Understanding and How to Prevent Stunting in Children

Understanding Stunting

Stunting is a condition when a child’s height is shorter than the age standard due to long-term malnutrition. This condition can be caused by malnutrition experienced by the mother during pregnancy or by the child during his growth period. A child’s body posture is influenced by various factors, such as genetics, hormones and nutritional intake. Therefore, there are children who are short because their parents are also short. However, stunting is different from short stature. Children with stunting definitely have a short body, but children with a short stature do not necessarily have stunting.

Based on WHO data, a country is said to be experiencing a stunting problem if the number of cases is above 20%. Meanwhile, based on 2018 data, the number of stunting cases in Indonesia was 30.8%, or three out of ten Indonesian children. Therefore, stunting is still a problem that must be addressed immediately.

Causes of Stunting

The main cause of stunting is long-term (chronic) malnutrition. This lack of nutritional intake can occur while the baby is still in the womb because the mother does not meet nutritional needs during pregnancy. According to WHO, around 20 percent of stunting occurs when the baby is in the womb. The trigger is inadequate nutritional intake. As a result, fetal growth becomes stunted.
Apart from that, children whose nutritional needs are not met during their growth and development can also experience stunting. Children need to get adequate nutrition in the first 2 years of life. This is because a lack of nutritional intake such as protein, zinc and iron is the main factor causing stunted physical growth in children. Inadequate nutritional needs for children are usually caused by inappropriate breastfeeding positions, not getting exclusive breast milk or poor quality complementary foods.

Stunting Risk Factors

The risk of stunting in children can increase if the pregnant mother has the following conditions or factors:

1. Intrauterine growth restriction (IUGR) A condition when the baby does not grow to a normal weight during pregnancy.
2. Short stature.
3. The mother does not gain weight during pregnancy.
4. Low education level.
5. Poverty.
6. Living in an environment with poor sanitation and not having access to clean water.

Meanwhile, in children, several conditions that increase their risk of experiencing stunting are:

1. Not getting exclusive breast milk.
2. Getting poor quality MPASI nutrition.
3. Experiencing neglect.
4. Suffering from diseases that prevent the absorption of nutrients, such as tuberculosis, anemia, congenital heart disease, chronic infections, and malabsorption syndrome.

Stunting Symptoms

Symptoms of stunting are often not recognized, because children are only suspected of having a short body. However, symptoms of stunting can generally be seen when a child is 2 years old.
Symptoms that indicate a child is stunting are:

1. The child’s body is shorter than the standard height for children his age.
2. The child’s weight may be lower for his age.
3. Stunted bone growth.
4. Easily hurt.
5. Learning disorders.
6. Growth and development disorders.

If you suffer from a chronic disease, children with stunting can experience a number of the following symptoms:

1. Not actively playing.
2. Chronic cough, fever, and night sweats.
3. The child’s body turns blue when crying (cyanosis).
4. Often weak.
5. Hard to breathe.
6. Clubbing finger, the tip of the finger or nail is shaped like the back of a spoon (widened and bent).
7. The baby cannot breastfeed well.

Go to the doctor immediately if your child’s height seems shorter than that of children his age, especially if the child experiences the symptoms mentioned above. Apart from that, children’s height, weight and growth and development checks need to be routinely carried out by a doctor or checked at the posyandu. For children under 2 years old, examinations need to be carried out every 1-2 months. Meanwhile, examinations for children aged over 2 years are carried out once every year.

Stunting Treatment

To make a diagnosis, the doctor will ask questions about the child’s food intake, history of breastfeeding, history of pregnancy and childbirth, and the environment where the child lives. After that, the doctor will carry out a complete physical examination to look for signs of stunting in the child.
The doctor will also measure the child’s length or height, weight, head circumference and arm circumference. A child can be suspected of experiencing stunting if his height is below the red line (-2 SD) based on the WHO growth curve.

However, this examination needs to be carried out several times to determine whether the child is stunting. To confirm the diagnosis, the doctor will also carry out supporting examinations including:

1. Blood tests, to detect health problems, such as tuberculosis, chronic infections, or anemia.
2. Urine test, to detect white blood cells in the urine which can be a sign of infection.
3. Stool examination, to check for parasitic infections or lactose intolerance in babies or children.
4. Echocardiography or ultrasound of the heart, to detect congenital heart disease.
5. Chest X-ray, to see the condition of the heart and lungs.
6. Mantoux test, to diagnose TB disease.

Handling stunting can include treating the disease that causes it, improving nutrition, providing supplements, and implementing a clean and healthy lifestyle. The following are actions that a doctor can take:

1. Treating the underlying disease, for example giving anti-tuberculosis drugs if the child suffers from TB.
2. Provide additional nutrition, in the form of foods rich in animal protein, fat and calories.
3. Provide supplements, in the form of vitamin A, zinc, iron, calcium and iodine.
4. Advise families to improve sanitation and implement clean and healthy living behavior (PHBS), in order to achieve a healthy family.

Stunting Complications

Stunting that is not treated immediately can cause complications in the form of:

1. Disorders of children’s brain development disrupt the learning process and reduce their achievement.
2. Metabolic diseases in adulthood, such as obesity and diabetes.
3. Children often get sick and get infections.

Stunting Prevention

Stunting can be prevented by avoiding factors that can increase the risk. Efforts that can be made include:

1. Fulfill adequate nutritional intake before planning a pregnancy and during pregnancy.
2. Carry out regular pregnancy checks.
3. Carry out the delivery process at a health facility.
4. Adequate nutritional intake, especially during the first 1,000 days of life, namely from fertilization of the egg until the child is 2 years old.
5. Provide exclusive breastfeeding until the baby is 6 months old.
6. Ensure children receive complete immunization.
7. Monitor child growth and development.
8. Stimulate children’s development from an early age.