Defisit pertumbuhan anak usia kurang dari 5 tahun banyak didapatkan di negara Asia Tenggara, termasuk Indonesia (Schultink, Warner, 2000; WHO, 1997). WHO melaporkan di tahun 1992 terdapat ± 50% anak berumur kurang dari 5 tahun diklasifikasikan sebagai pendek (stunted) (WHO, 1992), keadaan ini masih tetap bertahan sampai dengan tahun 1997 (WHO, 1997). Jika keadaan ini di Indonesia tidak mengalami perubahan dari tahun ke tahun, maka dapat membawa dampak terutama pada perkembangan kognitif anak di usia 7-8 tahun. Dampak lain dari pendek ialah melemahnya kekebalan tubuh, mengurangi performa kerja. Pertumbuhan anak umur antara setahun sampai masa 7-8 tahun sering disebut sebagai masa laten atau tenang. Keadaan ini berbeda dengan masa bayi dan remaja dimana pertumbuhan fisiknya sangat pesat. Walaupun pada masa anak ini pertumbuhan fisiknya lambat, tetapi merupakan masa untuk perkembangan motorik, kognitif, dan emosional (McGregor, 1995). Pertumbuhan dan perkembangan anak merupakan proses panjang yang berkesinambungan. Dengan demikian, derajat kesehatan anak perlu diketahui perkembangannya dan tidak hanya dilihat sesaat, melainkan harus dilihat secara berkesinambungan selama kehidupan anak. Penelitian ini menggunakan data longitudinal Indonesian Family Life Survei tahun 1993-2000. Determinan defisit pertumbuhan tinggi badan anak usia 7-8 tahun dianalisis dengan menggunakan uji regresi generalized estimating equation (GEE). Hasil penelitian menunjukan variabel yang dapat mempengaruhi defisit tinggi badan anak pada usia 7-8 tahun adalah defisit pertumbuhan anak di usia 1-2 tahun, faktor genetik (tinggi badan bapak dan ibu), kebiasaan minum susu, area tempat tinggal anak, kesehatan lingkungan, dan jenis kelamin. Variabel yang paling dominan terhadap defisit pertumbuhan tinggi badan anak yaitu jenis kelamin anak. Anak laki-laki lebih berisiko untuk mengalami defisit tinggi badan sebesar 1,7 kali dibandingkan dengan anak perempuan. Berdasarkan penelitian tersebut disarankan perlunya peran orang tua dalam memantau perkembangan anak, perbaikan kondisi sosial ekonomi, edukasi bagi orang tua, revitalisasi fungsi posyandu, dan pemberian nutrisi bagi anak sekolah.

Growth retardation during early childhood found in many Southeast Asian countries, including Indonesia (Schultink, Warner, 2000). WHO reported in 1992 there were 50% of children age less than 5± years and classified as stunting (WHO, 1992). This situation still survive until the year 1997 (WHO, 1997). If this situation in Indonesia does not change from year to year, it can bring, especially the impact on cognitive development in children ages 7-8 years. Growth retardation during early childhood is rarely made up; so stunted children usually become stunted adults. The growth of children age between one year to the 7-8 year period is often referred to as a latent or quiet. The situation is different with the baby and young people where physical growth is very rapid. It is acknowledged that growth retardation in early chlidhood works through in adolescence and adulthood, but no information on the growth from infancy until adolencence was available in Indonesia. Causes and long term effects of growth retardation can only be studied through longitudinal studies, and only a limited number of these studies have been done in Indonesia. This study were used longitudinal data Indonesian Family Life Surveys in 1993 through 2000. Determinant growth retardation of children aged 7-8 years analyzed using a Generalized Estimating Equation (GEE). The research results showed that there was a positive realtionship between children retardation at the age of 7-8 years and their height at 1-2 years, genetic factors (height of the father and mother), drinking milk habits, the area where children live, environmental health, and sex. The most dominant of the children growth retardation is sex of the children. The boys are more at risk to have stunted 1.7 times compared with the girls. Based on the study, we recommended that need role of parents in monitoring child development, improvement of socio-economic conditions, education for parents, revitalization posyandu function, nutrition intervention for school children are necessary to support the attainment of their optimal growth potential.

