Children who are undernourished during the first thousand-day window risk experiencing lifelong adverse consequences, including poor physical and cognitive development, poor health, and even early death. Research shows that nutrition counselling, growth monitoring and early detection of growth faltering along with timely action can help in addressing undernutrition among children between 0–23 months of age. This case study describes a pilot conducted in the Amethi Health Sub-Centre (HSC) of the Wazirganj block in Bihar state’s Gaya district. It applies the point of care continuous quality improvement (POCQI) approach for improving growth monitoring and promotion activities to address undernutrition prevalence at the community level with a focus on children 0–23 months. Within five months following the pilot, the percentage of children aged 0–23 months with weight for age within the normal category increased from 16% to 77%. During the same period, the percentage of children in the severely underweight category decreased from 15% to 2%.