Stunting Event in Child Growth and Development

Exclusive Breast-milk Relationships, Immunization Status, and Family's Economic

Status with Stunting in Children

Choirunisa Wahyuningsih, Desi Adelia, Dita Aulia Afifah, Kharima Salamah

Universitas Muhammadiyah Prof. DR. HAMKA, Jakarta, Indonesia

ABSTRACT

Stunting reflects chronic undernutrition during the most critical periods of growth and
development in early life. The purpose of the study to assess the incidence of Stunting in
children under five regarding exclusive breastfeeding, immunization status, family
characteristics. The conclusion, stunting among children is associated with lower family
income, not-exclusively breastfeeding, complementary feeding less favorable and incomplete
immunization. While not-exclusive is breastfeeding a dominant factor as the cause of the
child's risk of experiencing stunting. The impact of stunting if left untreated will cause
problems for the generation in the future, for example, impairment of mental development and
physical growth, and it will end in poverty and the threat of life survival, so it needs a proper
intervention to handle it.

A. INTRODUCTION
Stunting is a condition of malnutrition that occurs in children for a long time due to lack
of intake of nutrients that enter the body. The definition of stunting regarding the decision of
the Minister of Health Number 1995 / MENKES / SK / XII / 2010 is the nutritional status
based on the body length index by age (PB / U) and based on the height according to age (TB
/ U). A child can be said to be stunting if the index of length and height by age has been
measured, but the results are still below standard.
Stunting is one of the most common health problems in Indonesia. Health development
in Indonesia in the period 2015-2019 focuses on four priority issues that need to be addressed,
among others, the reduction of maternal and infant mortality, decreased prevalence of stunting
patients, the prevention of infectious diseases and the prevention of non-communicable
diseases. According to the Medium-Term Development Plan in 2015-2019, the target of
achieving a stunting prevalence reduction in children under the age of two is 28%.
 Based on the results of Basic Health Research (Riskesdas), the incidence of stunting in
Indonesia in 2013 amounted to 37.2%. Compared to stunting events in 2010 (35.6%) and in
2007 (36.8%), there was no significant decrease and improvement. In 2013, the highest
incidence of stunting occurred in 3 provinces, among others, East Nusa Tenggara (51.7%),
West Sulawesi (48.0%), and West Nusa Tenggara (45.3%). Meanwhile, the provinces that
experienced the lowest stunting incidence were Riau Islands Province (26.3%), D.I
Yogyakarta (27.2%), and DKI Jakarta (27.5%). According to the Nutrition Status Monitoring
(PSG) conducted by the Ministry of Health in 2015 shows as many as 29% of children in
Indonesia experience stunting, with the highest incidence in the province of East Nusa
Tenggara and West Sulawesi.
Characteristics of children who experience stunting not only seen from the weight that
is not following the standards. However, children affected by stunting can be seen by things
that can be seen in detail such as older-looking faces that do not match his age, hair that looks
dull, generally frequent diarrhea, his body looks thin, there is edema (swelling) on the feet and
face. Stunting problems in children indicate that there are chronic nutritional problems that
affect children in their growth and development. This is influenced by several factors, ranging
from the health conditions of the prospective mother, pregnancy, infant and toddler,
inappropriate nutrition intake and illness suffered. Like other nutritional problems, health
factors are not the primary cause of stunting in children. Other conditions or factors may
indirectly cause stunting in the child, such as the infant care pattern, the environmental
condition, and the health services obtained. Adverse effects that can occur in children
suffering from stunting are the short and long-term impact. Short-term effects of disruption of
growth and brain development, decreased intelligence in children, disruption of growth and
development of the body and can disrupt the metabolism in children. While the impact given
in the long term is to interfere with cognitive abilities in children and learning achievement,
decreased immunity contained in the body so easily affected by the disease, increasing the
risk of diabetes, heart disease and blood vessels, stroke, cancer, decreased work productivity,
causing death in children.
Therefore, the need for improvement and overcoming to overcome the problem of
nutrition in children. These remedial efforts include efforts to prevent and reduce direct
disturbance (specific nutritional interventions) and to prevent and reduce indirect disturbance
 (sensitive nutritional interventions). Specific nutritional interventions are usually performed
by health workers, while sensitive nutrition interventions involve many sectors such as food
security, sanitation, water supply, poverty alleviation, education, etc. In addition, other
interventions that can be done is to improve nutrition and health in pregnant women by
providing adequate nutrition and give tablets added blood, exclusive breastfeeding infants at
least until the age of 6 months, providing complete immunization to children, monitoring the
growth and development of children under five routinely in Posyandu, as well as doing a clean
and healthy lifestyle. It is expected to suppress stunting events in children.

