The 8 Things That End Childhood Too Soon: What Clinicians Should Know

Interviewer: Laurie Scudder, DNP, NP; Interviewee: Richard Bland, JD

Disclosures

June 30, 2017

In This Article

Malnutrition and Stunting: Around the Globe and in the United States

Medscape: Rates of stunting have improved globally, but this irreversible outcome of chronic malnutrition in the first 1000 days of life still affects almost one quarter of all kids younger than 5 years. Can you describe the degree of malnutrition that results in growth stunting, and the interventions that have shown some success?

Mr Bland: Stunting occurs because of chronic malnutrition. Some of the factors that contribute to risk include the child's weight at birth, how they're fed as infants, whether they suffer frequent bouts of disease, the quality of their diet, and the quality of their mother's diet during pregnancy.

We see a lot of overlap with stunting and infant mortality. Two thirds of the world's stunted children live in just 10 countries: India, Pakistan, Nigeria, Indonesia, China, Ethiopia, the Democratic Republic of Congo, Bangladesh, the Philippines, and Tanzania.

Malnutrition, like poverty, can be a vicious cycle, in which the girls who are malnourished and stunted as children grow up to have babies themselves who are malnourished and stunted.

The catalyst is oftentimes a mother who is malnourished and can't get the nutrition she needs to support her baby's growth during pregnancy. It is heart-wrenching because malnutrition, like poverty, can be a vicious cycle, in which the girls who are malnourished and stunted as children grow up to have babies themselves who are malnourished and stunted. And so this vicious cycle of intergenerational malnourishment and poverty go hand in hand, with children from poor families much more likely to be stunted than those from wealthy families. We see this intergenerational pattern with many childhood-enders. Some childhood-enders, such as malnutrition, can lead to other childhood-enders, including death or adolescent pregnancy.

I think it's illustrative to take a look at stunting data from just one country. In India, 29% of children younger than 5 years, or 1.3 million kids, are suffering from stunted growth. But the highest rates are found in the poorest areas, mostly populated by ethnic minority groups, where up to 40% of children are stunted.

What we see time and time again with childhood-enders is that it is an issue of inequity. At Save the Children, we believe that every last child deserves the opportunity to live, learn, and be protected. Yet, because of these fundamental inequities around the globe both between countries and within countries, we will not reach every last child until we bring more attention to such issues as stunting and the inequities within countries.

Deng, age 7, was separated from his mother during violence in South Sudan. Photo by Jonathan Hyams/Save the Children

Stunting is horrific, in that it hinders a child's brain development. Children who are stunted often perform poorly in school, leading to fewer professional opportunities later in life, further contributing to the cycle of poverty. It's also often impossible to mitigate once it occurs.

But, of note, stunting can be prevented on the front end. So Save the Children works with partners at all levels to address malnutrition with a wide range of integrated interventions and programs to mothers and children, largely delivered through health workers and community volunteers.

First, we support mothers' groups that educate women about nutrition during pregnancy and effective feeding and care practices for infants and toddlers, including breastfeeding, food preparation, and hygiene. Second, we support regular community-based growth monitoring and promotion activities. Third, we distributes micronutrients to targeted households that are most at risk. And finally, we make sure families that are at risk have prompt access to appropriate healthcare for child illnesses, such as diarrhea.

Medscape: What about malnutrition and food insecurity here in the United States? Although we fortunately only rarely see stunting, we do still see serious effects from lack of food. In your opinion, is hunger in the United States a healthcare issue?

Mr Bland: We absolutely believe that hunger is a healthcare issue here in the United States. We know that kids living with food insecurity are more likely to be in poor health, with higher rates of cardiovascular disease, high blood pressure, and diabetes, and other physical and mental health conditions down the line, which lead to higher healthcare expenses. Unequivocally, hunger is a healthcare issue.

But it's also an education issue. In the United States, Save the Children was founded in Appalachia during the Depression. What we discovered while trying to help children in eastern Kentucky during that time was that children in school could not learn if they hadn't eaten. Although that knowledge is kind of fundamental to many of us in 2017, it was not recognized during the 1930s. Yet, to this day, children here at home are suffering from hunger at an alarming rate. That means that it's both a healthcare issue and an education issue.

Food insecurity rates for children across America remain very high, with 20% of all children living in households lacking access to adequate food sometime during the year.

Food insecurity rates for children across America remain very high, with 20% of all children living in households lacking access to adequate food sometime during the year. That means millions of families across the country are struggling to put healthy food on their table. And nearly 550,000 US kids live in households with severe food insecurity, regularly going hungry or missing a meal. Or, if they are eating, they may be regularly forced to fill up on cheap, empty calories.

There are some interventions that Save the Children is investing in with many of our nonprofit organizational partners. In the United States, we have a program called Healthy Choices which partners with underserved schools in some of the poorest counties in America. We rely on research to pair physical activity with health education for these children to try to incorporate lifelong healthy habits.

But have no doubt: Many children in the United States are suffering from hunger. And that inevitably leads to healthcare problems and educational struggles.

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