Child mortality rate in Nepal has seen a significant decline in the past fifteen years and is expected to achieve ‘Millennium Development Goal (MDG) four’ before the stipulated time.1 A substantial improvement has been seen in controlling micro-nutrient deficiencies and childhood illnesses in the country, yet Protein Energy Malnutrition (PEM) among under five year children remains a stagnant problem posing a threat to child growth and development and a challenge to sustainability to what has been achieved in saving child lives. Statistics from Nepal Demographic and Health Survey (NDHS) 2006, NDHS 2001, Nepal Family Health Survey (NFHS) 1996 and first national nutrition survey in 1975 showed PEM unabated in last 35 years.2-5 During the period, various strategies, programs and policies have been developed and implemented in Nepal to improve nutritional status of the people. This article attempts to identify such efforts and explore the strengths and gaps remained within them.