Third in a series of posts on IFPRI’s work on growth monitoring and promotion (GMP) supported by the Gates Foundation. Read the first post here, and the second here.
Growth monitoring and promotion (GMP) programs are widely used to screen for nutritional and health problems among children, yet they face many challenges in practice. Recent research on the epidemiological foundations of GMP shows that the criteria commonly used in these programs do not accurately diagnose or screen for inadequate growth in individual children.
Despite these limitations and challenges with implementation, GMP remains a routine component of preventive child healthcare in 178 countries worldwide. This widespread reach offers a valuable opportunity: GMP infrastructure, staff, and routine visits with caregivers and their young children could be leveraged to deliver additional benefits—such as early childhood development (ECD)-focused interventions—to children.
In a recent article published in Advances in Nutrition, we examined whether the GMP platform could be used to improve ECD in children under 5 years of age living in resource-limited settings. Specifically, we explored the following questions:
- Can (and if so, which) growth indicators or ECD assessment tools be used to identify individual children at risk of poor development within the context of GMP?
- What caregiving interventions could feasibly be delivered within GMP visits, and how effective are they in improving ECD and psychosocial outcomes?
What we found:
Growth indices are not accurate predictors of suboptimal development
Across analyses of two large datasets from children in resource-limited settings, standard growth indices (e.g., height-for-age, weight-for-age z-scores) were not accurate predictors of children’s concurrent or later developmental status. Our findings suggest that growth indices and indicators should not be used to identify individual children at risk of suboptimal development. Essentially, while poor growth and poor development share similar underlying causes, anthropometric measures alone cannot reliably identify which individual children are developmentally at risk.
Specialized tools are necessary for accurate screening
If GMP programs aim to identify developmental concerns, they should utilize brief, validated ECD tools rather than anthropometric data. Our review found that instruments such as the Ages and Stages Questionnaire (ASQ) and the Survey of Well-being of Young Children (SWYC) are feasible options for trained frontline health workers, including those based in low- and middle-income settings. These tools can be used during routine GMP visits to screen for developmental risk and identify children in need of follow-up support.
Light-touch ECD interventions can be incorporated into GMP visits
We identified 10 “light-touch” ECD interventions, defined as those that could be delivered by trained frontline health workers, are not time-intensive for caregivers, and require infrequent contact. The most promising interventions were demonstration-based and practice-oriented, where providers model age-appropriate activities with the child and give caregivers time to practice during the visit. These interactive formats help caregivers gain skills and confidence to continue supporting their child’s development at home and within their busy schedules. Many of the interventions that were reviewed, however, have not yet been evaluated for their impact on child developmental outcomes, underscoring the need for additional research.
Considerations and next steps
Our study highlights the potential for GMP to serve as a platform for integrating certain ECD tools and programs. While growth indices alone are not accurate in determining developmental risk, GMP’s existing infrastructure and routine visits could be leveraged to deliver early learning and responsive caregiving interventions. Since nearly all children in resource-constrained settings could benefit from ECD services, universal delivery of caregiving interventions may be more beneficial and cost-effective than screening for and targeting individual at-risk children. Moving forward, further evidence is needed on how to implement ECD interventions within GMP in varying contexts and what their impact is on ECD outcomes.
Leila M. Larson is an Assistant Professor of Public Health at the University of South Carolina (USC); Edward A. Frongillo is a USC Professor of Public Health and Director of Global Health Initiatives; Rebecca Brander is a Research Fellow with IFPRI’s Nutrition, Diets, and Health (NDH) Unit; Marie T. Ruel and Jef L. Leroy are NDH Senior Research Fellows. Opinions are the authors’.
Reference:
Larson, Leila M.; Frongillo, Edward A.; Akter, Fahmida; Wooten, Shelbie; Brander, Rebecca L.; et al. 2025. Perspective: Growth monitoring and promotion as an opportunity to improve early childhood development. Advances in Nutrition 16(8): 100470. https://doi.org/10.1016/j.advnut.2025.100470
