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Explainer: What you should know about childhood malnutrition

What just happened?

The United Nations Children's Fund (UNICEF) recently published its flagship report, The State of the World’s Children 2019, examining the immense risks posed by malnutrition. According to the report, across the globe 1 in 3 children under the age of 5 is not getting the nutrition they need to grow well.

What is malnutrition?

Malnutrition is a lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to process the nutrients in the food that one does eat. According to UNICEF, the “triple burden of malnutrition” is undernutrition, hidden hunger, and overweight.

What is undernutrition?

Undernutrition is a lack of proper nutrition, caused by not having enough food or not eating enough food containing substances necessary for growth and health. In 2018, almost 200 million children under the age of 5 suffer from stunting or wasting because of undernutrition.

What is stunting?

Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and/or inadequate psychosocial stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. Stunting can cause impaired growth and has adverse functional consequences on the child, especially if it occurs in the first 1,000 days from conception until the age of 2.

The effect of stunting can carry over throughout the child’s life and lead to poor cognition and educational performance, low adult wages, lost productivity, and when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life. Stunting is both a symptom of past deprivation and a predictor of future poverty.

The number of stunted children has declined in all continents, except in Africa.

What is wasting?

Wasting is a reduction or loss of body weight in relation to height. It results from inadequate nutrition over a shorter period than occurs with stunting. Children are defined as wasting if their height-for-age is below minus two standard deviations from median weight for height of reference population.

Wasting can be lethal for children, particularly in its most severe forms. Most children suffering from wasting around the world live in Asia.

What constitutes overweight in children?

Overweight is defined as abnormal or excessive fat accumulation that presents a risk to health. Obesity is a severe form of being overweight. Depending on the age of the child, different methods to measure a body's healthy weight are available to determine whether they are overweight.

Overweight, long thought of as a condition of the wealthy, is now increasingly a condition of the poor, reflecting the greater availability of “cheap calories” from fatty and sugary foods in almost every country in the world. The number of overweight children has increased in every continent. Based on recent trends, the number of overweight under-5s will rise from 40 million children to 43 million by 2025.

Being overweight as a child can lead to a number of medical conditions, including gastrointestinal, musculoskeletal, and orthopedic complications, as well as the early onset of type 2 diabetes. Overweight can also lead to behavioral and emotional problems, including depression and stigmatization. Childhood obesity is also a strong predictor of adult obesity, which can have serious health and economic consequences.

What is hidden hunger?

Hidden hunger is a chronic lack of vitamins, minerals, or other macronutrients needed for proper development. Globally, at least 1 in 2 children under age 5 (about 340 million) suffers from hidden hunger. Hidden hunger can harm survival, growth, and development at every stage of life. Unfortunately, this condition is rarely noticed until it is too late to do anything to correct its effects.

What are the primary causes of malnutrition in children?

Malnutrition is caused mainly by the poor quality of children’s diets. According to UNICEF, 2 in 3 children are not fed the minimum recommended diverse diet for healthy growth and development.

For example, only 2 in 5 infants under 6 months of age are exclusively breastfed, and use of breastmilk substitutes is a growing concern. Sales of milk-based formula grew by 41% globally and by 72% in upper middle-income countries such as Brazil, China, and Turkey from 2008–2013. UNICEF estimates that breastfeeding could save the lives of 820,000 children annually worldwide.

Poor diets also drive malnutrition throughout early childhood. About 44% of children aged 6 to 23 months are not fed fruits or vegetables and 59% are not fed eggs, dairy, fish, or meat. Only 1 in 5 children aged 6 to 23 months from the poorest households and rural areas is fed the minimum recommended diverse diet for healthy growth and brain development.

Overall, millions of children are eating too little of what they need, and millions are eating too much of what they don’t need: poor diets are now the main risk factor for the global burden of disease, according to the report.

More broadly, the main driver of malnutrition is poverty. According to a 2016 UNICEF and World Bank Study, of the 385 million children living in extreme poverty around the world in 2013, half lived in sub-Saharan Africa and just over a third in South Asia. More than four out of five of these children lived in rural areas. Such children are more likely to be underfed and malnourished, get sick, not complete school, and fall back into poverty in the aftermath of drought, disease or economic instability. Poor children are also the least likely to have access to safe water and adequate sanitation, to receive preventative healthcare such as vaccinations, and when ill are less likely to get adequate medical care.

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