Impact of an integrated parenting and nutrition intervention on growth and development in stunted children at 24 months: evidence from the Stepping Stones programme in rural India

OBJECTIVES: This paper examines the differential impact of responsive parenting and nutrition interventions on early child development in stunted versus never-stunted children at 24 months of age in rural India. METHODS: We conducted a secondary analysis of data from Stepping Stones-a cluster randomised controlled trial involving 21 subcentres/clusters allocated to intervention or control group. The intervention comprised home visits, group sessions and community workshops, focusing on responsive parenting and nutrition. Developmental outcomes, cognitive, motor, language and socio-emotional, were assessed at 24 months using validated tools. A mixed-effects regression model with an interaction term was used to estimate effect sizes for stunted and never-stunted children. RESULTS: Among 588 children analysed, 35.9% were stunted at 24 months, and 35 (5.95%) of them exhibited 'early-onset persistent stunting'. The intervention improved cognitive (β=0.22), motor (β=0.23), language (β=0.17) and socio-emotional development (β=0.23) in never-stunted children compared with those who have not received intervention. For stunted children who have not received the intervention, a development score was lower for all development domains compared with never-stunted children, but not statistically significant (p>0.05). Although the effects differed between stunted and never-stunted children, the interaction effects between intervention and stunting were not statistically significant across all domains (p>0.05), indicating that the intervention's benefits did not significantly differ by stunting status. CONCLUSION: Integrated parenting and nutrition interventions improved developmental outcomes across all domains, regardless of the child's stunting status. These findings support universal application of such programmes, highlighting the need to integrate them into existing child development and nutrition programmes.