Stunting

Stunting is impaired linear growth, defined as height for age Z score below minus 2 relative to WHO growth standards. Severe stunting is below minus 3.

It reflects chronic or recurrent nutritional deprivation, infection and adverse environmental exposures rather than acute weight loss.

Stunting during the first 1000 days of life is particularly important because it is associated with impaired neurodevelopment, reduced educational performance and long term metabolic consequences.

The child is short for chronological age, often without the striking wasted appearance seen in acute malnutrition.

Associated findings may include:

• Poor developmental progress
• Recurrent infection
• Micronutrient deficiency
• Delayed motor development
• Low weight if wasting coexists

Markedly disproportionate short stature, dysmorphic features or preserved or increased weight despite poor height gain should trigger assessment for genetic, endocrine or skeletal disease.

• Measure recumbent length below 2 years and standing height thereafter.

• Plot height for age using WHO standards.

• Assess parental heights, birth history, growth trajectory and nutrition.

• Evaluate for chronic gastrointestinal, cardiac, renal, infectious or endocrine disease where indicated.

• Consider thyroid function, coeliac serology, FBC, renal function and other investigations when growth pattern is not readily explained nutritionally.

• Improve diet quality, protein and energy adequacy rather than focusing on one isolated nutrient.

• Continue breastfeeding and age appropriate complementary feeding.

• Treat chronic infection, diarrhoeal disease, parasitic disease and micronutrient deficiencies.

• Address environmental contributors including recurrent infection and poor sanitation.

• Children with severe or unexplained stunting require assessment for chronic medical disease and developmental consequences.