B. The Importance of Exclusive Breast Milk In Fulfillment Of Nutrition For Children To

Prevent Stunting
Breast milk is an ideal form of food in the fulfillment of nutrition for children because
breast milk can meet the nutritional needs of infants to live during the first six months of life.1
In this case, breast milk is a portion of food that is needed especially in infancy to toddlers to
grow and body development. Breast milk has several virtues for health and to help the growth
and development of a child. In breast milk there are three-quarters of the protein needs of
infants aged 6-12 months, besides breast milk also contains all essential amino acids needed
by infants.
Exclusive breastfeeding is the provision of breast milk to a child at least until the age of
6 months without providing other complementary foods. The benefits of breastfeeding given
by the mother to a child are numerous, including breastfeeding can improve immunity in
children and minimize the occurrence of health problems or infections experienced by
children. Besides breast milk can also improve the intelligence of a child. Infants who are not
exclusively breastfed for at least six months by their mothers have a higher risk of stunting
compared to babies given exclusive breastfeeding. This is because children who do not get
exclusive breastfeeding from their mothers do not get a balanced nutritional fulfillment such
as children who are given exclusive breastfeeding. Because in breast milk there are some
essential nutritional content and play a role in the growth and development of children under
five, among others, high enough protein, the content of many essential amino acids, minerals,
and many other contents that can affect the health of a child.
 The low level of exclusive breastfeeding is one of the causes of stunting in children
under five. In contrast, exclusive breastfeeding is good for mothers for children under five. It
will reduce the number of stunting events and can keep the growth of children can run
optimally.

C. Genesis Stunting Based on Completeness of Immunization

Immunization is a process to boost the immune system by entering the vaccine into the
body either by injection or orally. Immunization is done to reduce morbidity and mortality
from a disease that can still be prevented by immunization.
Immunization status in infants is very influential on the incidence of stunting in toddlers.
From the results of the research shows that the tendency of infants affected by stunting is
higher in toddlers or a child who does not get a complete immunization. While children who
get full immunization experience a lower stunting event. Immunization status in children is
one indicator of contact with health services. It is expected that contact with health services
can help improve nutritional status or stunting problems so that immunization status is also
expected to have positive effects or effects to improve nutrition problems, especially the
problem of stunting in children in Indonesia.

D. Stunting Events Viewed at Family Income Level

Work is the most important thing in determining the quality and quantity of food because
of work related to income. Thus, there is an association or relationship between income levels
with family nutritional status. If the income increases, it does not deny health and nutrition-
related health problems will improve. Conversely, if the family income is less, it will impact
on health problems such as lack of nutrient intake that occurs in the family.
Indirectly, the level of family income may affect the incidence of stunting in children.
For example, if a family with sufficient incomes will get adequate services, such as health
services, education, employment access and others. A reasonable family income level, eating
will minimize the occurrence of stunting because it can meet the nutritious food needs for
children who are experiencing growth and development.
E. Conclusions
Stunting is a condition of malnutrition that occurs in children for a long time due to lack
of intake of nutrients that enter the body. Stunting is caused by several factors, among others,
the intake of nutrients that enter during pregnancy is not meet the standards, and not touched
by immunization at the time of infants and toddlers. Exclusive breastfeeding, ASI MP and
economic status in the family may affect the incidence of stunting in children. If a child is not
breastfed at the time of the baby may increase the risk of stunting. This is because the breast
milk contained some essential substances that are needed by the baby in its infancy and
development. Similarly, breast milk ASI as a food support breast milk, MP ASI also play an
essential role in the growth and development of children. Provision of MP ASI to the baby
can also minimize the occurrence of stunting in children. Another factor that is also associated
with the incidence of stunting is the economic status of the family. Usually, stunting happens
to many families who have below the regular income, so it can not meet the nutritional needs
of the family.
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