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How long does it take to reverse the effects of stunting in children under 24 months?

This question was posted the Infant and young child feeding interventions forum area and has 5 replies. You can also reply via email – be sure to leave the subject unchanged.

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Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

30 Apr 2015, 11:20

Does anyone know of any research or practical interventions that have investigated plausible time frames for the rehabilitation of children under the age of 24 months with stunting? I am trying to get an idea of how long it might take to reverse the effects of stunting in terms of sex-matched height for age.

Obviously in order to effectively address stunting, all key causes will need addressing in parallel. But assuming they are, the issue is complicated by the fact that growth is episodic, with long periods of stasis (between 2 and 63 days) punctuated by short phases of saltation (growth spurts), so that there is no growth during 90–95% of healthy infancy.

We know that effects of both severe and moderate acute MN can be reversed in a matter of weeks, whereby 60 days is usually set as a cut-off for non-response. But is there something similar for stunting? I am assuming the timeframe will differ for cases of severe stunting and moderate stunting, although maybe catch-up growth is more rapid in severe cases, so the overall timeframe may be similar. Or maybe timeframes will differ for both severe and moderate, but also by age groups i.e. severe stunting 0-6m, 6-12m, 12-24m and moderate stunting 0-6m, 6-12m, 12-24m.

Any guidance would be very much appreciated....

Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

19 May 2015, 08:39

I just wanted to re-post the above to see if anyone has any feedback. As a guestimate I'm thinking maybe 4-6mths would be an adequate timeline to use (in programmatic terms) to try to reverse the effects of stunting and elicit 'catch-up growth' in small children under 24m? Assuming long periods of stasis (~60days), 4 months would allow for at least 2 x episodes of growth + 'catch-up' and 6 months would potentially allow for ~3 x episodes. Does anyone have any thoughts on this issue?

Henry Allieu

Nutrition Prog Manager/International Medical Corps

Normal user

19 May 2015, 09:51

This website would be helpful:
www:unsystem.org/scn/archives/app19/ch09htm
Ref: Improving Child Growth - Consequences of poor growth (Paragraph 3)

Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

19 May 2015, 15:01

Dear Henry - thanks so much for posting the link but it appears the page has been removed, or name changed, as it's registering as temporarily unavailable. Would you be able to email me the paper directly: hbarthorp@goal.ie
Much appreciated.

Anonymous 2918

Nutrition Advisor/USAID

Normal user

19 May 2015, 15:29

Hello, My current position focuses almost entirely on stunting rather than on acute malnutrition. Here is what I have learned: Most of the stunting that takes place in the first 1000 days is irreversible, so the idea is more to prevent stunting than to reverse it. The 1000 day window is also when most stunting takes place, and at the same time, this is also when the most important physical and cognitive development in our lives happens, so that's why the focus is on pregnancy and children under two. Very limited evidence shows that stunting may be reversed and then only to a limited extent, provided the child is removed from the conditions that caused, which is not likely. In addition, some catch-up growth is also possible during the adolescent growth spurt. It's unclear whether any of this potential limited catch-up growth is relevant - it may not correct many of the problems related to stunting beyond short stature. Some researchers also feel the study methodology surrounding the limited evidence for catch-up growth was faulty.

Sonya LeJeune

Normal user

19 May 2015, 16:12

Hi

This is a pertinent question and clearly something that agencies are discussing.

I've asked around and it seems difficult to answer because apparently there have been few interventions (or good operational research attached to interventions) which have managed to achieve a significant effect on growth.

It seems that many interventions have recorded some effects but none have recorded large enough effects to see a complete reversal from stunted to non-stunted (especially for most severe stunting).

Points where some studies have limitations include -
If significant effects on stunting and wasting are demonstrated, does this also provide information on optimal levels of supplementation?
How was compliance?
What other treatment (eg medical) did the intervention group receive, and which could affect the results?

This question seems to be one that has mainly been asked at population rather than individual child level in the past...

Sorry not be of more help!

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