BackgroundVery little is known about the prevalence of disability among Roma children. ObjectiveTo estimate the prevalence of disability and significant cognitive delay among Roma and non-Roma children aged from 2 to 17 years in four West Balkan countries. MethodsSecondary analysis of data collected in Round 6 of UNICEF's Multiple Indicators Cluster Surveys. Nationally representative samples of 6290 Roma and 13,005 non-Roma children in Kosovo, Montenegro, the Republic of North Macedonia, and Serbia. ResultsRoma children were twice as likely to have a disability, a less severe disability, multiple disabilities, and severe cognitive delay than their peers and were more likely to have functional limitations in all but one of the domains investigated. ConclusionsDisability is significantly more prevalent among Roma children aged 2–17 years than among their non-Roma peers in four Western Balkan countries. Future research should focus on the extent to which differences in disability may be attributable to differential rates of exposure to a range of social determinants.