SEATTLE, Wash. Dec. 2, 2025 – Nearly one million children around the globe fail to reach their fifth birthday every year due to devastating health consequences linked to child growth failure, making it the third leading risk factor for mortality and morbidity in children under five. That's among the new findings in the latest Global Burden of Disease 2023 study published in The Lancet Child & Adolescent Health today.
Estimates show the number of deaths associated with child growth failure (CGF) declined from 2.75 million in 2000 to 880,000 in 2023; however, the adverse health effects remain substantial and concentrated in sub-Saharan Africa, where 618,000 deaths were recorded, and in South Asia, with 165,000 deaths.
Among the different indicators of CGF, underweight accounted for the greatest disease burden with 12% of all deaths in children under five, followed by wasting with 9%, and stunting at 8%. Researchers also discovered that a larger proportion of children suffered from stunting than previously estimated.
CGF increases the risk of death and disability from various diseases, and almost 800,000 children younger than five years died due to lower respiratory infections, diarrheal diseases, malaria, and measles. In sub-Saharan Africa, 77% of diarrheal disease deaths and 65% of lower respiratory infection deaths in this age group in 2023 involved CGF. The proportions were also high in South Asia, where death estimates due to both causes were 79% and 53% respectively. The high-income region, which had the lowest number of deaths related to growth failure, had the lowest fraction of deaths from both causes at about 33% and 35% respectively.
"The drivers behind child growth failure are complex and cumulative due to feeding issues, food insecurity, climate change, lack of sanitation, or war," said Dr. Bobby Reiner , co-author and professor at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine. "Therefore, no single strategy will improve their health across all regions."
The research confirms that most stunted infants show signs of growth failure within the first three months of life, underscoring the importance of interventions before and during pregnancy. Wasting and stunting also create a destructive loop because stunting increases the risk of future wasting and vice versa, with this cycle worsening as children grow older. Growth failure in the first few months of life often indicate newborns born too small or too early, while growth failure in older infancy and early childhood might reflect other drivers of poor growth like nutritional inadequacy, repeated infection, or other causes.
"Given the difficulty in reversing stunting, the latest estimates in this study should be used to identify high prevalence locations, as early detection and intervention are critical," said Dr. Reiner.
