Child under-nutrition continues to be a significant public health problem among the rural indigenous hill tribes of Meghalaya, India requiring urgent attention and immediate action. The study assesses the magnitude of household food insecurity and its consequences on the nutritional status of children of 6–59 months among indigenous Garo tribe of Meghalaya, India dwelling under mountain specificities. An analytical cross-sectional study was conducted during December 2019 and September 2020 on 181 indigenous hill households, who reported having children in the age group of 6-59 months. Food access was measured as food consumption score (FCS). Majority of the sample indigenous hill households (76.24 per cent) are observed to be in borderline food security category (with average FCS of 31.60). Significant and positive correlation was observed between the household FCS and BMI of Children of 6–59 months. The households with higher FCS are having healthy children and children in food insecure households normally face malnutrition issues. Thus for improvement in the status of children, the focus should be on improvement of households FCS. For this effective policies and programmatic activities with focus on improvement of dietary diversity need to be initiated. Revitalising and strengthening the local food systems will increase local food production, improve the dietary diversity, and decrease the reliance on food supplies from outside the region.