The incidence of stunted growth has increased in the past few years. As more and more children are being diagnosed with obesity and malnutrition, there has also been a proportional rise in the cases of stunted growth.

Being obese or not receiving adequate nutrition during the most crucial growth years in childhood are considered the common causes of stunted growth. With the rising incidence of these causes – obesity and malnutrition – it has become more important to keep a watch on your child’s growth and development and look out for the early warning signs of stunted growth.

It is important specifically for parents to be aware of the causes and symptoms of stunted growth so that they can adopt appropriate healthier measures to help support the growth of the child. They should also be aware of what stunted growth means in order to keep the child healthy and safe.

If you have a kid in his or her growth years, keep reading to learn more about stunted growth and how to spot it.

What is stunted growth?

Stunted growth refers to the impairment of proper growth and development of the body in children usually due to poor nutrition, inadequate psychological stimulation, or repeated infections.

The growth of children is defined as ‘stunted’ when their height-to-age ratio is more than 200 deviations below the Child Growth Standard median recommend by the WHO (World Health Organization). [1]

It is estimated that nearly 150 million children younger than 5 years of age are suffering from this problem.

Stunted growth affects the physical development of the child. It may also prevent the child from reaching his or her full cognitive potential upon attaining adulthood.

This indicates that the implications of stunted growth are not limited to the height or physical growth of the child. It may also affect their emotional and intellectual abilities. [2]

Stunted growth occurs due to the reduced rate of growth and development of the body. It is considered the primary manifestation of malnutrition as it can deprive the body of essential vitamins and minerals needed for the growth of bones, muscles, and other tissues.  

Recurrent infections like helminthiasis and diarrhea, especially in early childhood may also contribute to stunted growth, though in an indirect manner.

Malnutrition of the mother during the fetal development stage can also lead to stunted growth in the child.

Once stunted growth is established, its effects might become permanent. Children with stunted growth may never regain their lost height. Also, most children may never gain the proportional body weight.

Early spotting of stunted growth would enable you to seek appropriate therapeutic and preventive measures to restore the proper growth of your child.

Let us learn more about stunted growth, its effects, and causes. This information will help you assess your child’s risk of having stunted growth and help you spot it at the earliest stage before it is established fully.

What are the health effects of stunted growth?

The impact of stunted growth on the child’s development has been established in several studies.

Stunted growth can have a huge impact on the overall health and well-being of a child. The most common effect of stunted growth is a shorter stature.

The other common health implications include:

  • Delayed mental development
  • Poor academic performance
  • Reduced productivity at the workplace
  • Reduced cognitive functions like memory and attention span
  • Increased risk of recurrent illnesses and premature death
  • Women with a shorter stature may have an increased risk of complications during childbirth due to a smaller pelvis
  • Women with stunted growth have a higher risk of delivering a low birth weight baby

Stunted growth may sometimes be passed on to the next generations.  This form of inheritance is referred to as the intergenerational cycle of malnutrition.

Studies have also shown that children who are stunted at the age of 2 years have a higher risk of poor academic achievements in life, with subsequent inter-generational and socio-economic consequences. [3] [4]

Also, multi-country research studies have suggested that stunted growth could be associated with a reduction in schooling with decreased economic productivity. [5]

Stunted children are also likely to have a higher risk of chronic non-communicable diseases such as obesity and diabetes during adulthood. This indicates that stunted growth can be the cause as well as the effect of obesity.

It was specifically noted that stunted children who have a substantial weight gain after the age of 2 years have a higher chance of becoming obese. This risk could be attributed to the metabolic changes occurring in the body due to chronic malnutrition.

The lack of proper nutrition may also lead to severe metabolic imbalances, especially if the child is exposed to a poor diet even during adulthood.

This might lead to a higher risk of other related non-communicable disorders like hypertension, metabolic syndrome, coronary heart disease, and even stroke.

This indicates that the implications of stunted growth are not limited to the child’s height. It may affect the overall functioning of vital organs and even put your child at risk of serious life-threatening disorders.

This indicates why it is important for parents to be aware of the early warning signs of stunted growth to be able to spot it early.

If you notice these signs in your child, or if the relevant risk factors like the stunted growth of the mother exist, be alert and keep a close watch on your child’s growth so that you can spot the signs of stunted growth at an early stage.

What are the causes of stunted growth?

Being aware of the causes of stunted growth is a critical step for spotting the condition. It keeps you aware of your child’s risk of developing stunted growth and thus, enables you to be more watchful.

