Stunting means a child is too short for their age because of long-term poor nutrition, repeated infections and inadequate care. According to UNICEF, the World Health Organization and the World Bank, around 150 million children under five worldwide are stunted, most of them in Africa and Asia. Stunting is not just about height: it is linked to poorer brain development, school performance and earnings, and a higher risk of chronic disease later in life.
Most stunting happens in the first 1,000 days, from conception to a child’s second birthday. This guide explains why that window matters, the causes of stunting, how growth is measured, and practical steps families, nurses and communities can take.
Imagine two babies born in the same village on the same day. One is exclusively breastfed for six months, then gets eggs, beans and vegetables with her porridge, sleeps under a net and has clean water. The other is given water and pap from the first weeks, has diarrhoea every month and eats mostly starch. At two years old, the second child is noticeably shorter. Her mother thinks she is “just small, like her father”. Without anyone realising, her future has been narrowed.
What is stunting?
A child is considered stunted when their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. It is a sign of chronic undernutrition, different from wasting (low weight-for-height, a sign of acute malnutrition).
Why the first 1,000 days matter
From conception to age two, the brain and body grow faster than at any other time. Poor nutrition and frequent infections during this period can have effects that are difficult to reverse later. That is why global nutrition programmes focus on pregnancy, breastfeeding and complementary feeding.
| Stage | Key actions |
|---|---|
| Pregnancy (about 270 days) | Nutritious diet, iron and folic acid as recommended, antenatal care, malaria prevention, no smoking or alcohol |
| Birth to 6 months | Early initiation of breastfeeding within one hour; exclusive breastfeeding (no water, pap or other foods) |
| 6 to 24 months | Continued breastfeeding plus diverse, safe complementary foods; responsive feeding |
| Throughout | Immunisation, clean water, handwashing, treating illness early, growth monitoring |
Causes of stunting
- Poor maternal nutrition and short birth spacing.
- Low birth weight and preterm birth.
- Not exclusively breastfeeding for six months.
- Poor-quality complementary foods: mostly starchy porridge without animal foods, legumes, fruit and vegetables.
- Repeated infections: diarrhoea, intestinal worms, malaria, respiratory infections.
- Poor water, sanitation and hygiene.
- Poverty, food insecurity and conflict.
- Limited maternal education and support.
Consequences
- Delayed cognitive development and lower school achievement.
- Weaker immunity and more severe infections.
- Lower adult income and productivity.
- Higher risk of obesity, diabetes and heart disease later.
- Stunted girls may later have smaller babies, continuing the cycle.
How growth is measured
Health workers measure length (lying down, under two) or height (standing, over two) and plot it on WHO growth charts, along with weight. Regular growth monitoring, often in child welfare clinics and immunisation visits, helps catch faltering growth early. See our guide to child growth monitoring and MUAC.
Good complementary foods from 6 months
- Enrich porridge with groundnut paste, milk, eggs or fish powder.
- Include animal-source foods (eggs, fish, meat, liver, milk) as often as possible.
- Add legumes (beans, lentils, cowpeas) and seeds.
- Offer dark green leafy vegetables and orange fruits and vegetables.
- Feed thick, not watery, foods; increase frequency and amount as the baby grows.
- Continue breastfeeding to two years or beyond.
- Prepare food hygienically and wash hands before feeding.
What nurses and health workers can do
- Promote early and exclusive breastfeeding, and support mothers with problems.
- Counsel on complementary feeding using local, affordable foods.
- Measure length/height accurately and explain the chart to parents.
- Treat and prevent diarrhoea (ORS and zinc), deworm as per guidelines, promote bed nets.
- Ensure immunisation and vitamin A supplementation where recommended.
- Refer children with faltering growth or acute malnutrition.
Severe acute malnutrition needs urgent treatment; see our guide to severe acute malnutrition.
Frequently asked questions
What is stunting?
Low height-for-age caused by chronic undernutrition and repeated infections.
Can stunting be reversed?
Some catch-up growth is possible, but effects on development are hardest to reverse after age two. Prevention in the first 1,000 days is key.
Is a short child always stunted?
No. Some children are naturally short. Growth charts and growth over time help tell the difference.
What is the difference between stunting and wasting?
Stunting is low height-for-age (chronic); wasting is low weight-for-height (acute).
But is stunting just about food?
No. Clean water, sanitation, healthcare, women’s education, birth spacing and income all matter. Food is essential, but children also need protection from infections and families need support.
Your next step: If you care for a child under two, look at their growth chart at the next clinic visit and ask the nurse to explain whether they are growing well. If you are a health worker, plot length at every visit, not just weight.
Related: Child growth monitoring · Severe acute malnutrition · Childhood diarrhoea
Sources: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates; WHO Child Growth Standards; WHO guidelines on infant and young child feeding; 1,000 Days initiative.
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