Objective: To evaluate the effectiveness of Sprinkles alongside infant and young child feeding (IYCF) education compared with IYCF education alone on anemia, deficiencies in iron, vitamin A, and zinc, and growth in Cambodian infants.Design: Cluster-randomized effectiveness study.Setting: Cambodian rural health district.Participants: Among 3112 infants aged 6 months, a random subsample (n = 1350) was surveyed at baseline and 6-month intervals to age 24 months.Intervention: Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months.Main Outcome Measures: Prevalence of anemia; iron, vitamin A, and zinc deficiencies; and growth via biomarkers and anthropometry.Results: Anemia prevalence (hemoglobin level <11.0 g/dL [to convert to grams per liter, multiply by 10.0]) was reduced in the intervention arm compared with the control arm by 20.6% at 12 months (95% CI, 9.4-30.2; P=.001), and the prevalence of moderate anemia (hemoglobin level <10.0 g/dL) was reduced by 27.1% (95% CI, 21.0-31.8; P = .001). At 12 and 18 months, iron deficiency prevalence was reduced by 23.5% (95% CI, 15.629.1; P < .001) and 11.6% (95% CI, 2.6-17.9; P =. 02), respectively. The mean serum zinc concentration was increased at 12 months (2.88 mu g/dL [ to convert to micromoles per liter, multiply by 0.153]; 95% CI, 0.265.42; P =. 03). There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time.Conclusions: Sprinkles reduced anemia and iron deficiency and increased the mean serum zinc concentration in Cambodian infants. Anemia and zinc effects did not persist beyond the intervention period.