Chronic malnutrition in children (stunting): causes and prevention
- Page updated onJuly 8, 2026
Chronic malnutrition is one of the two existing types of undernutrition, along with acute malnutrition. It manifests in children under five years of age as stunting and is associated with greater vulnerability to infectious diseases and delayed physical, motor, and cognitive development. In the long term, this delay also results in learning difficulties, poorer school performance, and reduced work capacity.
For all the above reasons, this issue has a significant impact on the economy of individuals, their families, and their communities, thereby reinforcing an intergenerational cycle of hunger and poverty. It is estimated to be responsible for the loss of 5%-7% of per capita income in low- and middle-income countries.
Table of contents:
Chronic child malnutrition: a problem with multiple causes
Prevalence of chronic child malnutrition
It is estimated that, in 2024, 23.2% (150 million) children under 5 years of age were chronically undernourished. The problem is mainly concentrated in Africa (with a prevalence of 30.3%) and South Asia (31.4%). These values are considered very low when below 2.5%, low when between 2.5% and 10%, medium between 10% and 20%, high between 20% and 30%, and very high when above 30%.
Although the current figure of 23.2% represents a significant reduction from the 33% prevalence of chronic malnutrition in 2000, this has not been symmetrical. The decline has been very pronounced in several densely populated countries in South Asia that have experienced the greatest economic growth during the period. However, in Latin America the decline has been far less pronounced, and in Africa the number of children with chronic malnutrition has actually increased, reaching 64.8 million (UNICEF et al., 2025).
The causes of chronic malnutrition have the greatest impact in the first months of life
Among the causes of chronic childhood malnutrition is the ongoing negative effect of hunger and its social determinants during pregnancy and the first two years of life. This period is known as "the window of opportunity of the first thousand days" (de Onis & Branca, 2016). During this time, food insecurity, limited access to health services, infections, deficiencies in water, sanitation and hygiene, and problems with infant feeding and care practices have a major impact on the development of these children's future potential (Prendergast & Humphrey, 2014).
Infections by digestive tract pathogens appear to be particularly relevant in this type of malnutrition. This is due to the enteric dysfunction (atrophy and chronic inflammation of the small intestine) they produce, not only in visible cases of diarrhoea but also in subclinical infections (WHO, 2016).
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Why does chronic malnutrition receive less humanitarian attention than acute malnutrition, if its long-term consequences are equally or more serious?
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What is chronic malnutrition and how is it diagnosed?
Like acute malnutrition, chronic malnutrition is defined by anthropometric criteria: a height-for-age index two standard deviations below the median of the WHO child growth standard. Children with chronic malnutrition have a shorter height than what would be expected for their age.
This method of measuring chronic malnutrition, although apparently straightforward, poses many problems. To begin with, it requires well-calibrated equipment (a stadiometer), a trained person, and the cooperation of the child, who must remain still for a few moments. This is often difficult when the child is in an unfamiliar environment or one that causes them fear. Another problem is that diagnosis depends on age, a piece of information that is sometimes not remembered accurately (especially if the birth took place in the community or if there was no adequate birth registration). However, the main barrier is that chronic malnutrition is not clearly visible. For example, two girls may appear to be in good physical condition and raise no suspicion of chronic malnutrition, if it is not known that one of them is much younger than the other (de Onis & Branca, 2016).
Acute vs chronic malnutrition: differences and similarities
Acute and chronic malnutrition are two distinct forms of malnutrition, with multiple and complex clinical manifestations. Although they differ in their pathophysiology, manifestations, diagnosis and treatment, the two are related and sometimes occur together.
Acute and chronic malnutrition differ in their pathophysiological mechanisms, their diagnosis and their treatment.
- The immediate cause of acute malnutrition is rapid weight loss, or an inability to gain weight at a time of high energy requirements, whereas in chronic malnutrition this occurs in a sustained way and over a more prolonged period.
- Acute malnutrition manifests as thinness and a lower weight than would be expected for height. Chronic malnutrition manifests as short stature: a height or length lower than would be expected for age, mainly as a consequence of delayed linear growth in the lower limbs during the first two years of life (Briend et al., 2015).
- Acute malnutrition can be diagnosed using the weight-for-height index or by measuring mid-upper arm circumference (MUAC), whereas chronic malnutrition is diagnosed using the height-for-age index.
- There is a treatment for acute malnutrition: with ready-to-use therapeutic food (RUTF) and antibiotics to prevent secondary infections, severe or moderate acute malnutrition can be reversed within weeks. However, there is no treatment for chronic malnutrition, which can cause irreversible physical and cognitive damage. Although such damage can also occur with acute malnutrition, it is less widely recognised (Bhutta et al., 2017).
- Worldwide, there are approximately three times as many children with chronic malnutrition as with acute malnutrition (UNICEF et al., 2025).
