Classroom Edition: Global Child Malnutrition with Ben Crookston — Why the First 1,000 Days Matter

Does height really matter? In this classroom edition, Ben Crookston explains how child malnutrition and stunting are more than physical measurements—they are powerful indicators of long-term health, cognitive development, and economic opportunity. Learn why the first 1,000 days—from conception to age two—represent a critical window for intervention, and how nutrition, maternal health, breastfeeding, and dietary diversity can shape a child’s future for a lifetime. 

Recorded, Edited & Produced by Averee Bates, Christy Gonzalez, Harper Xinyu Zhang, Madison McArthur, Kailey Hopkins, and Tanya Gale

Transcript

Cougar: [00:00:00] Hello, this is Cougar Hall, host of the Y Health Podcast. Today I'm excited to bring you a classroom edition. This format is designed to share one or more key concepts from a course offered here at Brigham Young University that we hope you find beneficial without the pressure of course assignments or tests. 

So breathe easy, sit back and enjoy. 

Ben: Hi, my name is. Ben Crookston. I'm a faculty member in the Department of Public Health here at Brigham Young University. Really excited to talk with you today and have been really grateful to be a faculty member here. I've been at BYU for about 15 years, and in this great department for that entire time. 

Today, I want to talk to you about an issue in global health that my colleagues and I talk about a lot that we try to address and make a difference in. And over the years as there have been major successes in global health, there are still some areas that need a lot of attention. And so one of those areas or where I'd like to talk to with you [00:01:00] today about, I wanna ask you a question to start off. 

How often do you think about your height? What does that mean to you? Some people might think about their height for how it impacts their ability to play basketball or to change a light bulb or something else that's simple. But today, I want you to think about height from a different perspective. Are you the height that you're supposed to be? 

In your DNA that helps you as you develop, did you reach the high potential that you should reach? And if you did, great, if you didn't, is it just about being a little bit shorter or are there other things at play that maybe are impacting you today as we think about global health and the successes over the last three, four, or five decades where we've seen child mortality rates drop precipitously. 

Maternal mortality rates drop as well. And where we've seen poverty go down and education go up, and we've seen so many great successes, there's still some pretty big areas that we need to address. And [00:02:00] you might say, well, what does height have to do with all this? Well, height is a really important indicator about our success in global health. 

Lemme tell you a little bit more. Children who experience what we call undernutrition or malnutrition, as you may have heard about it before. One of the ways in which that manifests is the height that they actually achieve. So a child who doesn't grow as tall as their DNA is genetically designed for them to experience what we call stunting. 

And that's when their height is falls short of where their body was capable of growing. And that happens for a lot of reasons, and I'll talk about those in a few minutes. I wanna talk a little bit about malnutrition or undernutrition in general, just to make sure that everybody's on the same page. When we think about malnutrition, we think about insufficient or excessive or imbalance consumption of nutrients, and when the body doesn't get what it should, whether that's too much or too little, we end up in places that are not optimal for the body's growth and development and operation. 

And there are also a number of [00:03:00] disorders and and diseases that might happen as a result of this. When we speak about malnutrition in general, we could be referring to both over or undernutrition, but in most cases, in low income or low resource countries, we're referring to undernutrition. When we speak about malnutrition and when we talk about a child who is shorter than they should be based on their genetic predisposition, we're talking about a child who's stunted. 

Now, there are other measures that are really important. I won't get into those today, but you might hear about wasting, which is when a child is too lean. This happens oftentimes in areas of high conflict and where people have been displaced by either that conflict or natural disasters. Thankfully, that's not a huge part of populations. 

It might represent anywhere from five to 15% of children. But when we think about other other measures, we really, the one that we deal with a lot is stunting. And in some places, as as many, as half or nearly half of all kids are still not achieving the height that they [00:04:00] should. Now, it's not always easy to notice this. 

If I were to give you a picture of, of two kids side by side with one being four and one being two, and I were to tell you that, and they, and say they're the same height, and I would say one of these children is stunted and the other one is not. You may look at that and not be able to recognize the difference between those two kids. 

Just on the surface, stunted kids don't necessarily look sick or ill, they may just be shorter, and if you don't have a reference point, you may not even realize what is going on. But what we do know about, about stunting and about why it matters is that kids that do experience this stunting over time, they're more likely to suffer from serious illness and to die. 

And many of those illnesses are like diarrhea, pneumonia, and measles. One of the challenges is there's this cyclical downward spiral with nutrition and with health where if a child experiences these diseases, especially chronic or episodic diarrhea or pneumonia, they then consume [00:05:00] or they're able to digest fewer calories during that time, which then leads to lower nutritional outcomes. 

And these things kind of build on each other in a negative way. Now kids who experience stunting also experience cognitive delays and sometimes permanent delays in their development because what we know is at the same time that the child isn't growing. At the same rate that they should be, that the other systems in their body are not receiving the nutrition that they need as well. 

And especially the neural system is really critical as we think about brain development and about cognition for a child. So what we do see is that kids that experience under nutrition specifically, or particularly stunting, are more likely to start school later. They're more likely to drop outta school earlier than their peers. 

And in cases where families have to decide perhaps with the context that they can't afford school fees for all their children, which children that they send to school, they're oftentimes having to make hard choices, and they may make those [00:06:00] around. The potential of a child. So if they look at their children and say, well, this child is smaller, shorter, um, they're less likely to succeed in school, so I'm not gonna use our limited resources to keep them in school. 

We'll have them help out around the house. So these kids face challenges on a number of fronts, and what we know from a lot of data and good research is that children who experience stunting are more likely to stay in a poverty cycle. That both also increases the chances of their own children experiencing stunting. 

