Learning Objectives: 1. The learner will identify the essential elements of an intervention for growth stunting. 2. The learner will describe the process used to deliver an intervention for growth stunting. Objective: The objective of this study was to examine the effects of an intervention for growth stunting delivered to children below the 5th percentile of height on the National Center for Health Statistics growth grid. Design: A quasi-experimental design was utilized in this study. The control group was enrolled in 1999, and the intervention group was enrolled in 2000, and was scheduled for a series of eight classes over a six month time period. Measurements on the variables of interest were collected initially, and then every six months for 1 or 2 years, depending on how long the child remained on WIC (Special Supplemental Nutrition Program for Women, Infants and Children). Population, Sample, Setting, Years: One hundred seventy-five children ages 12 to 24 months were enrolled in the study, 85 in the control group and 90 in the experimental group. The children were all recipients of WIC vouchers and were identified by their mothers as of Mexican-American ethnicity. The children all measured at or below the 5th percentile in height and did not have an underlying organic condition as the cause of the growth stunting, and were born full-term. The study occurred in 3 WIC clinics in a large Texas city in 1999 to 2001. The 3 WIC clinics were matched on ethnicity of participants. WIC controls for income as all recipients must be below 185% Federal poverty guidelines to obtain WIC. Concept or Variables Studied Together or Intervention and Outcome Variable(s): The outcome variables of this study were: growth in height and weight as measured by height in inches and weight in pounds and analyzed with z scores; maternal-child interaction as measured by the Nursing Child Assessment Satellite Training Teaching Scale; maternal perceived stress as measured by the Perceived Stress Scale; dietary quality as measured by the food pyramid and analyzed with a computerized diet program (Food Processor II); and home environment as measured by Home Screening Questionnaire. Acculturation, as measured by Acculturation Rating Scale for Mexican Americans, was examined as a mediating variable. Methods: The intervention was delivered in a series of eight classes, given at the WIC clinics as a replacement for the standard WIC nutrition education classes required of all participants. The classes were designed from the conceptual framework of the study, which is the Ecological Model of Growth. The Ecological Model of Growth is based on the epidemiological concepts of agent, host, environment and the ecological concepts of microsystem, mesosytem and macrosystem. The content of the classes covered the topics of appropriate nutrition for toddlers, oral health care, parenting education for parents of toddlers, safety, health maintenance, and community resources. Findings: The children whose mothers attended 6, 7 or 8 classes had the greatest increase in height without exceeding the median for weight and a greater increase in their intake of protein, zinc, fat, carbohydrate and calcium than did the control group or the children whose mothers attended fewer than 6 classes. The control children had a decrease in their intake of calcium, carbohydrates and zinc between the 1st and 2nd visits. The intervention group had a significantly greater intake of calories than did the control group at the 2nd visit (p=. 04). The intervention children whose mothers attended 6 or more classes had the greatest increase in their home environments. The maternal child interactions showed a strong dose effect, in that the more classes the mothers attended, the more the interactions with their children improved (p=.01). The intervention children were significantly more responsive to their mothers (p=.04) at the second visit. All the subgroups in intervention classes (0-2, 3-5, and 6-8) showed an increase in interaction scores, while the control group showed a decrease in interaction scores from the first to the second visit. Conclusions: An intervention for growth stunting, based on public health nursing principles of nutrition, parenting, health promotion and disease reduction, safety and community resources, can make a positive impact on stunted children’s growth patterns, their home environments and interactions with their mothers. Implications: Children who are below the 5th percentile height, without an underlying organic condition, benefit from education provided to their parents in a community nutrition program.
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