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.

Prevalence of Malnutrition in Holt-Supported Programs

When children enter Holt's child nutrition program, they start with child growth assessments and anemia screenings to evaluate their health and nutritional status. Utilizing nutrition screening system tools, we are able to quickly identify children who are malnourished or at risk for malnutrition. More than 18,500 baseline and follow-up screenings have now been conducted among more than 2,576 children at sites across China, Ethiopia, India, Mongolia, the Philippines 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).


Although 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.

During the first screening, 67% of children had one or more nutrition-related health issues. Compared to their most recent screenings, we have seen a 20% reduction in this area!

Within one year of entering the child nutrition program, the prevalence of nutrition-related health issues significantly decreased for children under 5 years of age.

A Photo Slideshow of Holt's Child Nutrition Program Trainings

At our partner care centers in India, China, Vietnam, Ethiopia, Mongolia and the Philippines, 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. The program was initially launched in two locations in India. Within a year and a half, the program expanded to five new locations in China and Vietnam. As of 2019, with 49 sites and 35 care centers, over 11,000 children in China, Vietnam, Ethiopia, the Philippines, Mongolia and India are benefitting from Holt’s child nutrition program. Children in Uganda and Haiti also receive nutrition programming – even though these countries have not fully implemented the child nutrition program yet. With an increasing number of sites around the world, over 800 caregivers have been trained on health screening, nutrition, hygiene and feeding practices.

  • 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. Holt also hired an independent evaluator to do an outside review of program implementation, as well as its impact on children. The results were overwhelmingly positive. Children at all sites 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. The CNP team conducted trainings at two sites in the Philippines and one site in Ethiopia. Caregivers and staff in both countries took the knowledge they gained during the training to educate additional caregivers and expand the program to new locations. 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 — marking the CNP’s first expansion into family strengthening.

  • In 2018, caregivers at a new site in Mongolia were trained, and CNP started serving children in foster care in the Philippines. Nutrition interventions and resources were shared in all the countries where Holt works. A new manual focused on community nutrition and health was developed, and further exploration into adapting CNP for parent trainings was completed. Research on CNP implementation was presented at the Food and Nutrition Conference and Expo in Washington D.C.

  • In 2019, along with our team of feeding specialists, the Nutrition Program completed Holt’s Feeding and Positioning Manual: Guidelines for Working with Babies and Children. This manual was developed to support caregivers of infants and children by providing a comprehensive set of resources regarding safe feeding practices for all children, especially children with special needs. As the first of its kind, the feeding and positioning manual will be translated into multiple languages to reach a wider audience globally and to ensure caregivers have access to safe feeding resources.

  • In 2019, six countries will be implementing and replicating Holt’s child nutrition program through our robust network of partners, helping thousands of children develop the healthy roots they need for a lifetime of success.

  • In 2020, the CNP program will continue expanding its work in the six countries where we already have a presence, as well as expand to additional countries where Holt works.


The Holt International Feeding and Positioning manual is intended to support the caregivers of infants and children by providing information regarding safe feeding practices. Additionally, this manual provides:

  1. General information on infant and child development
  2. Critical milestones for caregivers to monitor
  3. Helpful strategies that support not only feeding but enrich the overall well-being of each and every child

Strong child development is the foundation of prosperous communities. When a caregiver supports the development of a child, he or she is contributing to the health of the entire community. Caregivers are vital to healthy, well-developed children. A well-developed child becomes a healthy, productive and independent adult. The work that caregivers do — the love and care that they provide — is powerful and essential for a child to thrive.

This manual is intended to be used by all caregivers within a child’s life. Some of the information in this manual may be of interest to other health care workers, family members of children and community members. Depending on the needs of the individual, some may benefit from reading an entire chapter or section, or some may find it useful to refer to only certain handouts, illustrations, charts or activities.

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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.