Malnourishment Before Age Two

Irreversible Damage

‘By the time children reach their second birthday,’ says The Lancet in a 2008 series reporting on maternal and child undernutrition, ‘if undernourished, they could suffer irreversible physical and cognitive damage.’ The result is not only mental sluggishness, but also poor motor function and behaviour problems later in life, according to Professor Sally Grantham-McGregor from the Institute of Child Health in London. 

©Eric Miller
Nutrition for children in the first two years of life is important for their later development.

The negative effects of low birthweight, protein and energy shortages, and deficiencies in key micronutrients (such as iodine, iron and zinc) and fatty acids can be ‘transient, last for a longer time or be permanent’. If this kind of harm by the age of two is irreversible, children will go on to reach school carrying a brain that will always underperform.

They will be lumbered with a dullness in mental processing that slows their ability to grapple with ideas; to absorb, interpret and retrieve information; to think rationally and express their thoughts clearly; to plan, reason, intuit and connect fully with an information-overloaded world.

It stalls their efforts to learn at school, the effects of which will ripple through into their adult years: they will be less likely to get even a basic education, which will thwart their potential in the job sector, leaving them more likely to remain trapped in the very poverty into which they were born and which contributed to their own mental stunting in the first place.

And it will leave them likely to bring up their own children in the same poverty context that locked them into their own state of deprivation.

Passed onto the Next Generation

The closed feedback loop of poverty and deprivation is particularly true for girl children because, by virtue of biology and social norms, they are responsible for their babies’ nutrition, both in utero and beyond, for those first key months of development.

‘The consequences of insufficient nourishment continue into adulthood,’ writes The Lancet, ‘and are passed onto the next generation as undernourished girls and women have children of their own.’ Vitamin A, iodine and iron deficiencies are the three main micronutrients which, when they are in short supply, lead to ‘growth retardation, brain damage, diminished cognitive function and diminished working capacity in children and adults’, according to the United Nations Children’s Fund (UNICEF).

Although iodine deficiencies have been reduced quite dramatically in the South African population since the government required that table salt should be boosted with iodine in 1995, vitamin A and iron deficiencies in the country are still alarmingly high.

Long-term Effects of Malnutrition

Even though it is almost impossible to see the effects of long-term malnutrition on the physical body in the same way that you can see the impacts of starvation, there are a few ways of measuring a child’s body to see whether she has had the right kinds of foods in those critical years until a youngster turns five: a measure of the child’s height, weight and head circumference are a good proxy for gauging long-term nutritional status.

It has been shown, for instance, that stunting in height by the age of two years is the single most accurate measure of a child’s future capital, according to the Maternal and Child Undernutrition Study Group at the Johns Hopkins Bloomberg School of Public Health in Baltimore in the United States.

If the effects of nutrition shortages at this critical stage in a child’s growth prove to be irreversible, any growth after this age will be like trying to build the rest of the house on top of a foundation into which the builder has not poured enough cement. Long-term studies show that stunted, underweight children generally spend fewer years in school – meaning their cognitive growth is further slowed, they earn less as adults and so decrease their economic potential before they have even reached maturity.

One of the easiest ways to test for possible brain underdevelopment relating to long-term malnutrition is to measure the head circumference. If it is smaller than what is considered ‘normal’ by the age of five, then it is an indication, particularly, of protein deficiency in the child. Since there is a direct correlation between head circumference and brain size, an undersized skull circumference can tell a paediatrician what is going on with the brain as it develops inside its casing.

Head circumference in the first 24 months of life, according to Grantham-McGregor, is a good predictor for what a child’s IQ will be by the age of eleven.

The fact that this measurement at age two appears to be a better predictor of later IQ than the head size measurement by age four or five suggests that children under two are more vulnerable to the effects of malnutrition, writes Grantham-McGregor. Similarly, children suffering from severe malnutrition by the age of three have been shown to have a ‘fifteen-point deficit in IQ’ by the time they reach the age of eleven.

By Leonie Joubert