Lifespan Development. Tara L. Kuther

body takes on a hollow appearance. Another malnutritive disease is kwashiorkor, found in children who experience an insufficient intake of protein, which may occur when a child prematurely abandons breastfeeding, such as with the birth of a younger sibling. It is characterized by lethargy, wrinkled skin, and a fluid retention appearing as bloating and swelling of the stomach, face, legs, and arms. Because the vital organs of the body take all of the available nutrients, the other parts of the body deteriorate. Marasmus occurs most often in infants whereas kwashiorkor tends to occur in older infants and young children (Morley, 2016).

      Malnutrition influences development in multiple ways. Malnourished children show cognitive deficits as well as impairments in motivation, curiosity, language, and the ability to effectively interact with the environment throughout childhood and adolescence and even into adulthood (Galler et al., 2012; Peter et al., 2016). Malnourishment damages neurons, as shown in Figure 4.3, and the resulting neurological and cognitive deficits from early malnutrition last. For example, among Ghannan children who survived a severe famine in 1983, those who were youngest at the time of the famine (under age 2) scored lower on cognitive measures throughout childhood and into adulthood than did those who were older (ages 6 to 8) (Ampaabeng & Tan, 2013). Malnutrition during the first year of life is associated with depression years later, when those children are 11 to 17 years old (Galler et al., 2010). Some of the damage caused by malnutrition can be reversed. For example, motor and mental development can be enhanced if nutrition is reinstated early. However, long-term difficulties in attention, learning, and intelligence often remain, even into middle adulthood (Kim, Fleisher, & Sun, 2017; Schoenmaker et al., 2015; Waber et al., 2014).

      This child suffers from an extreme nutritional deficiency, kwashiorkor. Early treatment can reduce the deficits associated with kwashiorkor, but most children will not reach their full potential for height and growth.

      Dr. Lyle Conrad - Centers for Disease Control and Prevention, Atlanta, Georgia, USA Public Health Image Library (PHIL); ID: 6901 http://phil.cdc.gov/

      Although malnutrition is common in developing countries, it is also found in some of the world’s wealthiest countries. Because of socioeconomic factors, many children in the United States and other developed countries are deprived of diets that support healthy growth. In 2015, about 13% (or 15.8 million) households were categorized as food insecure. That is, they lacked consistent access to food to support a healthy lifestyle for all family at some point during the year (Coleman-Jensen, Rabbitt, Gregory, & Singh, 2016). Low-income families may have difficulty providing children with the range of foods needed for healthy development. In the United States, we have linked inadequate nutrition with stunted growth, health problems, poor school performance, and poor relationships with peers (Abdelhadi et al., 2016; Alaimo, Olson, & Frongillo, 2001; Hampton, 2007).

      In addition to providing adequate nutrition, the use of vaccines can promote the health of infants and young children, as noted in the Applying Developmental Science feature on vaccination.

      Figure 4.3 Effects of Malnourishment on Brain Development

      Source: De Onis and Branca, 2016, https://onlinelibrary.wiley.com/doi/epdf/10.1111/mcn.12231 licensed under CC BY 3.0 IGO, https://creativecommons.org/licenses/by/3.0/igo/legalcode

      Failure to Thrive

      Individual differences are the norm when it comes to growth; children grow at different rates. However, some children show significantly slower growth than other children their age. Some infants display failure to thrive, a condition in which their weight is below the fifth percentile for their age, meaning that they weigh less than 95% of same-age children (S. Z. Cole & Lanham, 2011). Their caloric intake is insufficient to maintain growth (Larson-Nath & Biank, 2016). Children with failure to thrive may be irritable and emotional, lack age-appropriate social responses such as smiling and eye contact, and show delayed motor development. Untreated, failure to thrive is accompanied by delays in cognitive, verbal, and behavioral skills that make it difficult for the child to achieve success in school, home, and peer environments.

      Failure to thrive can be caused by medical conditions., such as gastrointestinal and other health problems. Sometimes socioemotional and contextual factors contribute to failure to thrive, such as an insecure attachment to caregivers, parents with physical or mental health problems, emotional neglect and abuse, and, especially, living in poverty and experiencing contextual stressors such as violence within the community (Feigelman & Keane, 2017; Homan, 2016). Pediatricians typically treat failure to thrive by providing the child with the nutrients necessary to grow normally. They may also work with other health professionals such as psychologists and social workers to address underlying medical and psychosocial contributors (Feigelman & Keane, 2017). Although nutritional interventions can alleviate many of the effects of malnutrition on physical development, some children might show long-term cognitive and psychosocial deficits.

      Applying Developmental Science

      Vaccination

      Vaccines protect children and communities from diseases that once spread quickly and killed thousands of people.

      BSIP SA / Alamy Stock Photo

      Over the past 60 years, childhood diseases such as measles, mumps, and whooping cough have declined dramatically because of widespread immunization of infants. A vaccine is a small dose of inactive virus that is injected into the body to stimulate the production of antibodies to guard against the disease. Vaccines control infectious diseases that once spread quickly and killed thousands of people.

      Vaccines are administered early in life because many preventable diseases are more common in infants and young children. Vaccinations protect the child, as well as those in the child’s community. An immunized person is less susceptible to a disease and less likely to transmit it to others. State laws require schoolchildren to be fully immunized, a requirement that has increased vaccination rates and prevented many diseases.

      The Centers for Disease Control and Prevention (CDC) recommends that infants be vaccinated against most vaccine-preventable diseases by the time they are 2 years of age. Vaccination rates have increased markedly over the past 15 years. The proportion of children aged 19 to 35 months receiving the recommended series of vaccines increased from 69% to 83% between 1994 and 2004. However, the rate has stalled since, standing at 82% in 2013 (Child Trends Databank, 2015).

      Why are nearly one fifth of children unvaccinated? One reason is that many families in the United States do not have access to the health care they need. Children in families with incomes below the poverty level are less likely to receive the combined series vaccination (Child Trends Databank, 2015). Many parents are unaware that children from low-income families who do not have medical insurance can receive vaccinations through the federal Vaccines for Children Program, begun in 1994. In addition, the vaccination schedule is complicated, with specific vaccines administered at specific times in development (Kurosky, Davis, & Krishnarajah, 2017).

      Another, more troubling, reason for the stalled vaccination rate is the common misconception that vaccines are linked with autism. Some parents refuse to have their infants vaccinated due to this concern (Salmon, Dudley, Glanz, & Omer, 2015). Extensive research indicates that there is no association between vaccination and autism (Modabbernia,