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Infants born at term but who are small for gestational age are at higher risk for undernutrition and developmental delays.

Single interventions have had mixed results.

Within fourteen days of their birth, Dr. Chowdhury and colleagues enrolled thirteen hundred term small for gestational age infants in South Delhi, India, in a randomized trial.

Families received either usual care or an integrated package of health, nutrition, early child stimulation, and psychosocial support.

At twelve months, infants in the intervention group weighed eight kilograms compared with seven point eight kilograms in usual care.

Multiple secondary endpoints favor the intervention, with improvements in weight for age scores, less underweight, stunting, wasting, and anemia.

The difference in anemia was large, seventy-two point five percent to thirty-four percent.

Cognitive, language, and motor scores also improved.

And in an accompanying editorial, Dr. Yousafzai says that this study helps define what nurturing care can look like for a high-risk group.

The editorial highlights four themes.

Match the intervention to the child's risk, sequence the components in line with the child's early and evolving developmental needs, support maternal mental health and nutrition, and use evidence-based tools.

A remaining outstanding question is scalability because this trial used a high-intensity multidisciplinary team.