nutritional and metabolic status in children with MMA/PA complicated by feeding difficulties and is a safe, effective method for long-term enteral nutrition support.