Age-specific determinants of child growth among under-five children in Southern West Bengal, India

INTRODUCTION

Child growth is extensively renowned as a sensitive measure of population health and reflects the cumulative influence of nutrition, health care, and socio-economic conditions during early life.^1-3 Child growth retardation, or growth faltering, refers to a slower-than-expected increase in height or weight relative to age and serves as a key indicator of inadequate nutritional status in children.^4,5 Adequate nutrition throughout the initial five years of life is crucial for optimal physical nourishment, cognitive progress, and immune function.^6-8 However, undernutrition continues to be a primary public health problem with in India, specifically amid children below five years of age. Undernutrition is usually measured applying three key anthropometric indicators: stunting (reduced height relative to age), wasting (reduced weight relative to height), and underweight (reduced weight relative to age).^6-8 Globally, child undernutrition is a consistent primary public health concern. According to WHO (World health organization) 149 million children under 5 were estimated to be stunted (reduced height relative to age), 45 million were estimated to be wasted (too thin for height).⁹ Based on National Family Health Survey (NFHS-5) findings, in India highlight a continued high prevalence of undernutrition among children aged 0–59 months. Approximately 35.5% of children are stunted, 19.3% are wasted, and 32.1% are underweight.¹⁰ At the regional level, the situation remains concerning; in West Bengal, stunting, wasting and underweight amid the children were reported as 33.8%, 20.3%, and 31.6% respectively, reflecting a significant burden of chronic and acute malnutrition.¹¹ Child growth is influenced by a range of socio-demographic and feeding-related factors. Maternal education is a key determinant, as it affects knowledge and adoption of appropriate child feeding and care practices.^12-15 Family type may influence care giving patterns and intra-household resource distribution, while father’s occupation reflects the socioeconomic status of the household, which in turn affects food access and living conditions.^16-19 Feeding practices also play a critical role in child growth. Early initiation practices such as colostrum feeding are important for establishing immunity and supporting early nutrition. In later stages, factors such as feeding site, feeding problems (e.g., poor appetite or selective eating), and the child’s ability to self-feed can influence dietary intake and feeding behaviour. These factors collectively contribute to variations in nutritional status and growth outcomes among children.^12,19-21 Evidence suggests that growth faltering does not occur uniformly across age groups; rather, its magnitude varies with age, socio-economic conditions. Therefore, this individual study aims to measure the age-specific indicators of child growth among under-five children in Southern West Bengal, India, with a particular focus on the role of socio-demographic and feeding-related practices.^1,12,22

METHODS

This study adopted a community-based observational cross-sectional design to examine age-specific indicators of child growth amid children between 12 to 59 months of age. The study was carried out between January 2025 and February 2026 in North 24 Parganas. The district includes both rural and urban settings, representing varied socio-economic and cultural conditions.

The study participants composed of children between 12 to 59 months living in the selected area, along with their mothers or primary caregivers. Only those children who were permanent residents of the district were considered eligible.

Children with severe illness during the time of survey and those whose caregivers did not provide consent were excluded.

The participants were selected by applying simple random sampling. Initially, a list of households with children aged 1–5 years was prepared. From this sampling frame, eligible children were selected randomly, ensuring equal probability of selection, until the desired sample size was reached.

Data collection methods

Data collection was carried out through direct interviews with mothers or caregivers using a pre-tested structured questionnaire after obtaining informed consent. The questionnaire captured information on socio-demographic variables (age, sex, maternal education, and occupation), young child feeding practices (exclusive breastfeeding, colostrum feeding, self-feeding behaviour) and feeding-related issues such as appetite and feeding difficulties.^20,21

Statistical assessment

The study data were coded, entered into statistical package for the social sciences (SPSS), and subsequently analyzed. The data were summarized using descriptive statistics such as frequency distributions and percentages. Associations between age groups and selected variables were examined using the Chi-square test. A p value of less than 0.05 was considered statistically significant.

RESULTS

Table 1 showed the age wise distribution of nutritional status among children with difference in outcome across the different ages. The magnitude of wasting (weight-for-height) has been decreased with increasing age, from 86.0% among children aged 12-23 months to 76.0% in those aged 48-59 months. On the other hand, moderately wasted children increased with age, reaching 16.0% in the oldest age group. Severe wasting remained relatively low among all the age groups. The association between age and wasting was statistically significant (χ²=18.618, p<0.005), indicating that wasting varied meaningfully with age. In terms of stunting (height-for-age) the proportion of children having normal nutritional status remained relatively stable across age groups, ranging from 75.0% to 81.0%. Moderate stunting was slightly higher among children aged 48–59 months (17.0%), while severe stunting varied minimally between 6.0% and 8.0% among ages. The distribution of underweight (weight-for-age) showed relatively consistent patterns across all age groups. The proportion of normal nutritional status ranged from 73.0% to 77.0%, while moderate and severe underweight showed only minor variations.

Figure 1 report that amid the 12-23-month age children, underweight was the most frequently observed nutritional problem, affecting 26 % of the children, followed by stunting (21%) and wasting (14%).

As shown in Figure 2, among children aged 24–35 months, 26% were underweight, 25% were stunted, and 24% were wasted. Underweight was the most prevalent nutritional problem in this age group.

According to Figure 3, among the children age group of 36-47 months, around 23% of children were suffering from underweight, 19% were stunted and 16% were wasted. Underweight was the most prevalent form of undernutrition in these ages.

According to Figure 4, among the age group of 48-59 months, around 26% of children were suffering from underweight, 19% were stunted and 16% of children were wasted. In this age group also majority of children were suffering from underweight.

Overall the findings showed that the children from later age group, showed a higher proportion of malnutrition, specifically wasting and underweight, than the younger children. This individual pattern indicates inadequate nutrition among older group children.

