Childhood chronic malnutrition (stunting): causes, diagnosis and prevention
- Page updated onApril 20, 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 value of 23.2% represents a significant reduction from the 33% prevalence of stunting in 2000, this decline has not been symmetric. The decrease has been very pronounced in several heavily populated South Asian countries, which experienced the greatest economic growth during this period. However, in Latin America it has been far less marked, and in Africa the number of children with stunting has actually increased, reaching 64.8 million (UNICEF et al., 2025)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.
The causes of chronic malnutrition have the greatest impact in the first months of life
Among the causes of chronic child malnutrition is the sustained negative effect of hunger and its social determinants during pregnancy and the first two years of life. This period is known as "the thousand-day opportunity window" (de Onis & Branca, 2016)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. During this time, food insecurity, limited access to health services, infections, deficiencies in water, sanitation and hygiene, and poor infant feeding and caregiving practices have a major impact on the development of these children's future potential (Prendergast & Humphrey, 2014)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.
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 diarrhea, but also when there are subclinical infections (WHO, 2016)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.
🧠 Let's pause and reflect
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 way of measuring stunting, while apparently straightforward, poses many challenges. 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 even frightens them. Another problem is that its 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 stunting is not clearly visible. For instance, two girls may appear to be in good physical development and raise no suspicion of stunting, unless one knows that one of them is significantly younger than the other (de Onis & Branca, 2016)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.
With no effective treatment, addressing chronic malnutrition requires prevention and a multisectoral approach
There is no effective treatment for stunting. 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, tackling this problem has always taken a back seat. However, reducing stunting could have an enormous impact on the economy and future opportunities of the poorest households, their communities, and their nations (Shekar et al., 2017)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.
🧠 Let's pause and reflect
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
Intervening preventively on hunger and its causes makes it possible to reduce the prevalence of stunting, detect it and attempt to slow 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)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
Preventing chronic malnutrition requires a commitment to peace and environmental sustainability, along with advocacy actions that place it among the priorities of duty-bearers and holders of responsibilities. Additionally, programs are needed to ensure access to food, water, sanitation, hygiene, and health services in humanitarian crises, support programs for families and caregivers with a gender perspective, and comprehensive systems of universal social protection for all people, especially 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 leveraged to make up for previously accumulated delays. (UNICEF Office of Research – Innocenti, 2017)WHO (2023). Global Nutrition Report. Geneva: WHO. https://www.who.int/publications/i/item/9789240073234 During this period, the risk of developing overweight and obesity also increases if the diet is not adequate.
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
- 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. (April 20, 2026). Chronic childhood malnutrition (stunting): causes, diagnosis and prevention. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/chronic-malnutrition/