Syeli Santriawati, Armelia Moesri

Impact of stunting on child growth and development measured by the denver developmental screening test: a case report

Introduction

Impact of stunting on child growth and development measured by the denver developmental screening test: a case report. Case report on stunting's impact on child growth & development, measured by the Denver test. Covers severe malnutrition diagnosis & intensive nutritional intervention for a 23-month-old.

Abstract

Background: Stunting remains one of the major chronic nutritional problems and a continuing public health challenge in Indonesia. This condition is characterized by a height-for-age measurement below −2 standard deviations (SD) due to inadequate nutrient intake and recurrent infections during the child’s growth period. The long-term impacts of stunting include impaired motor, language, and personal-social development. This case report aims to illustrate the clinical presentation, diagnosis, and comprehensive nutritional management of a child with stunting and severe malnutrition to highlight the importance of intensive and multifaceted intervention. Case Illustration: We report a case of a 23-month-old girl with a body weight of 7.6 kg, a body length of 75 cm, a mid-upper arm circumference of 13 cm, and a head circumference of 42 cm. The anthropometric assessment showed weight-for-age (W/A), length-for-age (L/A), and weight-for-length (W/L) values below −3 SD, indicating a diagnosis of stunting and severe malnutrition. The patient’s very low body weight was associated with inadequate energy intake, particularly insufficient consumption of animal protein. Dietary history revealed that the child mainly consumed rice and vegetables, rarely ate animal-source foods or fruits, did not receive breast milk, and had not gained weight since the age of one year. Clinical findings included short stature, dull hair resembling corn silk, and dry skin. Nutritional interventions included of ONS (oral nutritional supplements) at 1.5 kcal/mL PER (Protein Energy Ratio) >10% with 600 kcal daily in divided doses, a high-calorie and high-protein (HCHP) diet, and nutritional counseling for the parents emphasizing dietary variety and nutritional quality. Conclusion: This case illustrates stunting with severe malnutrition in a 23-month-old child resulting from inadequate energy and protein intake. Intensive nutritional intervention with ONS, a varied HCHP diet, and family nutrition education is expected to improve nutritional status and support optimal child growth and development.

Review

This case report addresses a highly pertinent public health challenge in Indonesia and globally: childhood stunting and severe malnutrition. It provides a detailed account of a 23-month-old girl diagnosed with severe stunting and malnutrition, stemming from chronic inadequate energy and protein intake. The authors effectively illustrate the complex interplay of socio-dietary factors contributing to the child's condition, characterized by profound anthropometric deficits and clear clinical signs. The central aim of the report is to highlight the necessity of intensive and multifaceted nutritional interventions, offering a practical example for clinicians and public health practitioners. A strength of this report lies in its comprehensive detailing of the child's anthropometric measurements, dietary history, and the specific nutritional interventions employed, including oral nutritional supplements, a high-calorie/high-protein diet, and parental counseling. This granular information is valuable for understanding the clinical presentation and initial management strategies for such complex cases. However, a significant concern arises from the discrepancy between the title, which explicitly mentions "measured by the Denver Developmental Screening Test," and the abstract's content, which provides no data or discussion related to this developmental assessment tool. While the background references long-term developmental impacts, the absence of actual Denver test results for the presented case significantly undermines the title's claim and the report's potential to illustrate developmental outcomes related to stunting. Despite the noted omission regarding developmental screening, the report successfully underscores the critical role of prompt and integrated nutritional support in managing severe stunting. The proposed intervention strategy, combining targeted nutritional supplements with dietary modification and family education, aligns with best practices for addressing chronic malnutrition. This case serves as a valuable clinical reminder of the severe consequences of sustained poor dietary habits and the potential for improvement with focused efforts. For future research, it would be highly beneficial to follow up on the long-term outcomes of such interventions, particularly incorporating objective developmental assessments, to fully evaluate the impact of improved nutritional status on global child development.

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