Let Us Talk about Stunting

Let Us Talk about Stunting Three decades ago, studies on malnutrition primarily focused on the weight of a child. Lengths and heights were measured, and deficits noted, but not with the same rigor as was weight. Protein energy malnutrition was graded with reference to the weight for age. The undernourished and wasted child was noted as being at risk of higher morbidity and mortality. Treatment of an infant or child with acute moderate or acute severe malnutrition was addressed. It was not so with stunting. Over the past two decades, there is an increased awareness of the importance of lengths and heights of infants and young children, from birth to age 5 years, and the importance of stunting is better recognized. There are 161 million stunted children in 2013, and about half live in Asia and over one-third in Africa. When a child is subjected to a deficit in caloric intake, there is a drop in weight. When the deficit is chronic, there is a reduction in the velocity of growth, resulting in stunting. Stunting is defined as a falling  < −2 SD from the length-for-age/height-for-age (HAZ) WHO growth standards, and severe stunting as a value  < −3 SD of length/height for age. Stunting indicates that the malnutrition has gone on for an extended period. The prevalence of stunting in a community is a marker of social inequalities. The pattern of stunting in early childhood shows that the stunting process starts in utero. Low birth weight is the single most important predictor of stunting at 12 months of age. The period from conception to the second birthday (the first 1000 days) is a critical period during which stunting occurs. If the stunted child is a girl, the process is perpetuated. There is an intergenerational effect as well. If the mother is short, she may produce a small baby, and the low birth weight then impacts on the infant’s growth. Stunting is the most prevalent form of childhood malnutrition. It is important for us to recognize this and draw attention to it, as the effects and consequences of the stunting are not apparent when one looks at the child. There is no acute clinical effect of stunting, and in truth, the stunted child may be part of a community of stunted children, and the short stature is more the norm than an exception. The causes of stunting, like that of other forms of malnutrition, are complex, multifactorial and intertwined. The web of causation is complex and includes maternal factors such as breastfeeding practices, poor quality of complementary feeds and inadequate feeds and poor diet diversity. The web also includes socioeconomic factors such as lower literacy levels and water sanitation and hygiene. The consequences of stunting are thought to be short term and impacting on the child’s health; and long term, with poorer performance, productivity and earning capacity of the adult who was stunted in childhood [1]. The practicing pediatrician does not notice, or address stunting with the same intensity of care that he would provide a child with severe acute malnutrition. It is easy to take fairly accurate measures of weights, with some training. Measuring lengths and heights is more difficult, and needs more training. Good quality infantometers and stadiometers are not easily available, and the ones that are good are priced out of reach of the average clinic. This situation has to change. It is only in the past few years that stunting has gained recognition, and it is important that we capitalize on this recognition and make stunting the public health issue that it is. In 2012, the World Health Assembly endorsed a plan to improve maternal, infant and young child nutrition by 2025 [2]. The first target: A 40% reduction is observed in the number of stunted children aged < 5 years. To achieve this target, a multidisciplinary effort and multisectoral effort are required. As clinicians, we can focus on providing care to safeguard the first 1000 days of a baby’s life—from conception to the second birthday [3]. Every baby that thrives takes us closer to achieving the 40% reduction target. Together, we can make it happen. REFERENCES 1 de Onis M , Branca F. Childhood stunting: a global perspective . Matern Child Nutr 2016 ; 12 (Suppl 1) : 12 – 26 . Google Scholar CrossRef Search ADS PubMed 2 WHA Global Nutrition Targets 2025: Stunting Policy Brief. WHO/Antonio Suarez Weise. http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf (10 September 2017, date last accessed). 3 Stunting – the 1000 days. https://thousanddays.org/the-issue/stunting/ (10 September 2017, date last accessed). © The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Tropical Pediatrics Oxford University Press

