Nutritional, psychosocial, socioeconomic, and family factors associated with conceptual skill development among preschool children: evidence from Rupandehi District, Nepal

Conceptual skill development is a critical component that supports learning, reasoning, and problem-solving abilities during early childhood. However, studies on the association of nutritional, socioeconomic, and family-related factors with conceptual skill development in Nepal remain limited. This study aimed to identify nutritional, psychosocial, socioeconomic, and family factors associated with conceptual skill development among preschool-aged children in Rupandehi district, Nepal. A cross-sectional analytical study was conducted among 401 preschool children aged 3–5 years enrolled in Early Childhood Development centers in Rupandehi District, Nepal, recruited through a multistage sampling procedure. The conceptual skill development component of a standardized Cognitive Development Tool for preschool children was used to assess conceptual skill development. Data on anthropometric measurements, socio-demographic characteristics, psychosocial stimulation, and caregivers’ nutritional practices were collected through interviewer-administered structured questionnaires, anthropometric measurement, and observation using standardized tools. Multiple linear regression analysis was used to identify factors independently associated with conceptual skill development, with statistical significance set at P < 0.05. Higher height-for-age z-score, greater psychosocial stimulation, and relatively advantaged caste/ethnic group status were positively associated with conceptual skill development, whereas cesarean delivery and increasing child age were associated with lower scores. Associations observed for nutritional edema and household economic ranking were unstable across model specifications and are not interpreted as independent effects. The final regression model explained 35.3% of the variance in conceptual skill development (adjusted R² = 0.353, p < 0.001). Conceptual skill development among preschool children was associated with nutritional, psychosocial, and social factors. Higher height-for-age z-score, greater psychosocial stimulation, and relatively advantaged caste/ethnic group status were associated with better conceptual skill development, whereas cesarean delivery and increasing child age were associated with lower scores. Associations observed for nutritional edema and household economic ranking were unstable across model specifications and are not interpreted as independent effects. These findings highlight the need for early childhood development interventions that combine nutrition improvement, responsive caregiving and psychosocial stimulation, and attention to caste-based disadvantage to support conceptual skill development. What is already known about this topic? • Conceptual skill development is a fundamental aspect of early childhood development and supports learning, reasoning, problem-solving, and later academic readiness. • Nutritional status, psychosocial stimulation, socioeconomic conditions, and family environments have been associated with cognitive and developmental outcomes among young children. • Evidence from Nepal and other low- and middle-income countries has largely focused on overall cognitive development, while the combined association of nutritional, socio-demographic, and family-related factors with conceptual skill development remains limited.