Periode seribu hari pertama kehidupan (1000 HPK) merupakan masa yang sangat rentan terjadinya berbagai masalah gizi yang berdampak terhadap pertumbuhan dan perkembangan anak. Salah satu bentuk gangguan pertumbuhan yang sering muncul pada periode ini adalah stunting. Kelahiran risiko tinggi, khususnya kelahiran “4 TERLALU” (terlalu muda, terlalu tua, terlalu dekat, terlalu banyak) berperan penting dalam meningkatkan risiko morbiditas pada ibu dan anak. Sejumlah studi mengaitkan kelahiran “4 TERLALU” terhadap stunting, namun demikian temuan mengenai hal ini masih terbatas, tidak konsisten, dan umumnya hanya mencakup anak usia balita. Penelitian ini menggunakan data longitudinal Indonesia Family Life Survey (IFLS) tahun 2000, 2007, dan 2014 di 13 provinsi dengan 1.401 anak usia 0–59 bulan yang diikuti hingga usia remaja untuk menilai pengaruh kelahiran 4 TERLALU terhadap status stunting dan perubahan status stunting. Status stunting ditentukan dengan z skor PB/U atau TB/U berdasarkan standar WHO 2007, dan perubahan status dikelompokkan menjadi remained normal, height faltering, catch-up growth, dan remained stunted. Analisis dilakukan menggunakan Generalized Estimating Equation (GEE) untuk menilai dampak kelahiran “4 TERLALU” terhadap status stunting dan multinomial regresi logistik untuk menilai dampak kelahiran “4 TERLALU” terhadap perubahan status stunting di usia sekolah dan usia remaja. Hasil penelitian menunjukkan prevalensi stunting tertinggi pada usia balita (39%), menurun pada usia sekolah (35%), dan mencapai 25% pada remaja. Proporsi kelahiran terlalu muda sebesar 12,7%, terlalu tua 9,6%, terlalu dekat 6,8%, terlalu banyak 16,2%, dengan kelahiran risiko tinggi ≥1 sebesar 36,1% dan ≥2 sebesar 8,7%. Kelahiran terlalu dekat (<24 bulan) secara konsisten meningkatkan risiko stunting sejak balita hingga remaja, sedangkan kelahiran terlalu muda, terlalu tua, dan terlalu banyak tidak menunjukkan hubungan signifikan. Faktor lain yang berpengaruh antara lain usia anak pada saat baseline, berat badan lahir rendah, pendidikan ibu rendah, tinggi badan ibu ≤150 cm, tinggi badan ayah ≤161,9 cm, serta kondisi sosioekonomi dan lingkungan, di mana anak dari keluarga kuintil aset 3 memiliki risiko 21% lebih rendah dibanding kuintil 1. Analisis perubahan status stunting menunjukkan bahwa jarak kelahiran terlalu dekat meningkatkan risiko anak menjadi stunted (height faltering) dan remained stunted. Temuan ini menegaskan bahwa stunting bersifat dinamis dan kelahiran terlalu dekat berkontribusi besar pada gangguan pertumbuhan linier jangka panjang, sehingga diperlukan intervensi gizi, kesehatan reproduksi, dan pemantauan pertumbuhan yang berkesinambungan sejak masa sebelum konsepsi hingga masa remaja.

The first 1,000 days of life (1,000 HPK/Hari Pertama Kehidupan) represents a critical window during which children are highly vulnerable to various nutritional problems that can adversely affect their growth and development. Stunting is one of the most common forms of growth faltering that occurs during this period. Births with high-risk factors, particularly those related to the "4 Too's" (maternal age being too young or too old, a short birth interval, and numerous previous births), greatly increase the likelihood of illness among mothers and their children. Although several studies have linked the "4 Too's" birth characteristics to stunting, the evidence remains limited, inconsistent, and is generally confined to children under five years of age. This study used longitudinal data from the Indonesia Family Life Survey (IFLS) conducted in 2000, 2007, and 2014 across 13 provinces. A cohort of 1,401 children aged 0-59 months was followed through adolescence to assess the influence of the "4 Too's" birth characteristics on stunting status and its longitudinal changes. Stunting status was determined using height-for-age z-scores (HAZ) based on the 2007 WHO standards. Stunting status changes were classified as normal, height faltering, catch-up growth, and stunted persistence. Generalized Estimating Equations (GEE) were used to examine the impact of the 'Four Too' birth factors on stunting, while multinomial logistic regression was employed to investigate their effect on changes in stunting during school age and adolescence. The findings showed that stunting prevalence was most common among 5- year-olds (39%), decreased to 35% during school age, and dropped to 25% in adolescence. The proportions of high-risk births were as follows: 12.7% to mothers who were too young, 9.6% to mothers who were too old, 6.8% with a short birth interval, and 16.2% with high parity. The prevalence of births with at least one risk factor was 36.1%, while 8.7% had two or more risk factors. A birth interval of less than 24 months was constantly linked to an elevated risk of stunting from early childhood through adolescence, while no noteworthy correlation was found between births to mothers of young or older age and those of high parities. The other significant risk factors were the child's age at baseline, low birth weight, low levels of maternal education, maternal height of 150 cm or less, and paternal height of 161.9 cm or less. Socioeconomic factors also played a role, with children from the third asset quintile having a 21% lower risk of stunting than those from the first quintile. Analysis of the changes in stunting status revealed that short birth intervals increased the risk of a child experiencing height faltering or remaining stunted. These findings affirm the dynamic nature of stunting and highlight that a short birth interval is a major contributor to long-term linear growth faltering. Consequently, sustained nutritional and reproductive health interventions, along with continuous growth monitoring, are imperative from the pre-conception period through adolescence to break the intergenerational cycle of stunting.