Acute and chronic malnutrition share risk factors and an association with an elevated risk of death.
Despite their differences, acute and chronic malnutrition have much in common:
- The causes of both types of malnutrition are very similar (Bhutta et al., 2017). There are few risk factors for one type that do not affect the other, and some studies show that acute malnutrition sometimes acts as a cause of chronic malnutrition (Briend et al., 2015).
- Both types of malnutrition are concentrated mainly in Southern Asia and Africa, the regions with the highest prevalence of malnutrition in the world (UNICEF et al., 2025).
- In both acute and chronic malnutrition, body composition is altered, with a reduction in muscle and fat mass that can compromise the function of vital organs. The loss of muscle mass is less pronounced in chronic malnutrition (Briend et al., 2015).
- Both forms of malnutrition are associated with a higher risk of child mortality, although when malnutrition is severe, the risk of mortality increases considerably in the case of acute malnutrition, and even more so when both conditions occur at the same time in the same child, because of the interactions between them (Briend et al., 2015).
With no effective treatment, addressing chronic malnutrition requires prevention and a multisectoral approach
There is no effective treatment for chronic malnutrition. It is simply not possible to recover the growth and cognitive development lost over months or even years by taking nutritional supplements. For this and other reasons, the fight against this problem has always taken a back seat. However, reducing chronic malnutrition could have an enormous impact on the economy and future opportunities of the poorest households, their communities and their nations (Shekar et al., 2017).
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Under what conditions can humanitarian action genuinely contribute to preventing chronic malnutrition, when its causes are structural and its effects unfold over the long term?
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To fight chronic malnutrition, we must address the causes of hunger
Acting preventively on hunger and its causes makes it possible to reduce the prevalence of chronic malnutrition, detect it and attempt to halt its progression during early childhood, and mitigate its consequences. These efforts also include action against acute malnutrition, malnutrition in all its forms, food insecurity, poverty and inequality (Action Against Hunger, 2023).
Preventing chronic malnutrition requires a commitment to peace and environmental sustainability, and advocacy actions that place it among the priorities of duty-bearers and those with responsibilities. In addition, programmes are needed to guarantee access to food, water, sanitation and hygiene and health services in humanitarian crises, programmes to support families and caregivers with a gender perspective, and comprehensive universal social protection systems for all people, and above all the most vulnerable.
Although it is a priority for these actions to focus their effects on pregnant women, children under 2 or 3 years of age and their families, the "thousand days" is not the only window of opportunity. Growth does not stop at two years. On the contrary, adolescence brings a second period of accelerated development, which should be seized to recover ground lost earlier (UNICEF Innocenti, 2017). During this period, the risk of developing overweight and obesity also increases if the diet is inadequate.
References
- Action Against Hunger. (2023). Chronic malnutrition: An action framework for a preventive and multi-sector approach. https://accioncontraelhambre.org/sites/default/files/documents/chronic-prevention_techpaper_acf_2023_en_web.pdf
- Bhutta, Z. A., Berkley, J. A., Bandsma, R. H. J., Kerac, M., Trehan, I., & Briend, A. (2017). Severe childhood malnutrition. Nature Reviews Disease Primers, 3, 17067. https://doi.org/10.1038/nrdp.2017.67
- Briend, A., Khara, T., & Dolan, C. (2015). Wasting and stunting—Similarities and differences: Policy and programmatic implications. Food and Nutrition Bulletin, 36(1_suppl1), S15–S23. https://doi.org/10.1177/15648265150361S103
- de Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12(S1), 12–26. https://doi.org/10.1111/mcn.12231
- Prendergast, A. J., & Humphrey, J. H. (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health, 34(4), 250–265. https://doi.org/10.1179/2046905514Y.0000000158
- Shekar, M., Kakietek, J., Dayton Eberwein, J., & Walters, D. (2017). An investment framework for nutrition: Reaching the global targets for stunting, anemia, breastfeeding, and wasting. World Bank. https://doi.org/10.1596/978-1-4648-1010-7
- UNICEF Office of Research – Innocenti. (2017). The adolescent brain: A second window of opportunity. A compendium. UNICEF. https://www.unicef-irc.org/publications/pdf/adolescent_brain_a_second_window_of_opportunity_a_compendium.pdf
- UNICEF, WHO, & World Bank. (2025). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates: Key findings of the 2025 edition. World Health Organization. https://www.who.int/publications/i/item/9789240112308.
- World Health Organization. (2016). Childhood stunting: Context, causes and consequences — Conceptual framework. https://www.who.int/publications/m/item/childhood-stunting-context-causes-and-consequences-framework
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How to cite this page
Abarca, B. (July 8, 2026). Chronic malnutrition in children (stunting): causes and prevention. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/chronic-malnutrition/