Linear growth in early childhood is a strong marker of healthy growth and is also closely linked with child development in several domains including cognitive, language and sensory-motor capacities. Stunting indicates linear growth retardation that has been estimated to affect >30% of children aged <5 years of age.¹ Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median.  

Stunting is a result of chronic or recurrent undernutrition, usually associated with poor health and nutrition, frequent illness and/or inappropriate feeding and care in early childhood.² The major causes of stunting (linear growth retardation) are^3,4:

• Recurrent infections 

• Poor nutrient intake, absorption or utilization 

• Micronutrient deficiencies 

• Biological factors: Fetal growth restriction; maternal height 

Cognitive Function in Early Childhood

The preschool and school years are periods during which considerable learning occurs and higher cognitive functioning and skills needed for success emerge. It is a time of rapid and dramatic changes in the brain plasticity, and of fundamental acquisition of cognitive development and interpersonal skills. Both the learning environment and nutrition (including availability of protein, essential fatty acids, and micronutrients) during early childhood can influence brain functions such as neurogenesis, migration, cell division, myelination, and synaptic development and thus influence later intellectual and mental health outcomes.¹

Outcomes Associated with Underweight and Stunting¹: 

1. Delays in cognitive ability
2. Poorer attention
3. Poorer social relationships at school age

 Importance of Adequate Nutrition During Catch-up Growth^5-9

• Better nutritional and therapeutic regimens provide effective and safer catch-up growth in children with malnutrition and growth abnormalities 

• Attained height is the result of the interaction between genetic endowment and nutrient availability during the growth period 

• Both macronutrients and micronutrients help in the formation of “building blocks” for growth 

• Arginine promotes the multiplication of cells and help bones grow longer and increases height by +0.33cm in a year 

• Evidence indicates that catch-up growth can be achieved despite of stunted growth in infancy 

• A meta-analysis including 29814 children from 20 developing countries suggested that nutritional supplementation could improve children’s cognitive development 

Approximately 40% to 60% of adult bone mass is accrued during the adolescent years, with 25% of peak bone mass acquired during the 2-year period around peak height velocity.¹⁰ Hence, nutritional supplements have been recognized as the most suitable method of improving growth and physical health of children in developing countries. They are also crucial for early development including cognition.⁹ Thus, intervention at an early age is required to prevent irreversible changes during growth of child, by improving the intake of growth-limiting nutrients, including administration of micronutrient supplements, fortification of food with micronutrients or improved dietary intake.