Definition of Stunting: Causes, Symptoms, Impact, and How to Prevent It

Definition of Stunting – A child’s growth can be seen from their weight and height. Normally, these two factors develop together as the child gets older. If not, it will cause health problems, one of which is stunting.

Lately, you may often hear mothers with toddlers talking about stunting or from discussing health practitioners on social media. This is a natural thing, because stunting in children must be a concern and watch out for parents.

This one condition can be a sign that your little one’s nutrition is not fulfilled properly. If left alone, will have a longer impact. Starting from the inhibition of physical growth, reduced endurance, to interfere with the development of the child’s brain.

Therefore, in this article we will get to know more about the meaning of stunting, what are the causes, what are the signs and symptoms of stunting, and how to prevent it.

Definition of Stunting

According to the Presidential Regulation of the Republic of Indonesia Number 72 of 2021, what is meant by stunting is a disorder of child development caused by chronic malnutrition and recurrent infections. This disorder is characterized by a height that is below the standard set by the minister of health.

Meanwhile, according to the Ministry of Health, stunting is divided into two categories. The first is stunted, namely children under five with a z-score value less than -2.00 Standard Deviation. While the second is severely stunted or children whose z-score is less than -3.00 Standard Deviation.

In other words, stunting is a growth disorder in toddlers so that the child’s development is not in accordance (shorter) with standards and can have an impact in the short and long term.

The main factor that can cause stunting is a lack of nutrition. So it can be concluded that short stature is a characteristic of chronically malnourished children. But keep in mind, not all short children can be called stunted while stunted children are definitely short.

One of the indicators is the standard deviation described earlier. When the height is less than -2.00 standard deviation, the child is categorized as stunting. Parents should really pay attention to this, especially if this condition occurs in children who are less than 2 years old.

Grameds can learn a more complete understanding of stunting in the book Microbiota Vs Stunting in Children, compiled by Dr. Betty Yosephin Simanjuntak, SKM., MKM, Ns. Rahma Annisa, S.Kep., M.Kep, and Arie Ikhwan Saputra, S.SIT., MT.

Causes of Stunting in Children

Stunting can be caused by many factors that occur during toddler growth. However, the main causes are divided into 3 types, namely lack of nutritional intake during pregnancy, inadequate nutritional needs of children, and other factors.

1. Lack of nutritional intake during pregnancy

The World Health Organization (WHO) says that 20% of stunting conditions occur when the baby is still in the mother’s womb. The cause is a lack of nutritional intake during pregnancy, so that the fetus receives only a few nutrients.

As a result, the growth of the fetus in the womb becomes stunted until after birth. Therefore, pregnant women must ensure that they get good nutrition and nutrition.

2. Children’s nutritional needs are not fulfilled

This second cause can occur because the nutritional intake of children when they are less than 2 years old is not sufficient. This nutritional intake includes low-quality complementary foods (MPASI), children not being breastfed, and improper breastfeeding positions.

Not only that, many theories state that inadequate food intake can also be a factor causing stunting. Especially the intake of foods that contain protein, the mineral zinc, and iron when children are toddlers.

Stunting usually starts when a child is 3 months old. This developmental process then begins to slow down when the child turns 3 years old. After that, the child’s height continued to increase but was below the standard for assessing height based on age (TB/U).

You need to know that there is a slight difference in the condition of stunting in children aged 2 to 3 years and children who are more than 3 years old. Children aged 2 to 3 years whose height is below standard can describe the ongoing process of stunting.

Whereas in children who are more than 3 years old, this condition indicates that the child has indeed experienced growth failure or stunted.

3. Other causal factors

Apart from the two factors above, there are several other factors that can cause stunting in children, including:

• Mothers lack knowledge about nutrition before pregnancy, during pregnancy, and after giving birth
• Limited access to health services, such as pregnancy and postpartum services.
• Unequal access to clean water and sanitation
• Nutritious food is still relatively expensive so it is not accessible to everyone

Signs and Symptoms of Stunting in Children

Grameds needs to remember that not all toddlers who are short are stunted. The reason is, stunting is a very short body condition when viewed from the standard for measuring height for age made by WHO.