Let Us Talk about Stunting

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Publisher
Oxford University Press
Copyright
© The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com
ISSN
0142-6338
eISSN
1465-3664
D.O.I.
10.1093/tropej/fmx104
Publisher site
See Article on Publisher Site

Abstract

Three decades ago, studies on malnutrition primarily focused on the weight of a child. Lengths and heights were measured, and deficits noted, but not with the same rigor as was weight. Protein energy malnutrition was graded with reference to the weight for age. The undernourished and wasted child was noted as being at risk of higher morbidity and mortality. Treatment of an infant or child with acute moderate or acute severe malnutrition was addressed. It was not so with stunting. Over the past two decades, there is an increased awareness of the importance of lengths and heights of infants and young children, from birth to age 5 years, and the importance of stunting is better recognized. There are 161 million stunted children in 2013, and about half live in Asia and over one-third in Africa. When a child is subjected to a deficit in caloric intake, there is a drop in weight. When the deficit is chronic, there is a reduction in the velocity of growth, resulting in stunting. Stunting is defined as a falling  < −2 SD from the length-for-age/height-for-age (HAZ) WHO growth standards, and severe stunting as a value  < −3 SD of length/height for age. Stunting indicates that the malnutrition has gone on for an extended period. The prevalence of stunting in a community is a marker of social inequalities. The pattern of stunting in early childhood shows that the stunting process starts in utero. Low birth weight is the single most important predictor of stunting at 12 months of age. The period from conception to the second birthday (the first 1000 days) is a critical period during which stunting occurs. If the stunted child is a girl, the process is perpetuated. There is an intergenerational effect as well. If the mother is short, she may produce a small baby, and the low birth weight then impacts on the infant’s growth. Stunting is the most prevalent form of childhood malnutrition. It is important for us to recognize this and draw attention to it, as the effects and consequences of the stunting are not apparent when one looks at the child. There is no acute clinical effect of stunting, and in truth, the stunted child may be part of a community of stunted children, and the short stature is more the norm than an exception. The causes of stunting, like that of other forms of malnutrition, are complex, multifactorial and intertwined. The web of causation is complex and includes maternal factors such as breastfeeding practices, poor quality of complementary feeds and inadequate feeds and poor diet diversity. The web also includes socioeconomic factors such as lower literacy levels and water sanitation and hygiene. The consequences of stunting are thought to be short term and impacting on the child’s health; and long term, with poorer performance, productivity and earning capacity of the adult who was stunted in childhood [1]. The practicing pediatrician does not notice, or address stunting with the same intensity of care that he would provide a child with severe acute malnutrition. It is easy to take fairly accurate measures of weights, with some training. Measuring lengths and heights is more difficult, and needs more training. Good quality infantometers and stadiometers are not easily available, and the ones that are good are priced out of reach of the average clinic. This situation has to change. It is only in the past few years that stunting has gained recognition, and it is important that we capitalize on this recognition and make stunting the public health issue that it is. In 2012, the World Health Assembly endorsed a plan to improve maternal, infant and young child nutrition by 2025 [2]. The first target: A 40% reduction is observed in the number of stunted children aged < 5 years. To achieve this target, a multidisciplinary effort and multisectoral effort are required. As clinicians, we can focus on providing care to safeguard the first 1000 days of a baby’s life—from conception to the second birthday [3]. Every baby that thrives takes us closer to achieving the 40% reduction target. Together, we can make it happen. REFERENCES 1 de Onis M , Branca F. Childhood stunting: a global perspective . Matern Child Nutr 2016 ; 12 (Suppl 1) : 12 – 26 . Google Scholar CrossRef Search ADS PubMed 2 WHA Global Nutrition Targets 2025: Stunting Policy Brief. WHO/Antonio Suarez Weise. http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf (10 September 2017, date last accessed). 3 Stunting – the 1000 days. https://thousanddays.org/the-issue/stunting/ (10 September 2017, date last accessed). © The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Journal of Tropical PediatricsOxford University Press

Published: Jan 5, 2018

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