Introduction: The global burden of child undernutrition is widely documented; standalone outpatient paediatric clinics, which reflect real-world clinical experience, remain significantly underreported. In Southern India, undernutrition is conventionally attributed to economic deprivation; however, parenting-linked feeding difficulties in financially stable households represent an equally significant yet poorly recognised contributor in outpatient settings. Objectives: To assess the prevalence of stunting and underweight among children aged 6 months to 5 years, and to determine the dual contributory drivers, socioeconomic deprivation and parenting-linked feeding difficulties, alongside existing counselling gaps in a standalonepaediatric outpatient setting in Southern India. Methods: A retrospective clinical audit was conducted over 12 months at Naari Advanced Child Care Center. A total of 480 children aged 6 months to 5 years were included. Anthropometric measurements were plotted against the WHO Child Growth Standards. Clinical observations were reviewed to identify contributory factors, and counselling gaps were documented at each visit. Results: Of 480 children audited, underweight was identified in 55% (n=264) and stunting in 20% (n=96). Two distinct driver profiles emerged; economically deprived households demonstrated food insecurity and poor dietary diversity , while financially stable households presented with maladaptive feeding behaviours, including screen-feeding, pampering, and reward-based negotiation. Structured feeding behaviour counselling was inconsistently documented across visits, reflecting a significant counselling gap in routine outpatient practice. Conclusions: This audit reveals parenting-linked feeding behaviours contributing to growth faltering over economic deprivation lone, yet remain inadequately addressed. Tailored counselling alongside nutritional access is essential for effective growth promotion instandalone paediatric outpatient settings.