Holt's Child Nutrition Program

Why is Nutrition for Orphaned and Vulnerable Children Different?

From before a child is born to about 5 years of age, their brains develop rapidly — much more rapidly than at any other time in life. Like little sponges, they soak up information about the world around them, cognitively creating the building blocks they need for healthy emotional, physical and social development. Proper nutrition is critical to ensure the brain has all it needs to develop, unimpeded by roadblocks. If children do not receive proper nutrition in this most critical stage of growth, the effects can be grave — and in many cases, irreversible. Children may become stunted or underdeveloped for life — affecting their ability to perform well in school, reach key developmental milestones or bond relationally with others. They are unable to reach their full, thriving potential. Malnutrition affects nearly 250 million children worldwide and malnutrition and hunger-related diseases are the biggest killer of children under age 5 in the developing world (UNICEF, 2016).

The children Holt serves globally are among those most at risk for malnutrition and hunger-related diseases, in particular orphaned or abandoned children living in care centers, many of whom have significant special needs.


The Power of Nutrition

Meet the children whose lives have been transformed through Holt's child nutrition program.

How Holt's Child Nutrition Program Works

Holt's Child Nutrition Program is proving highly successful at reducing malnutrition among orphaned, abandoned and vulnerable children in Holt-supported child care centers and foster care projects around the world. By bringing together partnering NGOs, medical experts, front-line caregivers and local government representatives, Holt's child nutrition program puts in place sound tools and practices that our partners can use to implement, track and evaluate critical nutrition and feeding changes that truly improve child health and nutrition. Holt's child nutrition program primarily focuses on the youngest and thus most vulnerable children, those between the ages of 0-6, who are at highest risk for nutrition-related illnesses. At the same time, Holt's child nutrition program works to standardize new practices across care centers and communities so they become routine. In this way, all children in care will benefit from nutrition, health and growth standards initiatives.

STEP 1: Training Caregivers

Holt leads multiple-day, in-person training sessions with on-the-ground staff and caregivers at our overseas programs. Holt equips our partners with nutrition and feeding manuals, translated into their local language by Holt, and furnishes all necessary equipment to ensure our partners are prepared to accurately assess, monitor and create action plans for children in their care or programs.

STEP 2: Assessing Children

Once trained, the first action of our partner staff is to assess the baseline nutrition, health, height and weight of each child in their programs. To track and monitor individual child progress over time, they then record these findings utilizing the same methodologies from care center to care center and country to country.

STEP 3: New Tools

Often, care centers lack some basic tools needed to accurately track a child's growth and overall health. Holt provides a package of child measurement and growth monitoring tools and a hemoglobin testing machine to monitor children for iron-deficiency anemia — a condition that is detrimental to healthy brain development.

STEP 4: Supplements

Many children require supplements to ensure they receive adequate amounts of vitamins and minerals such as iron. Holt's child nutrition program shows our partner staff how to properly prescribe supplements and make nutritional interventions. Some children simply need more nutrition-rich formulas or snacks, and care centers may need to introduce a more diverse array of meal options or adjust menus. Even minor changes like these are critical to meeting children's individual nutrition needs.

STEP 5: Tracking

Once caregivers are trained on proper nutrition and feeding methods, and on-the-ground staff have recorded a baseline nutrition screening for every child, medical staff begin to regularly monitor and track different aspects of children's growth and development — usually every one-to-three months depending on the child's age, needs and overall health status. Holt provides the materials required and a standardized database to ensure children's health results are being properly recorded and analyzed over time.

STEP 6: Community Impact

While Holt's child nutrition program is specifically designed to improve nutrition and feeding among orphaned and vulnerable children living in child care centers, our program has the potential for a significantly broader impact. When our partners overseas learn the curriculum, they begin to take what they learn out into the communities— improving the health and nutrition of children in our family strengthening programs as well. Caregivers and partner staff lead trainings for parents with vulnerable children in the community. Or they implement what they learned during Holt's child nutrition program trainings into their preschool, educational or school lunch programs — combatting malnutrition by making adjustments to children's regular snacks, meals or emergency food supplies. Parents learn about the nutritional benefits of milk, for example, and to encourage school-aged children to snack on fruits and vegetables instead of starchy, sugary snacks. In this way, Holt's child nutrition program has the potential to improve nutrition for thousands more children every year.

Prevalence of Malnutrition in Holt-Supported Care Centers

Numbers reflect data collected between May 2013 and August 2016.

