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Child malnutrition is the result of poor health, inadequate diets, suboptimal caregiving practices and unsanitary environments. While on average urban children are less likely to suffer from malnutrition than rural children, data shows that the opposite is true for urban children living in poverty. In high-density low-income neighbourhoods, inadequate housing and infrastructure, limited access to basic services and exposure to environmental hazards are major factors that, combined with low and irregular earnings, contribute to food insecurity and malnutrition. Practical action needs to consider and address these context-specific multiple challenges. NGOs can contribute to the successful design and delivery of interventions by supporting the capacity of grassroots organisations of the urban poor and local governments and in so doing ensure that initiatives have the long-term horizon essential to achieve change.