Many factors may affect the way children express their social skills or emotional competencies or the rate at which children acquire social skills or emotional competencies. These factors include 1) environmental risk factors such as living in an unsafe community, receiving care within a low-quality child care setting, lack of resources available in the community or lack of policies supporting children and families, etc, 2) family risk factors such as maternal depression or mental illness in the family, parental substance abuse, family violence, poverty, etc. and 3) within-child risk factors such as a fussy temperament, developmental delay, and serious health issues. All of these factors need to be taken into careful consideration when gathering information to fully understand and support children's social and emotional health through a comprehensive, ecological approach.

Child development is a gradual unfolding of biologically determined characteristics and traits that arises as the child learns from experiences. In developing countries, more than 200 million children under five years fail to reach their potential in cognitive and social development due to poverty, poor health, nutrition, and deficit care. Most of these children live in South Asia and Sub-Saharan Africa and many of them are exposed to multiple risks including poverty, malnutrition, poor health and un-stimulating home environment, which detrimentally affecting their development . Health associated to poverty, nutrition and social factors hinders from attaining to their full developmental potential. Other factors that compromise overall development during pregnancy and after birth are parent’s behavioral, dietary deficiencies, chronic infections, exclusive breastfeeding, inadequate feeding practices and lack of stimulation

Maternal nutrition

Nutrition is important before and during pregnancy and is most influential non-genetic factors in foetal development. Women with preconception healthy Body Mass Index (BMI) tend to gain an appropriate amount of weight during pregnancy  and women with BMI below 19.1 have fivefold increase in delivering low birth weight baby . Maternal under nutrition is a risk factor for foetal growth restriction and adverse perinatal outcomes.

Inadequate intake of good nutrition and mother’s poor nutritional status during pregnancy are indicative of intrauterine growth restriction  whereby affecting brain development . Low maternal weight before conception is associated with an increased risk of low birth weight and symmetrical growth restriction  and pregnancy loss . In developing countries, intrauterine growth restrictions is mainly due to poor maternal nutrition and infections , which makes up to 11% of births. Furthermore, low birth weights babies are more likely to be stunted by age of two years . In 2010, 9.9% of 72.2% Bhutanese babies weighed at birth had low weight of less than 2500g but whether this low birth weight is associated with maternal under-nutrition is not known. Similarly, 33.5% of Bhutanese children are found to be stunted .

Childhood Nutrition

Breast feeding

Breast milk is ideal and best food for infants , it provides a unique nutrient constituting of proteins, carbohydrates and fats needed for optimal cell function and growth. Further, the contents changes to suit the nutrient requirements of child’s development with age . Exclusive breastfeeding up to six months of age helps in improving health and development of the child. Breastfed babies are less likely to develop obesity  and will have lower cholesterol level in their later life . Fatty acid in breast milk develops brain and thus enhances cognitive development and visual acuity. In Bhutan, despite considerable effort put in promoting exclusive breast feeding, only 48.7% of mother breastfed their children exclusively, 59% have initiated breastfeeding within one hour of birth and 65.7% continued to breastfeed up to 24 months . Much effort needs to be emphases in early initiation of breast feeding along with skin to skin contact between mother and baby in order to help in increasing exclusive breast feeding.

Complementary Feeding

An appropriate and adequate start of complementary feeding at six months is critical for development. In many developing countries, children of these age groups do not receive timely, appropriate and adequate feeding to grow to optimum level. Adding food too soon takes the place of