in In the previous article of this two-part series, I outlined the many negative health effects of childhood obesity. For the second part, we’ll turn our attention to the other side of the spectrum – children who are underweight.
The term “stunted growth” is used to describe children who do not grow at the rate expected for children of the same age and sex. The World Health Organization (WHO) has standardized the definition of faltering growth as two standard deviations (z-score from −2 to -3) below mean age and sex.
While we know Malaysia holds the title of the fattest country in Southeast Asia, the 2018 Global Nutrition Report also ranks us as the worst in ASEAN in terms of nutrition. The criteria of interest were a certain proportion of the population with stunted and anemic women of reproductive age and obesity. In ASEAN, Malaysia is the only country reported to meet all three of the above “burdens”.
Local statistics estimate that in 2018, nearly 20% of our Malaysian children, or about 500,000 children, are experiencing faltering growth.
It has long been shown that poor growth is closely related to long-term deficits in cognitive functioning and academic performance. The child’s development is delayed and the child cannot achieve his expected educational potential in school. Oftentimes, psychosocial problems that contribute to faltering development, including poverty and resulting from a broken family, play a role in further limiting a child’s abilities.
Paradoxically, early growth stunting in low-income populations also presents a risk of later obesity due to improper nutrition resulting in a doubling of the burden of undernutrition and then obesity. A possible explanation is that the troubled family may choose a diet that is primarily high in carbohydrates and lacks other necessary nutrients due to the high cost of living.
80% of faltering growth cases are due to inadequate intake. This may be environmental (due to poverty), social (poor knowledge of proper diet, inadequate milk dilution, child neglect, etc.), or related to feeding difficulties (medical conditions such as cerebral palsy, cleft palate, etc.).
The remaining 20% is due to increased calorie demand (eg in children after major surgery or chronic disease) and ineffective use of calories (eg due to chronic diarrhea/vomiting, children with diabetes etc.). This list is not exhaustive and there are actually many potential medical causes for stunted growth.
In identifying faltering growth, early identification is best. During the first two years of life, all children have scheduled visits to health care facilities for vaccinations, during which time routine measurements of weight, height and head circumference are taken. More than just the absolute number of measurements, the trend of the parameters must also be taken into account. After the age of 2 years, an annual clinic visit is recommended to measure growth until at least 5 years of age.
Early recognition and early steps in managing faltering growth work wonders in allowing a child to grow up healthily and reach their fullest potential.
Dr. Yip is a pediatrician attached to KPJ Sentosa KL. Through his articles, he aims to help raise public awareness of common issues related to children’s health.