Between May 2013 and August 2016, Holt's child nutrition program initiated child growth assessments and anemia screenings to evaluate the health and nutritional status of children. Utilizing nutrition screening system tools, we were able to quickly identify children who were malnourished or at risk for malnutrition. Baseline and follow-up screenings have now been conducted among more than 986 children at sites across China, Ethiopia, India, Mongolia and Vietnam.

Nutrition-Related Problems Found in Children


Children who are stunted are not as tall for their age as they should be due to delayed growth — an indicator of chronic malnutrition. Stunting is associated with increased mortality rates, reduced cognitive ability, and poor school and job performance.


Wasting, or extreme thinness, evaluates weight relative to height and is the most accurate indicator of malnutrition because it's less likely to be affected by any disabilities a child may have. Wasting reflects severe weight loss due to acute malnutrition or severe illness.


A child who is underweight has a low body mass for their age, which is influenced by both the height of the child (height-for-age) and his or her weight (weight-for-height).


Commonly caused by micronutrient deficiencies of iron, folate and B12. Iron deficiency is the most common cause of anemia in children, which can significantly impact their cognitive development and ability to fight infection while causing other developmental delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks.

Overall, findings from Holt's baseline child screenings in 2013 showed that 78% of children younger than 5 had at least one nutrition-related health problem including stunting, wasting, underweight and/or anemia.

As pilot sites for the child nutrition program, two care centers in India have received interventions for the longest period of time. Here, outcomes showed the highest and most consistent improvement across all indicators among children younger than 5.

May 2013

August 2016

A Photo Slideshow of Holt's Child Nutrition Program Trainings

At our partner care centers in India, China, Vietnam and most recently in Ethiopia, Holt's child nutrition program team has worked extensively with caregivers and staff — providing nutrition and feeding education to ensure every child receives the vital nutrients they need to thrive.

Quotes from Caregivers Who Have Received Child Nutrition Program Training

Child Nutrition Program Impact Timeline

Since 2013, Holt's child nutrition program has grown to serve hundreds of children at multiple sites, and continues to expand to more countries where Holt works.

  • The Holt International Child Nutrition Program was established in 2013. As of 2018, over 2,000 children in China, Vietnam, Ethiopia, the Philippines, Mongolia and India are benefitting from Holt's child nutrition program and well over 450 caregivers have been trained on health screening, nutrition, hygiene and feeding practices.

  • Holt's child nutrition program was initially launched in two locations in India in the beginning of 2013. Within a year and a half, the program had expanded to five new locations in China and Vietnam.

  • In 2015, Holt conducted a full analysis of all the child health data collected from these sites. The results showed dramatic improvements in all key indicators — including malnutrition risk, stunting, wasting, anemia and feeding issues — at every implementing site.

  • Also in 2015, Holt hired an independent evaluator to do an outside review of program implementation and its impact on children. The results were overwhelmingly positive. At all sites, children were reported to be noticeably less sick, less often; Holt considers this a qualitative success.

  • In 2016, Holt conducted initial assessments in Ethiopia and Mongolia that led to trainings in 2017. Vietnam expanded the program to five new locations in 2016 and further expanded in 2017.

  • In 2017, Holt China scaled the Child Nutrition Program to two additional sites and one partner in India conducted a program implementation training at two new locations.

  • In 2017, the CNP team conducted trainings at two sites in the Philippines and one site in Ethiopia. Within the year, caregivers and staff in both countries took the knowledge they gained during the CNP training to educate additional caregivers and expand the program to new locations. In 2017, Vietnam also expanded CNP to three new locations. Multiple sites in Haiti were also assessed.

  • In India, staff at one of the trained sites adapted the curriculum and developed a new program to serve children and their parents in a Montessori school setting — marking the CNP’s first expansion into family strengthening.

  • In 2018, a new site will be trained in Mongolia and CNP has already begun serving children in foster care in the Philippines. Nutrition interventions and resources will be shared in all the countries Holt works in. A new manual focused on feeding and positioning practices — as well as a community nutrition manual — will be developed, and further exploration into adapting CNP for parent trainings will be completed.

  • By 2019, seven or eight country programs will be implementing and replicating the child nutrition program throughout our robust network of partners, helping thousands of children develop the healthy roots they need for a lifetime of success.

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Holt International is a registered 501(c)3 nonprofit organization. All donations are tax deductible to the full extent of the law. EIN: 23-7257390.