Tamil Nadu’s high vaccination coverage gives its health system regular contact with young children. Yet the latest National Family Health Survey (NFHS-6) shows that wasting among under-fives has risen from 14.6 percent in NFHS-5 to 17.4 percent, while only 20.6 percent of children aged 6–23 months receive an adequate diet. Overweight affects 2.2 percent of under-fives, down from 4.3 percent in the previous survey. The more pressing finding is that routine contact with children has not translated into consistently healthy growth.
Tamil Nadu’s next priority is to make those contacts count: to recognise growth concerns early, support families with practical advice and follow children through the care they need.
Drawing the Line on Health-System Accountability
The health system cannot determine what food a household can afford, whether it has safe water or how the wider food environment shapes children’s diets. Those conditions require action across income, agriculture, sanitation and social protection policy. Health services can, however, be held accountable for assessing children, recognising growth concerns, counselling families, completing referrals and checking what happens next.
Dietary diversity is one area where informed support can help. In a 2024 analysis of 57,714 Indian children aged 6–23 months, Bikash Khura and colleagues found that children meeting minimum dietary diversity had lower odds of being underweight. A 2025 analysis of Comprehensive National Nutrition Survey data by Sangita Thenarangam and colleagues associated dietary diversity with lower odds of stunting and zinc deficiency, though not wasting. These are associations, not proof that counselling alone will improve growth. They do show why feeding practices deserve attention alongside the resources families need to put advice into practice.
The Missed Opportunity in Routine Visits
Immunisation and growth-monitoring visits offer repeated chances to discuss breastfeeding, complementary feeding and locally available foods. Evidence from a randomised trial in a Delhi health centre suggests that even brief support can change feeding practices: two counselling sessions during routine immunisation visits increased exclusive breastfeeding at six months by 26.1 percentage points and timely initiation of complementary feeding by 34.8 percentage points relative to the control group. The result makes a case for using existing visits more fully; it does not establish that the same gains will follow across Tamil Nadu.
The policy shift is from nutrition counselling only when a child is identified as malnourished to healthy-diet support for every child, with closer attention and follow-up when growth departs from a healthy course.
Making Follow-Through the Measure of Care
Three changes would turn that principle into routine practice.
First, block and district reviews should examine what happened after a child was screened. Was a growth concern identified? Did the family receive appropriate support? Was a referral completed? What did the next assessment show? Recording this pathway in Health Management Information System (HMIS) and Integrated Child Development Services (ICDS) records would make follow-through visible, rather than treating each contact or referral as an endpoint.
Second, health and ICDS teams should agree on a small common set of feeding and growth indicators, including breastfeeding, dietary diversity, meal frequency and complementary feeding. Joint block-level reviews could then identify where advice, assessment or referral is breaking down. The aim should be to use information already gathered to guide care while avoiding duplicate entry for frontline workers.
Third, routine visits during the first 1,000 days should bring feeding support together with developmental surveillance, caregiver guidance and early stimulation. These needs are connected in a child’s life and can be addressed through existing encounters. Indian trials of combined nutrition and responsive-parenting support offer a further reason to take development seriously, although the proposed approach would need to be adapted and assessed in Tamil Nadu.
The test for Tamil Nadu is whether a routine child-health visit leads to the right next step—and whether the system knows if that step happened.