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Many infants experience malnutrition, with devastating effects on physical growth. One in four children in the world suffer from growth stunting, a reduced growth rate. Children in developing countries are at especially high risk of chronic malnutrition and growth stunting. For example, growth stunting affects 43% of children in East African countries, 34% in West Africa, and 35% in South-Central Asia (de Onis & Branca, 2016). Infants who consume a diet that is chronically insufficient in calories, nutrients, and protein can develop marasmus, a wasting disease in which the body’s fat and muscle are depleted (Kliegman et al., 2016). Growth stops, the body wastes away, the skin becomes wrinkly and aged looking, the abdomen shrinks, and the body takes on a hollow appearance. Another disease related to malnutrition is kwashiorkor, found in children who experience an insufficient intake of protein, which may occur when a child prematurely abandons breastfeeding, such as after the birth of a younger sibling. Kwashiorkor is characterized by lethargy, wrinkled skin, and fluid retention appearing as bloating and swelling of the stomach, face, legs, and arms. Because the vital organs of the body take all of the available nutrients, the other parts of the body deteriorate. Marasmus occurs most often in infants, whereas kwashiorkor tends to occur in older infants and young children (Morley, 2016).

A swollen belly is characteristic of kwashiorkor, an extreme nutritional deficiency.

Lyle Conrad/CDC

Malnutrition influences development in multiple ways. Malnourished children show cognitive deficits as well as impairments in motivation, curiosity, language, and the ability to effectively interact with the environment throughout childhood and adolescence and even into adulthood (Galler et al., 2012; C. J. Peter et al., 2016). Malnourishment damages neurons, as shown in Figure 4.3, and the resulting neurological and cognitive deficits from early malnutrition last. For example, among Ghannan children who survived a severe famine in 1983, those who were youngest at the time of the famine (under age 2) scored lower on cognitive measures throughout childhood and into adulthood than did those who were older (ages 6 to 8) (Ampaabeng & Tan, 2013). Malnutrition during the first year of life is associated with depression years later, when those children are 11 to 17 years old (Galler et al., 2010). Some of the damage caused by malnutrition can be reversed. For example, motor and mental development can be enhanced if nutrition is reinstated early. However, long-term difficulties in attention, learning, and intelligence often remain, even into middle adulthood (Kim, Fleisher, & Sun, 2017; Schoenmaker et al., 2015; Waber et al., 2014).

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Figure 4.3 Effects of Malnourishment on Brain Development

Source: de Onis and Branca (2016), https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.12231 licensed under CC BY 3.0 IGO, https://creativecommons.org/licenses/by/3.0/igo/legalcode

Although malnutrition is common in developing countries, it is also found in some of the world’s wealthiest countries. Because of socioeconomic factors, many children in the United States and other developed countries are deprived of diets that support healthy growth. In 2017, about 16% of U.S. households with children were categorized as food insecure. That is, they lacked consistent access to food to support a healthy lifestyle for all members of the family at some point during the year (Coleman-Jensen, Rabbitt, Gregory, & Singh, 2018). As shown in Figure 4.4, rates of food insecurity are higher in Black and Hispanic households (22% and 18%, respectively) and those headed by single parents (20% for homes headed by single men and 30% for those headed by single women). In the United States and other developed nations, food insecurity is linked with stunted growth, poor school performance, and health and behavior problems (Shankar, Chung, & Frank, 2017; Zhu, Mangini, Dong, & Forman, 2017).

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Figure 4.4 Food Insecurity

Source: Coleman-Jensen et al. (2018).