Stunted growth, also known as stunting, refers to impaired growth and development in children, which results in a lower than average height for the child's age. Stunted growth can develop due to a range of direct and indirect causes, often in the context of living in poverty and food insecurity. Causes include poor fetal growth in the womb (fetal growth restriction), unsafe sanitation, poor quality drinking water, childhood infections and diarrhea, malnutrition in the mother or the child.
Stunting is largely irreversible if occurring in the first 1000 days from conception to two years of age. Stunting increases the risk of death during childhood. Affected children generally do not recover lost height, and once stunting occurs, its effects are often long-lasting. Stunted children may experience worse cognitive development and poorer health in adulthood.
Among children under five years of age, the global stunting prevalence declined from 26.3% in 2012 to 22.3% in 2022 and 23.2% in 2024. It is projected that 19.5% of all children under five will be stunted in 2030. More than 85% of the world's stunted children live in Asia and Africa.
Signs and symptoms
Stunted growth in children has the following public health impacts: Greater risk for illness and premature death Delayed cognitive development, and poor school performance Reduced intelligence quotient Future risk of obesity Women of shorter stature have a greater risk for complications during childbirth due to their smaller pelvis and are at risk of delivering a baby with low birth weight Stunted growth can be passed to the next generation, known as the "intergenerational cycle of malnutrition"
Early-life stunting can also lead to long-term developmental challenges. If a child is stunted at the age of 2, they tend to have a higher risk of poor cognitive and educational achievement in life, with subsequent socioeconomic and intergenerational consequences. Stunting might also lead to reductions in schooling, decreased economic productivity, and poverty. Stunted children also display higher risk of developing chronic non-communicable conditions such as diabetes and obesity as adults. If a stunted child undergoes substantial weight gain after age 2, this can lead to obesity. This is believed to be caused by metabolic changes produced by chronic malnutrition that can produce metabolic imbalances if the individual is exposed to excessive or poor quality diets as an adult. The development of obesity can lead to a higher risk of developing other related non-communicable diseases such as hypertension, coronary heart disease, metabolic syndrome, and stroke.
On a societal level, stunted individuals may have physical and/or cognitive delays, affecting their performance in their careers. Stunting can therefore limit economic development and productivity, and it has been estimated that it can affect a country's GDP by up to 3%.
Stunting is prevalent in the Global South and has severe consequences, including increased risk of infections and death. The global percentage of stunted growth decreased from 33% to 22.3% between 2000 and 2022. The largest drop took place in Asia, from 37.1% in 2000 to 28.2% in 2012 and 22.3% in 2022. Despite global progress, the prevalence of child stunting was greater than 30% in 28 countries in 2022 (most of which are in sub-Saharan Africa).
Causes
Almost all stunting occurs within the 1,000-day period that spans from conception to a child's second birthday, which constitutes a window of opportunity for growth promotion. The recognition of prenatal factors underlines the intergenerational aspects of growth, and the need for early interventions. The three main causes of stunting in South Asia, and probably in most developing countries, are poor feeding practices, poor maternal nutrition, and poor sanitation. The leading risk factors for stunting are fetal growth restriction (birth weight below the 10th percentile) followed by unimproved sanitation and diarrhea. 22% of stunting cases can be attributed to environmental factors, while 14% to child nutrition. In addition, women's education, gender equality, the quantity and quality of foods available also play significant roles in stunting rates.
Feeding practices Inadequate complementary child feeding and a general lack of vital nutrients besides pure caloric intake are some causes of stunted growth. Children need to be fed diets that meet the minimum requirements in terms of frequency and diversity to prevent undernutrition. Exclusive breastfeeding is recommended for the first six months of life and nutritious food alongside breastfeeding for children aged six months to two years old. Prolonged exclusive breastfeeding is associated with undernutrition because breast milk alone is nutritionally insufficient for children over six months old. Breastfeeding for a long time with inadequate complementary feeding leads to growth failure due to insufficient nutrients, which are essential for childhood development. The relationship between undernutrition and prolonged duration of breastfeeding is mostly observed among children from poor households with uneducated parents, as they are more likely to continue breastfeeding without meeting the minimum dietary diversity requirement. Material was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
Maternal nutrition Poor maternal nutrition during pregnancy and breastfeeding can lead to stunted growth of children. Proper nutrition for mothers during the prenatal and postnatal period is important for ensuring healthy birth weight and healthy childhood growth. Prenatal causes of child stunting are associated with maternal undernutrition. Low maternal BMI predisposes the fetus to poor growth leading to intrauterine growth retardation, which is strongly associated with low birth weight and size. Women who are underweight or anemic during pregnancy are more likely to have stunted children, which perpetuates the intergenerational transmission of stunting. Children born with low birth weight are more at risk of stunting. However, the effect of prenatal undernutrition can be addressed during the postnatal period through proper child feeding practices.
