Child survival & development in middle childhood

Supporting children during a unique period of physical, cognitive and social change.

Smiling children in school

The Challenge

Problems experienced by children in the first five years of life can, have the potential to impact a child into middle childhood and beyond, meaning action to address these are critical.

School Medical Inspections have revealed a significant number of school-aged children with health problems. 2013 FHB data shows that 41% of all students reported having recently experienced some type of medical problem. Poor nutrition continues into later childhood with one third of school-aged children recording a low BMI for their age, 11.5% exhibiting stunting and 11% showing signs of anemia. The prevalence of stunting increases with age from 9.9% at 6 years to 21.1% at 12 years. Obesity is also a growing concern and increases rapidly with age, from 1% of children under five to 9.6% of school children aged 6-12 years. (Nutritional status, dietary practices and patterns of physical activity among school children aged 6-12 years, MRI 2016).

Despite public investment in school health and nutrition in Sri Lanka, the health and nutritional status of school age children requires attention. Existing policies are weak and fragmented, and there is no overarching policy on school health and nutrition. This has led to inefficiencies and poor program design, which is further compromised by limited monitoring and evaluation.

A paucity of quality water and sanitation services combined with poor knowledge of appropriate hygiene practices greatly increases the risk of infection and disease. This means that caregivers are unable to identify gaps and are less likely to seek quality services. Schools, where children spend most of their time, do not integrate health promotion concepts and life skills development sufficiently, nor do they widely implement standardized delivery of water and sanitation.  

The Solution

UNICEF and our partners work to enhance the capacity of health workers and primary teachers to deliver evidence-based, quality services in health, nutrition and WASH. This means a streamlined effort to improve skills and competencies. We are also working towards the use of formal behavioral change indicators in assessing and monitoring the health and hygiene status of children during household visits.

UNICEF is also working towards maintaining proper nutrition and hygiene within homes and schools. We are leading the strengthening of partnership between the Ministry of Health, Nutrition and Indigenous Medicine (MoHNIM) and the Ministry of Education (MoE) so that teachers and parents can play their part, with increased knowledge.


Everything we do at UNICEF, from planning to execution, is grounded in empirical data, independent evaluation, rigorous research and thoughtful analysis. This information is gathered with the help of our own staff and the help of our network of partners in communities around the country. UNICEF will further leverage its vast regional and global resource bases to broker appropriate knowledge products and tested models in support of Sri Lanka.

UNICEF supports research and uses it to inform every decision we make. We rely on hard evidence to assess any situation on the ground, and we use these findings to drive programs, policies and initiatives.

If you would like to learn more about child survival and development in middle childhood, please have a look at the resources below.


Watch our Parenting Masterclasses. ‘Eat, Play, Love’: Sri Lanka’s children need more to ensure they enter adulthood without a disadvantage