Table 2 showed distributions of socio-demographic characteristics varied across ages. Most of the mothers had secondary education (75.0%), followed by tertiary education (16.0%), while only a small proportion had no or primary education. Regarding maternal occupation, most mothers were not employed (87.0%), and only 13.0% were employed. Father’s occupation showed a diverse pattern, with the majority being semi-skilled workers (82.0%), followed by unskilled (11.0%) and skilled workers (7.0%). A statistically significant relationship was observed between father’s occupation and age group (χ²=98.712, p<0.01). According to the family structure, joint families (57.0%) were more common than nuclear families (43.0%). The distribution of family type varied significantly across age groups (χ²=41.609, p<0.01).

Table 3 showed age wise distribution of young children ages 12-59 months. Exclusive breastfeeding was reported in 73.0% of children overall, with higher prevalence in younger age groups (82.0% in 12–23 months) compared to older children (55.0% in 48–59 months). Similarly, colostrum feeding was practiced among the majority of children (80.0%), with a gradual increase among older ages. As per results, in case of feeding site, feeding in front of the TV/phone was the most common practice among all the ages (73.0%), while feeding at a child table or having no definite place was relatively uncommon. Feeding site showed a strong and statistically significant association with age (χ²=223.52, p<0.01). Feeding problems also varied significantly with age (χ²=296.309, p<0.01). Overall, 62.0% of children had limited appetite, followed by little interest (21.0%) and selective eating (47.0%). The pattern of feeding difficulties differed across age groups, indicating age-related changes in feeding behaviour. In case of self-feeding practices, 39.0% of children were self-feeders, with a higher proportion recorded in the youngest age group (61.0%) compared to older groups. This association was statistically significant (χ²=8.623, p<0.03).

DISCUSSION

Child growth reflects the overall nutritional and health status of children and is inclined by an amalgamation of biological, socio-economic, and behavioural aspects. Growth faltering, wasting, in particular, continues to pose a significant public health challenge across many low- and middle-income nations.^23,24 The present study result reflects a clear age related variation in child growth within children aged 12–59 months in Southern West Bengal. The findings demonstrate that wasting showed a significant association with age (χ²=18.618, p<0.005), with a decline in normal nutritional status as age increased, while moderate wasting increased in older age groups.⁴ This specific pattern suggests that children may become more vulnerable to acute malnutrition as they grow older. According to a study related to multiple countries data showed that nutritional status changes with age and reflects accumulated exposure to adverse condition.²⁵ On the other hand, stunting and underweight did not show significant variation across the age groups, showed a relatively stable distribution. This pattern indicates that chronic undernutrition initiate early in life and persist across age groups without fluctuation.^2,26 According to a study conducted in Sub–Saharan-Africa showed that stunting shows stable growth deficit over time.²⁷ This study found a significant association between father’s occupation and ages provide a age specific variation in socio economic condition of households that eventually influencing child growth. A similar study also showed reported that father occupation directly influences child growth via household income and living condition.¹⁴ According to present study outcome, the significant relationship between family type and different ages reflect variation in the care giving pattern and recourses of that individual household. Similar studies have reported that family structure influence child growth through its impacts on care practices, food access and economic support.^13,29 According to the study outcome majority of mother’s were having secondary education and not employed to any work.³¹ As per this study outcome young children’s were having higher prevalence of breast feeding and colostrum feeding. Similar study results also reported that breast feeding related practices are more frequent during the early days of childhood.²⁸ This study outcome revealed the predominance of feeding in front of the TV/phone and a significant association was also showed between feeding site and ages. According to a study conducted in Korea revealed that 30.7% of children were exposed to media during meals was significantly associated with unhealthy food eating pattern, poor eating and poor dietary quality.²⁹ This present study outcome showed a significant age wise variation in feeding problem among children. Limited appetite was the most usual feeding problem, followed by little interest in food and selective eating. A similar study finding showed in some recent studies, were feeding difficulties such as food selectivity and low interest in eating were found to vary across developmental stages in young children.^30,31 According to the findings of the present study, self-feeding practices differed significantly across age groups among young children. A higher proportion of self-feeding was observed in younger children, indicating age-related differences in feeding independence. Similar findings have been reported in previous studies, which demonstrated a significant association between child age and the development of feeding behaviours.³¹

CONCLUSION

The findings revealed notable age-related differences in wasting among children, with a gradual reduction in the proportion of children exhibiting normal nutritional status as age increased (χ²=18.618, p<0.005). Feeding-related behaviours, particularly the location of feeding, were significantly linked to age (χ²=223.52, p<0.01), reflecting behavioral transitions during child development. A statistically significant relationship was also observed between age and feeding-related difficulties (χ²=296.309, p<0.01), where poor appetite emerged as the most frequently reported concern. Variations in self-feeding behaviour across age groups were significant (χ²=8.623, p<0.03), indicating progressive development of feeding autonomy with advancing age. Furthermore, socio-demographic characteristics, including father’s occupation (χ²=98.712, p<0.01) and family structure (χ²=41.609, p<0.01), showed significant associations with age, suggesting their potential contribution to child nutritional and developmental outcomes. These observations emphasize the importance of implementing age-sensitive nutritional strategies that promote suitable feeding practices and timely recognition of feeding-related concerns. Enhancing caregiver awareness regarding healthy child-feeding behaviours, alongside improving socio-economic support within households, may contribute to lowering the prevalence of undernutrition.

ACKNOWLEDGEMENTS

The authors extend their sincere gratitude to all children and their caregivers who willingly participated in the study and contributed valuable information. The authors are also thankful to their mentors and colleagues for their continuous support, insightful suggestions, and encouragement throughout the research.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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