Not to be taken lightly

IN In the previous article in this two-part series, I described the many negative health effects of childhood obesity. For part two, we will turn our attention to the opposite side of the spectrum – children who are underweight.

The term “staggering growth” is used to describe children who are not growing at the rate expected for children of a similar age and gender. The World Health Organization (WHO) has standardized the definition of growth failure as two standard deviations (z-score of -2 to -3) below the mean for age and sex.

While we know that Malaysia holds the title of the most obese country in Southeast Asia, a 2018 Global Nutrition Report also ranks us as the worst in ASEAN in terms of nutrition. Outcomes of interest were a certain percentage of the population with stunting, anemia in women of reproductive age, and obesity. Within ASEAN, Malaysia is the only country to have fulfilled the three “burdens” listed above.

Local statistics estimate that in 2018, about 20% of our Malaysian children, or about 500,000 children, are stunted.

It has long been established that poor growth is strongly associated with long-term deficits in cognitive functioning and academic performance. The child’s development is delayed and the child is not able to reach their expected learning potential in school. Often the psychosocial issues that contribute to failing growth, including poverty and coming from a broken family, contribute to further restricting a child’s abilities.

Paradoxically, in low-income populations, early stunting is also a risk for later obesity due to poor diet leading to the double burden of undernutrition and then obesity. One possible explanation is that the struggling family may opt for a diet that is mostly high in carbohydrates and lacking in other necessary nutrients due to the high cost of living.

80% of cases of stunting are attributed to insufficient intake. This can be environmental (due to poverty), social (poor knowledge of proper nutrition, improper dilution of milk, child neglect, etc.) or related to feeding difficulties (medical conditions such as paralysis brain, cleft palate, etc.).

The remaining 20% ​​are due to increased caloric needs (eg in children after major surgery or with chronic illnesses) and inefficient use of calories (eg due to chronic diarrhoea/vomiting, children with diabetes, etc). This list is not exhaustive and there are in fact many possible medical causes for poor growth.

To identify failing growth, early recognition is best. During the first 2 years of life, all children have scheduled visits to health facilities for vaccinations, and it is during this time that routine measurements of weight, height and head circumference are taken. More than the absolute number of measurements, it is also necessary to take into account the evolution of the parameters. Beyond 2 years, it is recommended to have an annual visit to the clinic to measure growth until at least 5 years.

Early recognition and the first steps in managing failing growth do wonders to allow the child to grow healthily and reach their maximum potential.

Dr. Yeap is a Pediatrician attached to KPJ Sentosa KL. Through his articles, he aims to help increase public awareness of common issues associated with children’s health.