Healthy Growth and Development
What is stunting?
The goal of early nutrition is to ensure survival and the achievement of one’s full potential for growth and development. To stunt means to hinder growth, to dwarf. The external manifestation of stunting is an attained size, specifically height, that is below the limits of normal variation among children of a given age and sex. Less easily detectable are functional deficits related to sub-optimal development of the brain and other organs, which affect different abilities such as language, learning, psychosocial behaviour and work capacity.
The most direct causes of stunting are adequate nutrition (insufficient food intake or consumption of foods lacking in essential growth-promoting nutrients) and recurrent infections or chronic diseases (which cause poor nutrient intake, poor absorption and utilization, or other forms of nutrient loss). Delays in functional development for a young child can result from lack of psychosocial stimulation and nurturing, limited opportunities to play, learn and interact with the environment, and abuse or neglect.
Policy brief
Global nutrition targets 2025: stunting policy brief
Stunting in a nutshell videos
The Healthy Growth Project
Promoting Healthy Growth and Preventing Childhood Stunting is a project coordinated by the WHO Department of Nutrition and funded by the Bill and Melinda Gates Foundation.
Among its aims are to develop tools and a framework to support countries in setting and implementing stunting reduction agendas; help shift focus from underweight to stunting as the indicator for tracking undernutrition; highlight the association between undernutrition in early life and later development of overweight/obesity, with attendant risk of non-communicable diseases; and contribute to the achievement of the 2012 World Health Assembly stunting reduction targets (Resolution WHA 65.6).
Recognition that nutrition-sensitive interventions also are critical for stunting prevention has broadened the scope of candidate actions for stunting reduction. Therefore, in addition to improved complementary feeding, interventions to strengthen food systems, promote healthy diets, improve maternal health, water supplies, sanitation and hygiene are among the multi-faceted actions being undertaken to address stunting.
Project activities include:
- Analysis of data on global trends and determinants of growth indicators
- Collaborating with global and country-level partners to set and implement national stunting reduction agendas
- Supporting countries to roll out the WHO Child Growth Standards while promoting best practices for growth assessment and counselling on infant and young child feeding
MCN Supplements
Promoting healthy growth and preventing childhood stunting: a global challenge
The World Health Organization's global target for reducing childhood stunting by 2025: rationale and proposed actions
Contextualising complementary feeding in a broader framework for stunting prevention
Multi-sectoral interventions for healthy growth
Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study
The economic rationale for investing in stunting reduction
The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction
Key principles to improve programmes and interventions in complementary feeding
Designing appropriate complementary feeding recommendations: tools for programmatic action
Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam
The conceptual framework
Childhood Stunting: Context, Causes and Consequences is the title of the conceptual framework that summarizes three levels of issues associated with stunted growth and development. It is a direct product of the Healthy Growth Project.
Building on the UNICEF conceptual framework on causes of malnutrition, this adaptation places stunted growth and development at the core, because they share common causes and the period from conception to age 24 months is highly sensitive for both. Strategies that promote and protect healthy growth are likely to benefit children’s physical, mental, socio-emotional, and intellectual growth and development.
Stunting in childhood has concurrent, short-term and long-term consequences affecting health and human capital development. The consequences include poor cognition and educational performance, low adult wages, and lost economic productivity. Stunting followed by excessive weight gain in later childhood leads to increased risk of nutrition-related chronic diseases in later life.
Among the immediate causes of stunting, the framework gives prominence to complementary feeding without minimizing the importance of breastfeeding. Maternal factors that could exert a trans-generational influence or directly impact the offspring’s growth and development in the first 1000 days are highlighted. The home environment section expands on care needs; that is, the home should ideally provide a supportive, clean, safe and stimulating environment to adequately nurture both mother and child.
The context layer (community and societal factors) expands on the underlying and basic causes of malnutrition illustrated in the UNICEF framework. Sectors highlighted here are home to the stakeholders responsible for nutrition-sensitive programmes, which have a critical role to play in stunting reduction.
10 Steps to successful growth assessment and counselling
Take genuine interest in the child (look at him, smile, call him by name) to help him trust and feel safe with you. This is reassuring for the mother too.
Observe how the child and mother are interacting and look for signs of what may require more attention.
Explain to the mother why you’re taking measurements and that you need her help to do them correctly. Guide her to help you.
Plot the measurements on the chart, show it to the mother and explain to her how her child is growing. Link this conversation to the child’s feeding, care, protection and stimulation.
Compliment the mother for the behaviours she is putting into practice to promote healthy growth and development.
When discussing possible causes of poor growth, engage the mother fully in the conversation and let her identify some potential causes herself.
Listen to her with empathy, and encourage her to take the action that’s within her means.
Work together with her in defining feasible steps to help improve child’s growth and development.
Limit your advice to 2 or 3 actions for improved care and feeding that are most important and feasible.
Ask checking questions to ensure that the mother understands the recommendations and then set a general goal for improved growth for the child’s next visit.
Publications
Setting and implementing national stunting reduction agendas
The causes of stunting extend beyond hunger and food availability, and its consequences prevent communities and nations from achieving their social and economic development aspirations. Stunting affects physical growth, and is interrelated with morbidity and mortality in childhood, cognitive and motor development, learning capacity, school performance, adult productivity, reproductive health, and non-communicable disease risk in later life. Investing in stunting reduction is arguably a sustainable way to boost national development by increasing economic productivity and lowering health expenditures.
The collective task of attaining global nutrition targets depends on the quality and resourcing of the plans made and implemented at country level, as long as the political will, resources and capacity to reduce stunting exist. These efforts should measure up to the national burden in all its complexity – how many under-fives are stunted? Where do they live? What are the determinants of stunting in specific contexts? The causes of stunting are rooted in varied sectors, calling for cross-sector and trans-disciplinary approaches to adequately address the problem. Similarly, vertical coherence is required among inter-dependent initiatives at national, subnational and grassroots levels.
Successful national coordination consists in, i) creating enabling policy environments and governance structures to direct and support multiple stakeholder collaboration; and ii) empowering and equipping implementers to translate policies into action. Subnational implementation needs strategic and operational capacity in order to deliver appropriate and timely services to the constituencies served on behalf of governments and other entities. Participation by households and communities as partners is critical because the most important actions – with a direct impact on stunting prevention – are undertaken by caregivers at household level.
Communities need to be sensitized to the causes and consequences of stunting and to caregivers’ role as the main protagonists of healthy child growth and development (providing appropriate feeding, care and stimulation). Subnational service provision infrastructures should be strengthened to deliver high quality preventive and curative health services, safe water supplies, education, services in agriculture and environmental and social protection, etc. In turn, service providers at this level should be able to count on the central level for the supplies, skills and motivation required to fulfil their role.
Publications
Childhood stunting: challenges and opportunities
