Understanding the Association between Stunting and Child Development in Low- and Middle-Income Countries: Next Steps for Research and Intervention

Stunting affects approximately 25% of children under age five globally (i.e. 156 million pre-school age children). In this review, evidence of a relationship between stunting and child development in low- and middle-income countries is summarized, and issues for further research are discussed. We focus on studies measuring low height-for-age caused by experiences of chronic nutritional deprivation among children less than 5 years old as the exposure and gross and cognitive abilities, fine motor skills, psychosocial competencies, or schooling and learning milestones as outcomes. This review highlights three key findings. Firstly, the variability in child development tools and metrics used among studies and the differences in timing and frequency of the assessments complicate comparisons across study findings. Secondly, despite methodological differences and differential associations, considerable evidence from across many countries, supports an association between stunting and poor child development. Effect sizes differ by development domain with greater effects shown for cognitive/schooling outcomes. How stunting influences child development, which domains of child development are more affected, and how the various domains of child development influence one another require further research. Finally, there is some evidence of positive synergistic interaction between nutrition and stimulation on child development. However, understanding how best to improve child developmental outcomes – either through nutrition programs or integrated nutrition and psychosocial stimulation – is a key area of further inquiry. Given that nearly 40% of children under age five suffer from loss of developmental potential - for which stunting is likely one of the key risk factors - reductions in stunting could have tremendous implications for child development and human capital formation, particularly in low- and middle-income countries.