The Ministry of Health of the Republic of Indonesia explained that toddlers can be said to be stunted if their height has been measured, then compared to WHO standards, and the results are below normal.

This means, stunting is not a health problem that can be guessed or estimated. To be sure, measurements must be taken at a doctor, posyandu, or puskesmas. Apart from that, there are still other characteristics that can be signs and symptoms of stunting, namely:

• Slowed growth.
• The child’s face looks younger than his peers.
• Delayed tooth growth.
• The ability to focus and learn memory of children has poor performance.
• At the age of 8 to 10 years, children become quieter and don’t make much eye contact with the people around them.
• Toddler weight tends to decrease.
• The development of the child’s body is hampered, for example a girl is late having her first menstruation.
• Children become susceptible to infectious diseases.

The Impact of Stunting on Children

Stunting in children can affect their entire growth and development. In the short term, the impact of stunting consists of disrupted brain development, metabolic disorders, intelligence, and physical growth.

Meanwhile, in the long term, stunting that is not handled properly from the start can cause various impacts, including:

• Makes the cognitive development ability of the brain decrease
• Children are susceptible to disease because their immune system is weak
• Children are more at risk of developing metabolic diseases, such as obesity.
• Children have learning difficulties
• Diseases of the heart and blood vessels
• When they are adults, children with short stature will find it difficult to compete in the world of work and their productivity levels tend to be low
• In girls, stunting can cause health and development problems in their offspring when they are adults. This usually occurs in adult women who are less than 145 cm tall.
• Pregnant women whose height is below average will experience a slowdown in the growth of the uterus, placenta and slowed blood flow to the fetus.
• Babies born to mothers who are below average height are more at risk of serious medical complications. Such as stunted growth and stunted nerve development and intellectual abilities. This condition continues until the child has its own offspring.

Management of stunting in infants and children

Stunting can indeed have an impact until children grow up. The good news, this condition can still be treated. According to the Indonesian Ministry of Health, editing is heavily influenced by parenting styles, the scope and quality of health services, the environment, and also food security.

Therefore, one of the first treatments for children diagnosed with stunting is to provide proper parenting for children. This proper parenting pattern includes exclusive breastfeeding for 6 months, Early Breastfeeding Initiation (IMD), and breastfeeding together with complementary foods until the child turns 2 years old.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend that babies aged 6 to 23 months get optimal complementary food for ASI.

Preferably, MPASI given to children should contain at least 4 types or more than 7 types of food. Such as nuts, tubers, eggs or other sources of protein, dairy products, vitamin A, and others.

In addition, mothers must also pay attention to the Minimum Meal Frequency (MMF) requirements for babies aged 6 to 23 months who are breastfed and not breastfed, as well as those who are already getting complementary foods.

For babies who are breastfed aged 6 to 8 months, the MMF is 2 times per day or more. Then, babies aged 9 to 23 months, 3 times per day or more. Meanwhile, for babies who are not breastfed aged 6 to 23 months, the MMF is 4 times per day or more.

Not only that, the availability of food at home also plays a role in overcoming stunting in children. For example, the quality of food consumed daily by children must be improved.

How to prevent stunting in children

Stunting or children who are short in stature is actually not a new problem in the world of health. In Indonesia, stunting is a nutritional problem in children that cannot be resolved properly.

The proof is that the Nutrition Status Monitoring (PSG) data belonging to the Indonesian Ministry of Health shows that the number of stunted children in Indonesia is quite high. Especially when the numbers are compared to other nutritional problems such as underweight, obese or malnourished children.

According to data from the Indonesian Toddler Nutrition Status Survey (SSGBI) conducted in 2021, the number of stunted children in Indonesia is 5.33 million or 24.4%. This number is down from previous years. However, the government is targeting the stunting rate in Indonesia to drop to 14% in 2024.

So, can stunting in children be prevented from an early age? Of course, the government has also made stunting prevention a priority program in order to meet the set targets.

