GROWTH AND STRESS
Growth and stress are interrelated. Poor nutrition is itself stressful. Children with acute marasmus or kwashiorkor (severe form of malnutrition caused by inadequate intake of protein and calories, and it usually occurs in the first year of life, resulting in wasting and growth retardation) have elevated free cortisol levels. Stunted children have higher cortisol levels, higher heart rates, fewer vocalizations, more inhibitions, and less attentive behavior than their well-grown peers in response to physical and psychological stressors. Their cortisol levels correlate with nutritional status. Thus, prolonged cortisol exposure may mediate the heightened physiologic activation and poor cognitive performance common among poorly nourished children.
Independent of malnutrition, stress itself directly affects growth. Prolonged exposure to stress inhibits secretion of growth hormone and other growth factors; children with anxiety disorders tend to be shorter adults because of reduced growth hormone secretion. The poor growth exhibited by many institutionalized children likely reflects both inadequate nutrition and other stressful environmental factors.