As well as impeding their own socioeconomic development. So why does this happen? Some of these answers may be obvious to you, and a lot of times we would think about, well, a child who's shorter as a result of undernutrition must just not be getting the right kind or must not be getting adequate calories. 

That's partially true, but, but many children who experience stunting actually get adequate calories, but typically from very few, few, uh, foods. So what they lack is what we call dietary diversity, and they oftentimes lack really [00:07:00] key critical nutrients, both macro and micronutrients. So they may be lacking in both. 

Proteins and fats, they may be lacking in specific vitamins and other micronutrients while getting adequate carbs to maintain a certain level, but not able to really grow the way that they should. As I mentioned earlier, these kids oftentimes struggle with repeated and chronic infections, and so they're more prone to those, but those infections then also reduce their ability to absorb calories or to have the energy and the interest to continue to consume food while they're sick. 

A lack of maternal education can contribute to this as well, including other challenges that moms may face, postpartum depression and their own sickness. And then one of the key indicators is if a mother doesn't survive the pregnancy or the delivery, then the child outcomes drop pretty hard in a very significant way. 

Now we also know that social exclusion being on the margins in the society can also contribute to this, and maybe the lack of availability of a caregiver. So maybe the mother [00:08:00] works in the fields all day, is unable to provide to the child in the way that they'd like to. And as I mentioned earlier, sometimes war enforced migration, whether that's student natural disaster or conflict, also impact these children tremendously. 

Now, what can we do about all This is a question that many of my students often raise, and there really isn't a magic bullet on how to solve undernutrition. To unwind such a big challenge, takes a really thoughtful, systematic response rather than a a one size fits all type solution. But what we do know is there is a window in which addressing this is by far the most important time, and it's what we call the first a thousand days. 

The first a thousand days is that approximate a thousand days from when a child is conceived. To when the child gets to their second birthday, and we know that the nutrition and the exposure and the experience of a child during that time immensely impacts their ability to grow and develop the way that they should. 

We also know that the end of that a thousand [00:09:00] days, that the trajectory that the child is on from a nutrition and a growth point of view is hard to change. Not impossible, but it's challenging. So let's talk about the first thousand days for a minute. So when a child is conceived and is in utero during that pregnancy, the foods that the mother consumes, the dietary diversity that she's able to experience and to provide and to pass on through her to her child, as well as the sickness and challenges that a mother faces. 

All impact that baby's growth and development in utero. And this can lead to either successful or, or a complicated pregnancy and delivery. And so what we hope for that, kids that are born in an adequate birth weight, which currently we use, just a simple threshold of two and a half kilograms or a little bit over five pounds as being, is being kind of cut off between low birth weight versus inadequately developed baby in utero. 

And this is really important, especially in places where the lifesaving [00:10:00] structures and support systems are not in place or not readily available in hospitals and in clinics. To have children that go full term and that come out and that are weighing at a healthy weight so that they have a very good start. 

We know then in the first six months then of their life that breast milk is best in almost all cases, and it helps that child both as a superfood because of the nutrients it contains, as well as the ability to pass on protection against illness and disease from the mother's immune system. And then from six months to two years, we also know that it's really critical then to present and provide complimentary foods to breast milk and to continue to breastfeed children. 

For up to two years while giving these additional foods that are, um, start to build the child's dietary diversity. When we meet and do those things in those first thousand days, those kids are 10 times more likely to overcome the most life-threatening childhood diseases. They complete, on average, four and a half more grades of [00:11:00] school. 

And they go on to earn 21% more in adult wages, which leads to healthier families and healthier individuals, which is really critical. One of the really awesome things that I've been able to learn about recently is the work that the church of Jesus Christ Lord Saints is doing to currently address child under nutrition around the world and through recent initiatives that the church has implemented is working in low income countries around the world. 

With relief society presidents and bishops and primary presidents to reach out to kids who are experiencing nutritional challenges and to make sure that they have adequate calories in the right kinds of childhood diversity in their diet or child dietary diversity. And this is, has the potential to really reshape a future generation in the church and in the communities that where these church members live, where they share these ideas and these practices with others. 

It's a major initiative currently with the General Primary and Relief Society presidency, and it's really exciting to see this work going [00:12:00] on. There are lots of other nonprofits that are working in this space as well that see this as really critical to what we do and to making a difference in child and nutrition. 

So when you think about your height and the future, remember your height really does matter, but it matters for things that maybe we don't always think about. Things that we take for granted, and that. What we really need to think about as we think about how to make the world healthier is giving every child a chance to be able to reach their potential through good nutrition and development. 

The one last thing I'll say to this is, while adequate nutrition and the right kind of dietary diversity are really critical. W to round out a child's development and growth during these early years also requires a few other things that are really important, safety and security, that a child grows up in an environment in which they feel safe and are safe. 

A chance to be able to learn in what we call stimulation is really critical. At the same time that the brain needs the right nutrients to grow and develop, it also needs the right kind of stimulus to [00:13:00] grow and and develop so that it can reach its potential. So what we call active feeding or games or other sorts of in, of learning and stimulation for the child are really critical to that neural development. 

In fact, there are studies that show that you could provide a child with great nutrition and if that child lacks good learning stimulation, they'll fall, fall short of their own cognitive development and growth as they could. Responsive caregiving is also critical, and also monitoring and helping other areas of health where we can reduce infection and disease. 

By improving water and sanitation, reducing the spread of disease through immunizations and other initiatives and programs all combined together to help a child to have a healthy and great start in their future. Thank you for your time today. 

Cougar: Thank you for supporting the Y Health Podcast. We look forward to continuing to provide you with engaging discussions as well as more focused educational content through our new classroom edition and our timely public health [00:14:00] service announcements. 

We really truly appreciate your support and hope that you find the Y Health Podcast beneficial.