Mechanisms linking height to early child development among infants and preschoolers in rural India

Abstract

Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.6 months) and 316 preschoolers (mean age 36.6 months) in rural India from a randomized controlled trial of multiple micronutrient powders (MNPs). Measures included height (height‐for‐age z‐scores based on WHO standards), inflammation (C‐reactive protein concentration >5 mg/L), nurturance (HOME Inventory), child development (Mullens Scales of Early Learning), and inhibitory control (preschoolers). Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between height and child development over time (infants: enrollment, 6 and 12 months; preschoolers: enrollment and 8 months). Moderating effects of inflammation and nurturance were tested with interaction terms. Among infants and preschoolers, height and nurturance were positively associated with all domains of child development over time, with the exception of inhibitory control. Among preschoolers, in the presence of inflammation, height was not associated with child development. Among infants, but not preschoolers, a nurturant home environment attenuated significant associations between height with fine motor and receptive language development. The mechanisms associated with children's development over time are multifactorial and include direct and indirect associations among nutrition, health, and the home environment, as supported by the Nurturing Care Framework.

Joint roles of parenting and nutritional status for child development: Evidence from rural Cambodia

“…There is empirical justification for hypothesizing that there are independent and interaction effects between environmental stimulation, including parental stimulation, stunting, and child development. In support of the hypothesis that nutrition and parenting exert unique influences on child development, even when children have experienced early stunting, sensitivity to environmental stimulation is consistent throughout the first five years of life (Black et al, ). There is also evidence of an interaction effect between parenting and nutrition.…”

“…There is also evidence of an interaction effect between parenting and nutrition. Cognitive stimulation, as delivered through parenting, may ameliorate some of the effects of poor early nutrition on child development (Grantham‐McGregor, Powell, Walker, & Himes, ; Paxson & Schady, ), and stimulating home environments may mitigate the association between stunting and child development for infants and toddlers (Black et al, ; Nguyen et al, ), but a similar effect was not noted for preschoolers (Black et al, ). Thus, the role of environmental stimulation in ameliorating the negative impacts of stunting may vary by child age.…”

Studying Executive Function Skills in Young Children in Low‐ and Middle‐Income Countries: Progress and Directions

“…In rural Pakistan, children’s height for age at 24 months was related to preschoolers’ EFs, controlling for direct measures of antecedent and concurrent general cognitive skills, as well as families’ food insecurity, stimulation, and socioeconomic resources (Obradović et al, ). In rural India, concurrent measures of height for age and anemia, but not acute inflammation, were related to eight‐month change in preschoolers’ inhibitory control (Black et al, ). While a growing number of studies link linear growth and stunting to emergent EFs in low‐ and middle‐income countries, other mechanisms by which nutritional deficiencies may affect EF development have been understudied.…”

“…Furthermore, it remains unclear how acute and chronic inflammation, which can result from infectious diseases and subclinical infections, intersect with nutritional status, and growth to compromise emerging cognitive skills and particularly EFs (Black et al, ; Krebs, Lozoff, & Georgieff, ). We also need to examine known neural and physiological correlates of EFs in young children from low‐ and middle‐income countries.…”

Introduction to special issue on global child development studies

“…However, some of these risks disproportionately affect children in low‐ and middle‐income countries (LMIC). For example, multiple studies assess implications of risks related to malnutrition and poor growth (Black et al, ; Milosavljevic et al, ; Pyykkö et al, ), and Lu and Chang () examine how early environmental instability (i.e., reoccurring and prolonged separation from parents) affects aggression, risk‐taking, and life history strategies. Several studies report important interactions between different levels of analysis, such as child growth status and parenting (Berkes, Raikes, Bouguen, & Filmer, ), school climate and community violence (Starkey et al, ), and teacher training and child outcomes (Wolf, Aber, Behrman, & Peele, ).…”