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Stunting: historical lessons that catch-up growth tells us for mapping growth restoration
  1. Christiane Scheffler1,
  2. Michael Hermanussen2,
  3. Alan Rogol3
  1. 1 Institute of Biochemistry and Biology, University of Potsdam, Potsdam, Brandenburg, Germany
  2. 2 Pediatrics, University of Kiel Faculty of Medicine, Kiel, Schleswig-Holstein, Germany
  3. 3 Pediatrics, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Dr Alan Rogol, Pediatrics, University of Virginia, Charlottesville, VA 22903-1738, USA; adrogol{at}

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Growth within the broad range of normal for age, sex and ethnicity is considered a good sign of general health and of proper living conditions. Starvation, emotional deprivation and chronic, particularly endocrine and inflammatory, diseases, impair growth; persistence of such conditions leads to stunting—long-term preventing from growing, resulting in short stature—and will raise the susceptibility to further illness and mortality.

Detailed scientific observations exemplifying the close link between nutrition, living conditions, health and growth date back to the medical literature of the end 19th and early 20th centuries. Multiple observations of school physicians and paediatricians specify the impact of starvation and neglect on child growth during and after World War I,1 and recognise the significance of catch-up growth during refeeding. Catch-up growth is not limited to refeeding but systematically occurs in children whenever relieved from growth-inhibiting conditions. In 1906, Igl2 published growth patterns of Austrian boarding school children aged 7–17 years, who almost completely failed to grow during the regular school year but caught up in height during the 2 months of summer holiday at home.

Mortality statistics in European orphanages since the 18th century highlight the importance of emotional care on infant survival. Scientific observations on emotional deprivation and its effect on infant and child growth became prevalent in the 20th century. Shortly after World War II, Widdowson3 investigated children in two German orphanages. Her concern with the growth of the children led her to a feeding experiment in one—to supplement the barely adequate caloric intake with additional bread and jam. This was based on …

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  • Contributors AR drafted the original outline and version. All authors contributed to the multiple revisions and the overall concept, drafted part of the first version of the manuscript, reviewed and contributed to multiple other versions of the manuscript, approved the final version for submission and are accountable to all aspects of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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