Very low birth weight (VLBW, <1500 g) infants are at an elevated risk of neurodevelopmental disorders, later obesity and cardiometabolic disease; if and how neurodevelopmental disorders impact chronic disease risk is poorly understood. The most common neurodevelopmental disorders experienced by VLBW children are those of social-emotional functioning. We compared dietary patterns and body composition between VLBW children with poor vs. typical social-emotional functioning using linear mixed models adjusted for sex, gestational age, cognitive impairment, parental education, and body mass index (BMI). VLBW children ( n=158) attending the Donor Milk for Improved Neurodevelopmental Outcomes trial with 5.5-year follow-up participated. Poor social-emotional functioning was based on standardized parent-rated questionnaires and/or parent-reported physician diagnosis of autism spectrum or attention-deficit/hyperactivity disorders. Most children had diets categorized as “needs improvement” (67%) or “poor” (27%) and 29% of children exhibited poor social-emotional functioning. Poor social-emotional functioning was positively associated with 100% fruit juice (β=0.3 cup equivalents/day; 95% CI 0.1, 0.5) and energy intake (β=118.1 kcal/day; 95% CI 0.9, 235.2). Children with poor social-emotional functioning were more likely to have a limited food repertoire ( p=0.02), but less likely to exceed dietary fat recommendations ( p=0.04). No differences in overall diet quality or body composition were observed. Diet counselling and research are essential to improving the nutrition of VLBW children to mitigate chronic disease risk. Trial registration — Optimizing Mothers’ Milk for Preterm Infants Program of Research: Study 1 – Impact of Donor Milk at Kindergarten, NCT02759809, https://clinicaltrials.gov/ct2/show/NCT02759809 . Novelty: Overall diet quality and body composition did not differ between VLBW children with poor vs. typical social-emotional functioning. Most had diets “needing improvement” or “poor” according to the Healthy Eating Index-2010. Diet counselling may help mitigate chronic disease risk in this vulnerable population.