Let us have a look at the common causes responsible for stunted growth in children.

Stunting is more likely to occur during the first 1000 days of the child after his or her birth. Hence, the period spanning from conception to roughly the child’s 2nd birthday could be considered crucial for his or her growth and development.

Children living in unhygienic conditions are at risk of recurrent attacks of intestinal infections due to which they may have stunted growth. The intestinal infections cause loose motions due to which the body might lose a large share of essential vitamins and minerals. This could lead to malnutrition thus increasing the chances of having stunted growth.

Improper feeding practices, poor sanitation, and lack of adequate maternal nutrition might put your child at risk of stunted growth. Consider these risk factors as the warning signs and take steps to correct them in order to restore the healthy growth and development of your child.

Let us have a closer look at how these factors could affect the height and overall growth of your child.

Maternal nutrition

Inadequate breastfeeding and the lack of essential nutrients are the common causes of stunted growth. The diet of the child and the mother should comprise of all essential vitamins and minerals in recommended quantities in order to prevent undernutrition. [6]

Exclusive breastfeeding is usually recommended for the initial six months of life. This may be followed by a gradual reduction in the frequency of breastfeeding and a simultaneous increase in the complementary feeding of nutritious foods for children aged 6 months to 2 years.

Prolonged exclusive breastfeeding could lead to undernourishment of the child as breast milk alone may not be nutritionally sufficient for children above six months of age. [7]

Hence, there is a need to create awareness about the nutritional needs of children and the optimum periods of breastfeeding.

This could help mothers know the importance of starting complementary foods at the right age and allow them to make modifications in the child’s diet to ensure he or she does not suffer from malnutrition.

If you have been breastfeeding your child for longer than the recommended duration, it is advisable to consider this as a sign of a higher risk of stunted growth.

Poor nutritional status

Poor nutritional status of the mother during pregnancy and breastfeeding could lead to stunted growth of the child. Proper nutrition of the mother during the prenatal as well as postnatal period is essential for ensuring the baby has a healthy birth weight and childhood growth.

The prenatal causes of stunted growth are linked to maternal undernutrition.

A lower maternal BMI (body mass index) has been found to predispose the developing fetus to poor growth resulting in intrauterine growth retardation that is strongly associated with the low birth weight. [8]

Women who are anemic or underweight during pregnancy are also more likely to have children with stunted growth.

This may also perpetuate the intergenerational transmission causing the condition to recur even in the next generations.

It is possible to address these effects of prenatal undernutrition during the postnatal period through appropriate child feeding practices.

Women who have already given birth to a low birth weight baby in the past also need to be more cautious during the next pregnancy. They should improve their nutritional intake to avoid the risk of stunted growth in the next child.

Sanitation

There is a close link between the children’s height or linear growth and the sanitation practices of the household.

The ingestion of fecal bacteria by children while putting household items or soiled fingers in the mouth can lead to intestinal infections. This could affect the child’s nutritional status by reducing nutrient absorption, diminishing appetite, and increasing nutrient loss.

Recurrent diarrhea and worm infections like helminthiasis have been commonly linked to poor sanitation. These conditions are also known to contribute to stunted growth in children.

There is evidence that a condition linked to poor sanitation known as environmental enteropathy can also stunt the growth of children. Environmental enteropathy refers to a syndrome that causes abnormal changes in the small intestine of patients. It usually occurs due to the lack of basic sanitary facilities and frequent exposure to fecal contamination. [9]

Generally, the risk of stunted growth is more in children who have 5 or more episodes of intestinal infections with diarrhea before 2 years of age. It is easier to spot stunted growth if you know your child is exposed to these risk factors or causes.

Improvements in the safety of drinking water and adopting good handwashing and toilet use practices might reduce stunting in these cases.

The causes we discussed so far like nutrition and hygiene are preventable or modifiable to a large extent. There are some other factors that are not preventable. These factors are related to the hormonal imbalances occurring in children during the growth years.

Let us have a look at how to spot the stunted growth caused due to hormonal imbalances, specifically the deficiency of growth hormone.

What is Growth Hormone Deficiency?

The lack of adequate secretion of growth hormones is one of the most common unavoidable causes of stunted growth.

The signs and symptoms of growth hormone deficiency depend on the age of the person.

In adults, the growth hormone deficiency might cause a different set of symptoms compared to the children with the same condition.

Let us have a look at how to spot stunted growth linked to growth hormone deficiency.

