NNIW95: Growth faltering: Underweight and stunting

The great majority of attention on growth faltering concentrates on the first ‘1000 days’ with a much lesser focus on toddlers and young pre-schoolers. The rationale for this is understandable since the first 1000 days covers the period of most rapid growth and changes in body composition, the period of breastfeeding and the complex transition from breast-feeding and weaning to complementary feeds, and then moving to the family/adult diet. There has also been a strong perception that, once a child has become stunted or wasted in the first 2 years of life there is little hope of recovery; an assumption we address below. This paper will describe the timing of the development of stunting and wasting, addressing three critical periods: intergenerational, in utero and in early post-natal life. The question of whether toddlers and young pre-schoolers can recover from stunting and wasting will also be addressed; our own studies suggest that a degree of recovery is certainly possible. The hormonal mechanisms regulating early growth will be examined. Finally, the issue of whether toddlers and young pre-schoolers should have special foods and diets will be discussed.