Several ways to prevent stunting according to the Guidelines for Implementing Healthy Indonesia with a Family Approach include:

1. Preventing stunting for pregnant women and those who are giving birth

1. Monitoring the health of the first 1,000 days of a baby’s life optimally and handling it.
2. Carry out routine and periodic antenatal care.
3. Mothers carry out the delivery process in health facilities, such as health centers, midwives, and doctors.
4. Giving food high in protein, calories, and micronutrients to babies (TKPM).
5. Parents must detect infectious and non-communicable diseases from an early age.
6. Eliminate the possibility of children getting worms.
7. Exclusive breastfeeding for 6 full months.
8. Conduct discussions with obstetricians to prevent stunting properly.

2. Preventing stunting for toddlers

1. Monitor the growth and development of toddlers regularly.
2. Giving supplementary food (PMT) in toddlers.
3. Parents must do early stimulation of child development.
4. Ensuring children receive optimal health services and care.
5. Discuss with the pediatrician to adjust stunting prevention with the child’s habits so that the results are maximized.

3. Preventing stunting for school-age children

1. Ensuring that children’s daily nutritional intake is met according to their needs.
2. Educating children about knowledge related to health and nutrition slowly and using language that is easy to understand.

4. Preventing stunting for youth

Actually, stunting in adolescents can no longer be treated. However, there are still some treatments that can be done when children are 14 to 17 years old, including:

1. Teach children to get used to practicing Clean and Healthy Behavior (PHBS).
2. Ensuring children have a balanced nutritional pattern.
3. Forbid children to smoke and use drugs.
4. Teaching reproductive health to children.

5. Preventing stunting for young adults

1. Increase understanding of Family Planning (KB).
2. Examination of communicable and non-communicable diseases so that they can be detected early.
3. Always apply Healthy Clean Living Behavior (PHBS), a balanced nutritional pattern, don’t smoke, and don’t use drugs.

In addition, according to the National Strategy to Accelerate the Reduction of Stunting set by the government, stunting prevention can be carried out in several ways, including:

• Pay attention to nutritional intake and nutrition for pregnant and lactating women, pay attention to diet, and consume various and balanced types of food.
• Conduct routine health checks for pregnant women, infants, and toddlers.
• Provide a variety of foods to children so that the little one avoids the problem of difficulty eating.
• Always maintain the sanitation of the living environment.
• Get education about stunting, good parenting, and good nutrition and nutrition for children’s growth and development.
• Carry out complete vaccinations according to recommendations from the Indonesian Pediatrician Association (IDAI) from birth.

So in conclusion, stunting prevention can be done by ensuring that expectant mothers get good nutrition. When the child is born, make sure the child gets quality food intake. This is also explained by the Tanoto Scholar in his book entitled Prevent Stunting Before It’s Critical.

In this book, there are various interesting stunting prevention ideas divided into four categories, namely consumption patterns, parenting patterns, basic health services, and environmental health.

Can Stunted Children Get Normal Growth?

Unfortunately, stunting is a growth disorder that cannot be reversed. This means, when a child has been declared stunted since he was a toddler, his growth will continue to slow down until he is an adult.

When entering puberty, children cannot achieve maximum growth because they have been stunted since childhood. Even though their food intake is rich in nutrients, their growth will not be as high as that of other normal children.

Even so, children must still get a variety of highly nutritious food intake to prevent children from experiencing worsening conditions and worsening growth disorders.

In conclusion, if you want to prevent stunting, children must get maximum nutrition in their early life. More precisely, during the first 1,000 days of a child’s life.

Then, if Grameds realizes that your little one has the characteristics or symptoms of stunting, then immediately consult with the nearest pediatrician so that this problem can be dealt with appropriately and quickly.

If you need a reference about stunting counseling with pediatricians, the book Stop Stunting with Nutrition Counseling compiled by the Indonesian Nutritionist Association can be your first choice. Because this book summarizes a variety of basic and important information that is mainly conveyed by nutrition experts in efforts to prevent stunting.