Agriculture Reference
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aggressive behavior, and poorer social relationships than classmates or neighbor-
hood controls (Richardson et al. 1972, Galler and Ramsey 1989).
The Jamaican follow-up study of stunted children provided the most informa-
tion on possible long-term social-emotional effects of childhood growth retar-
dation. Children stunted in early childhood had more conduct disorder at age 11
years (Chang et al. 2002) and were more inhibited and less attentive in a test ses-
sion than nonstunted children (Fernald and Grantham-McGregor 1998). At 17 years,
stunted participants reported more symptoms of anxiety and depression and lower
self-esteem than participants who were never stunted. Parents of the stunted group
reported more problems with hyperactive behavior than parents of nonstunted par-
ticipants (Walker et al. 2007).
i m P a C t of f s u P P L e m e n t a t i o n o n D e v e L o P m e n t
If undernutrition contributes to poor child development, then interventions to
improve nutrition in undernourished children or reduce undernutrition in children
at high risk of growth retardation would be one approach to reducing the cognitive
and behavioral consequences. A number of randomized trials have been reported in
which food supplements were given in an attempt to improve children's nutritional
status and development.
supplementation trials with undernourished children
Indonesia
In Indonesia, 20 day care centers on tea plantations were randomized to treatment or
no treatment (75 supplemented, 38 control children aged 6-20 months). Snacks were
provided 6 days a week for 90 days. Supplementation benefited motor but not mental
development when measured at the end of intervention (Husaini et al. 1991). Sixty-
six supplemented children and 36 controls were remeasured at age 9 years. Benefits
were found for one of four cognitive tests only in children who were less than 18
months at the beginning of the intervention. No differences were found in arithmetic
or verbal comprehension (Pollitt et al. 1997).
Indonesia
Two cohorts of nutritionally at-risk children were enrolled from 24 day care centers in
Indonesia. One cohort comprised 53 children aged 12 months and the other 83 children
aged 18 months. Children were randomized to energy plus micronutrients, skimmed
milk plus micronutrients, or skimmed milk only. The supplement was provided 6
days a week for 1 year. In the 12-month cohort, children who received the energy
intervention had benefits to motor and mental development, increased vocalizations,
longer duration of play, and decreased fussing but no differences in sociability. There
were no significant benefits to the 18-month cohort (Pollitt and Schurch 2000).
Jamaica
There were 129 stunted children aged 9 to 24 months who were identified by
house-to-house survey of poor neighborhoods in Kingston, Jamaica. Children were
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