Maternal undernutrition increases the risk of stunting at 2 years of age. 20% of stunting is attributed to being born small-for-gestational-age (SGA). An estimated 33% of stunting at 2 years was attributed to fetal growth restriction and preterm birth in 2011 in developing countries, and 41% in South Asia. Restricted pre- and postnatal growth are in turn important determinants of short adult height, increasing the likelihood of the next generation experiencing stunted growth.
Sanitation One notable contribution to stunted growth is a lack of sanitation—an example of this is countries where public defecation is practiced.Spears, D. (2013). How much international variation in child height can sanitation explain? - Policy research working paper. The World Bank, Sustainable Development Network, Water and Sanitation Program The ingestion of high quantities of fecal bacteria by young children through putting soiled fingers or household items in the mouth leads to intestinal infections. This affects children's nutritional status by diminishing appetite, reducing nutrient absorption, and increasing nutrient loss.
Around 25% of stunting cases could be attributed to five or more episodes of diarrhea before two years of age. Since diarrhea is closely linked with water, sanitation, and hygiene (WASH), this is a good indicator of the connection between WASH and stunted growth. To what extent improvements in drinking water safety, toilet use and good handwashing practices contribute to reducing stunting depending on how bad these practices were prior to interventions.
Environmental enteropathy The condition termed environmental enteropathy is proposed as an immediate causal factor of childhood stunting. This is an asymptomatic small intestinal disorder characterized by chronic gut inflammation, reduced absorptive surface area, and disruption of intestinal barrier function. This small bowel disorder can be attributed to sustained exposure to intestinal pathogens caused by fecal contamination of food and water.
Land degradation Southern Asia and sub-Saharan Africa are regions where land degradation coincide with high poverty rates and childhood stunting. In 2025, 47 million children under five years of age suffering from stunting live in areas where stunting overlaps with significant yield losses from land degradation. These areas represent a convergence of environmental degradation and human deprivation.
Diagnosis The international definition of childhood stunting is a child whose height-for-age value is at least two standard deviations below the median of the World Health Organization's (WHO) Child Growth Standards.
Growth stunting is identified by comparing measurements of children's heights to the WHO 2006 growth reference population: children who fall below the fifth percentile of the reference population in height for age are defined as stunted, regardless of the reason. The lower than fifth percentile corresponds to less than two standard deviations of the WHO Child Growth Standards median.
As an indicator of nutritional status, comparisons of children's measurements with growth reference curves may be used differently for populations of children than for individual children. The fact that an individual child falls below the fifth percentile for height for age on a growth reference curve may reflect normal variation in growth within a population: the individual child may be short simply because both parents carried genes for shortness and not because of inadequate nutrition. However, if substantially more than 5% of an identified child population have height for age that is less than the fifth percentile on the reference curve, then the population is said to have a higher-than-expected prevalence of stunting, and malnutrition is generally the first cause considered.
Prevention Three main factors are needed to reduce stunting: an environment where political commitment can thrive (also called an "enabling environment") applying several nutritional modifications or changes in a population on a large scale which have a high benefit and a low cost a strong foundation that can drive change (food security and a supportive health environment through increasing access to safe water and sanitation). To prevent stunting, it is not just a matter of providing better nutrition but also access to clean water, improved sanitation (hygienic toilets), and hand washing at critical times (summarized as "WASH"). Without provision of toilets, prevention of tropical intestinal diseases, which may affect almost all children in the developing world and lead to stunting, will not be possible.
The underlying determinants can be ranked in terms of their potency in reducing child stunting: percent of dietary energy from non-staple foods (greatest impact) access to sanitation and women's education access to safe water per capita dietary energy supply The first two of these determinants (access to sanitation and diversity of calorie sources from food supplies) need attention in particular because they have strongest impacts but are farthest from their desired levels.