In the last post, I mentioned that I have been enlightened by so much of the information that we are compiling for SPOON’s Adoption nutrition website, like the impact of growth spurts on iron stores.  Another area that I found very interesting is the difference between wasting and stunting in malnutrition.  It partly explains why several parents in our survey noted that their kids were chubby upon adoption and so they assumed that meant they were well-nourished.   Michael Georgieff M.D., of the University of Minnesota, recently explained the phenomena of “wasting” and “stunting.”   Suddenly, I more thoroughly understood why even though some adopted kids look chubby, they are malnourished.  I was reminded of the time I was chided by a babyhouse doctor for feeding five year old Bakha an orange, “If you keep feeding her, she’ll get fatter and never walk.”  She couldn’t walk because of rickets.  She had a slightly chubby appearance because of stunting.  She looked short and stocky but didn’t really have an ounce of fat on her.  Now I get it.

Dr. Georgieff explains wasting and stunting the following ways:

Wasting: “Think of wasting as being too light for your frame. This is what most people think of with ‘malnutrition’ and it occurs because when there is a calorie deficit in children, the first body compartment to be affected is fat stores (and therefore weight), before the length or head (brain growth).”

Stunting: “Stunting refers to a condition where the frame is too small for the weight. Usually, in fact, both weight and length are abnormally low, but the length is “more low” than the weight, giving the false impression of a short, chubby appearance. In fact, they are not chubby from excess fat, but from excessively short length.  This is the pattern we see with preemies and internationally adopted kids (sometimes) and reflects not just inadequate calories, but also hormonal changes that stunt the linear growth. These hormonal changes are triggered by stress hormones (cortisol for example). Thus, it is probably a mixture of stress and malnutrition that give that body habitus. In the old literature, it was called ‘psycho-social dwarfism.’”

When Bakha came home at age 5 weighing 28 pounds and only 32″ tall, her developmental pediatrician encouraged me to feed her a diet high in fat, calories, and protein.  She assured me that the calories would go to height and not girth.  And if she did gain too much weight, we would just deal with that later.  She was right.  It all went to height.  I punched up her food with so many extras, and she grew like a weed.  It’s a little tricky to know just how much she grew, since some of the height can be attributed to her bones straightening out and her hip and knee contractures going away, but she easily grew 8 inches in the first year home, maybe more.

Here is Bakha, age 5, standing next to her 3 year old cousin.  This was taken the day after we got home:

And here are the two of them 16 months later.  You can see that Bakha’s high-fat, high-cal diet went straight to height.  Now of course you know I’m not advocating that you all go out and feed your kids whole milk spiked with cream, powdered milk, and Carnation Instant Breakfast the way I did.  You know to talk to your doctors about your personal situations.  I’m just sharing my story.