The symptoms of growth hormone deficiency in children

The most common symptom of the deficiency of growth hormone in children is the shorter stature. If your child is significantly shorter than the children of his or her age, it could be due to the deficiency of this hormone.

Kids with growth hormone deficiency often grow less than two inches per year.

This difference is drastic considering that the children with normal levels of growth hormone usually grow about two and a half inches a year from the age of 1 year until puberty after which they grow by nearly 4 inches a year.

The signs of growth hormone deficiency in children include:

  • The face appears younger than the children of the same age
  • Delayed puberty
  • Increased fat deposition around the stomach or face
  • Mild chubbiness
  • Sluggish hair growth
  • Slower tooth development

The symptoms of growth hormone deficiency in adults

The common symptoms of growth hormone deficiency in adults tend to vary depending on their genetics, nutrition, and lifestyle.

The common symptoms of growth hormone deficiency in adults include:

  • Anxiety and depression
  • Decrease in sexual functions
  • Baldness in men
  • Decreased muscle strength and mass
  • Reduced memory
  • Difficulty in concentrating
  • Heart problems
  • Fatigue and extreme tiredness
  • Insulin resistance
  • Elevated triglyceride levels
  • High levels of LDL “bad” cholesterol
  • Reduced bone density
  • Reduced tolerance to exercises
  • Low energy levels
  • Increased sensitivity to cold and heat
  • Dry and thin skin

Other causes and symptoms of stunted or delayed growth

The presence of risk factors like maternal malnutrition, lack of hygiene, or growth hormone deficiency point to the diagnosis of stunted growth.

Here are a few more causes and signs that will help you spot stunted growth.

  • A family history of short stature: If parents or any other family member have short stature due to the deficiency of growth hormone, the child may grow at a slower rate resulting in stunted growth.
  • Constitutional growth stunting: Some children may have a delayed “bone age”, which means their bones might mature at a rate slower than what is normal for their age. Children with this issue may reach puberty at a later age. So, they may have a below-average height in their early teenage years, though they might catch up with their peers later in adulthood.
  • Hypothyroidism: Children with an underactive thyroid gland due to a condition called hypothyroidism may have stunted growth. The thyroid plays a vital role in releasing hormones that promote growth. So, stunted or delayed growth is possible in children with an underactive thyroid.

If a child has a low level of thyroid hormones like thyroxine due to hypothyroidism, he may show signs like loss of energy, dry skin, constipation, dry hair, and difficulty in staying warm.

  • Turner syndrome: It is a genetic condition known to affect the growth of the body. Children with Turner syndrome may have normal amounts of growth hormone. However, their body is unable to use it effectively due to which their growth is affected.
  • Down syndrome: It is a genetic condition characterized by stunted growth and the lack of development or proper functioning of vital organs.
  • Skeletal dysplasia: Skeletal dysplasia refers to a group of conditions that can cause problems with the growth of the bones due to which the patient may have stunted growth. 
  • A growth delay could be diagnosed in a child if the rate of increase in his or her height seems to be slower.
  • If the child has a certain form of dwarfism, the size of his or her arms and legs could be out of proportion to the torso.
  • If the child has a low level of thyroid as well as growth hormones, it might be evident in the form of lack of proportional growth of the face, causing him or her to look abnormally younger than the actual age.
  • If the delayed growth is the result of stomach or bowel diseases, the child may have blood in stools, diarrhea, vomiting, constipation, and nausea.

Conclusion

The key to spotting stunted growth is to be aware of the common cause and symptoms. Being aware of the factors that can contribute to the stunting of growth would help you assess your child’s overall growth and development and enable you to spot the problem at an earlier stage.

Spotting stunted growth at an earlier age and identifying its causes would help you seek appropriate measures to restore the normal growth of your child.

References:

  1. https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN
  2. https://www.powerofnutrition.org/the-impact-of-stunting/
  3. https://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf
  4. https://www.thelancet.com/series/maternal-and-child-nutrition
  5. https://www.thelancet.com/series/maternal-and-child-undernutrition
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050870/
  7. https://journals.sagepub.com/doi/10.1177/156482659902000203
  8. https://pubmed.ncbi.nlm.nih.gov/25830938/
  9. https://www.susana.org/en/knowledge-hub/resources-and-publications/library/details/1794
Author

I am a doctor and working as a research based Medical Writer and Editor for more than 8 years. Passion for writing and an excellent medical background are my strong points. I love to combine my two passions into a profession wherein I can write professional articles in the field of medicine, health, and nutrition.​