A cross-sectional study among 44 children (0–24 months) in Kendujhar district (2024) assessed immunization status and birth weight. Data from interviews were analyzed using logistic regression (predictors of immunization) and Fisher’s Exact Test (birth weight vs. dietary/feeding factors). Key factors included supplementary food, breastfeeding frequency, rice/protein intake, cooking oil use, Iron Folic Acid Syrup, Deworming tablet, junk food, morbidity and sex ratio. The logistic regression model was statistically significant (χ² = 13.58, df = 3, p = 0.0035), identifying family size and birth order as important predictors of child nutritional status. Children from larger families (≥6 members) and higher birth orders (3rd/4th) had significantly lower odds of adverse outcomes compared to smaller families and first/second-borns. Maternal belief that multiple immunizations at the same visit are unsafe showed a negative association, though not statistically significant. Nutritional and feeding practices emerged as strong protective factors. Children receiving supplementary food (multigrain mix and egg) from the Anganwadi Centre had markedly lower risk of low weight (14% vs. 75%; OR = 0.06, 95% CI: 0.012–0.26). Frequent breastfeeding (≥9–10 times/day), high rice consumption, intake of protein-rich foods, and use of soybean/sunflower oil were all associated with substantially reduced risk of low weight. Intake of IFA syrup also conferred significant protection, with nearly half the risk of ( Low Weight) LW compared to non-consumers (RR = 0.53; OR = 0.22). Child morbidity and dietary exposures showed consistent associations with growth outcomes. Frequent morbidity episodes (≥4–5/year) nearly doubled the risk of LW (RR = 1.88, OR = 4.5), while daily junk food consumption tripled the risk of excess weight gain (RR = 2.95; OR ≈ 9). Attributable fraction analysis suggested that a large proportion of adverse outcomes could be explained by these modifiable risk factors. Deworming significantly reduced disease occurrence, with risk in the exposed group (20.8%) much lower than in the unexposed group (55%). Statistical tests confirmed this protective effect, showing about 62–78% lower risk/odds of disease among the exposed. The study highlights the role of family characteristics, maternal perceptions, feeding practices, morbidity, and dietary exposures in influencing child growth outcomes. Interventions focusing on improving nutrition (supplementary feeding, protein intake, IFA supplementation, deworming tablet), promoting optimal breastfeeding and reducing morbidity could substantially reduce the burden of low weight and abnormal growth among children consuming junk foods.