Growth Faltering: Underweight and Stunting.

The great majority of attention on growth faltering concentrates on the first "1,000 days" with a much lesser focus on toddlers and young preschoolers. The rationale for this is understandable since the first 1,000 days cover the period of most rapid growth and changes in body composition, the period of breastfeeding, and the complex transition from breastfeeding and weaning to complementary feeds, and then moving to the family/adult diet. There has also been a strong perception that, once a child has become stunted or wasted in the first 2 years of life, there is little hope of recovery, an assumption we address below. This paper will describe the timing of the development of stunting and wasting, addressing 3 critical periods: intergenerational, in utero, and early postnatal life. The question of whether toddlers and young preschoolers can recover from stunting and wasting will also be addressed; our own studies suggest that a degree of recovery is certainly possible. The hormonal mechanisms regulating early growth will be examined. Finally, the issue of whether toddlers and young preschoolers should have special foods and diets will also be discussed.