Significance Childhood malnutrition is a global health problem not attributable to food insecurity alone. Sequencing DNA viruses present in fecal microbiota serially sampled from 0- to 3-y-old Malawian twin pairs, we identify age-discriminatory viruses that define a “program” of assembly of phage and eukaryotic components of the gut “virome” within and across pairs where both cotwins manifest healthy growth. This program is perturbed (delayed) in both members of discordant pairs where one cotwin develops severe acute malnutrition and the other appears healthy by anthropometry. This developmental delay is not repaired by therapeutic foods. These age- and disease-discriminatory viruses may help define familial risk for childhood malnutrition and provide a viral dimension for characterizing the developmental biology of our gut microbial “organ.”