Healthy Growth & Development

Healthy Growth & Development: A Nutritional and Natural-Health Reference

1. Definition and Overview

Healthy growth and development refers to the progressive, orderly attainment of physical size, organ maturation, neurological function, and psychosocial competence across the lifespan — from conception through adolescence. David Barker's Developmental Origins of Health and Disease model (DOHaD) led to the recognition of healthy growth as a cornerstone for lifespan health. This framework has been supported by a vast array of epidemiological evidence linking early life body size to future chronic disease risk and longevity.

This is especially important in the pediatric age since children need an adequate intake of energy and nutrients for growth and development with respect to their full potential. Rigorous evidence shows clear links between adequate nutrition and physical activity — provided in the context of responsive emotionally supportive care, safety, security, play and learning — and optimal physical, cognitive, and socio-emotional growth and development.

Building on the UNICEF conceptual framework on causes of malnutrition, the WHO Healthy Growth Project places stunted growth and development at the core, recognising that strategies which promote and protect healthy growth are likely to benefit children's physical, mental, socio-emotional, and intellectual growth and development. Stunting in childhood has concurrent, short-term and long-term consequences affecting health and human capital development, including poor cognition and educational performance, low adult wages, and lost economic productivity.

2. How Healthy Growth Presents: Stages and Indicators

The WHO growth charts for children under the age of five were developed in 2006 based on the Multicenter Growth Reference Study, whose goal was to describe the growth of healthy children; this work was conducted in six countries — Brazil, the United States, Ghana, Norway, India, and Oman — with children who lived in socio-environmental and economic conditions ideal for adequate development.

Middle childhood and early adolescence bridge the period between the relatively steady growth occurring from two years to five years of age and the final maturation period of late adolescence to adulthood; this period is characterized by multiple dramatic inflection points in the course of growth and development, including transformational changes in the brain and cognitive processing, linear bone growth and bone mineralisation, body composition, and other organ systems. It is also during this period that major sex-driven inflections and divergences occur in growth and development, and the nutrition of children during this period is critical for supporting these changes.

The clearest sign of chronic nutrient deficiency affecting growth is stunting, defined by the World Health Organization as a child's height falling more than two standard deviations below the median for their age. Moderate stunting is visible as a child being noticeably shorter than peers, while severe stunting — three or more standard deviations below median — indicates significant developmental limitation.

Based on the standards developed by the World Health Organization, there are three types of growth trajectory in children: standard or normal growth, delayed growth, and rapid growth.

3. Body Systems Involved

Healthy growth and development is not a single-system event; it represents the integrated maturation of multiple interacting biological systems simultaneously.

• Skeletal System: Calcium, phosphorus, and protein are important components of bone; adequate intake of these nutrients is required for normal bone development. Other nutrients including vitamin D, vitamin K, magnesium, zinc, and fluoride are also involved in bone metabolism, and many of these nutrients are intercorrelated and act in a synergistic way.
• Endocrine / Hormonal System: The interaction between nutrition and pubertal development involves many endocrine and metabolic pathways, including the kisspeptin and GPR54 system, the leptin system, glucose-insulin homeostasis, and the hypothalamic–pituitary–growth, hypothalamic–pituitary–gonadal, and hypothalamic–pituitary–adrenal systems.
• Neurological System: Early childhood is a period of rapid brain development, with increases in synapses rich in the omega-3 fatty acid DHA continuing well beyond infancy. Iodine is an essential mineral for thyroid hormone synthesis and is required for brain development; iodine deficiency can have detrimental effects on cognitive function and is the primary cause of intellectual disability around the world.
• Immune System: The early-life gut microbiome plays a shaping role in immune, metabolic, and neurological systems during infancy and childhood; the maturation of gut microbial communities is influenced by delivery mode, breastfeeding, diet, antibiotic exposure, physical activity, and environment.
• Musculoskeletal System: Immediately after the performance of resistance exercises there is an increase in circulating levels of testosterone and growth hormone. The increase in muscle mass, which is more than 25% of the newborn's weight and approximately 40% in adult life, reaches its peak velocity in the pubertal phase and benefits from physical activity.
• Gastrointestinal System: Gut microbiota succession overlaps with intensive growth in infancy and early childhood. There is evidence that the development and modulation of the gut microbiome during early life can affect human growth, development, and health.

Research supports the understanding of relevant biological systems and factors that influence mechanisms of physical and neurological development, beginning in utero and extending through the lifespan, as well as the role and impact of nutritional status in these systems, including the external contextual — social, behavioural, and environmental — factors that influence these processes.

4. Contributing and Associated Factors

4.1 Prenatal and Perinatal Factors

Maternal nutrition may have long-lasting effects on the growth and development of the child, because fetal life is a critical period for organogenesis and the development of metabolic systems, including the skeleton. Research suggests that maternal polyunsaturated fatty acid (PUFA) levels during pregnancy influence the morphology of the offspring's brain, including brain volume and white matter integrity; higher maternal omega-3 PUFA levels, particularly DHA, have been linked to larger brain volumes and improved white matter microstructure in children, with these effects especially evident in grey matter.

Folate is a water-soluble vitamin needed for DNA and RNA synthesis and the formation of the nervous system; maternal folate deficiency during the early stages of pregnancy is associated with an increased incidence of congenital malformations, including spina bifida and anencephaly.

4.2 The "First 1,000 Days" Window

The first 1,000 days of life are a crucial brain development period in which adequate nutrition is vital for optimal growth and cognitive development. Most scientific papers emphasise the importance of establishing proper eating and lifestyle habits to prevent chronic noncommunicable diseases in the first 1,000 days.

4.3 Pubertal Nutrition

Nutrition is one of the most important factors affecting pubertal development. Puberty entails a progressive nonlinear process starting from prepubescent to full sexual maturity through the interaction and cooperation of biological, physical, and psychological changes; consuming an adequate and balanced healthy diet during all phases of growth appears necessary both for proper growth and normal pubertal development.

Overweight or obese children are more likely to enter puberty early. Patients suffering from secondary malnutrition due to chronic diseases also have delayed onset of puberty and a reduced pubertal growth spurt; although the aetiology of abnormal puberty in these patients is multifactorial, nutritional deficiency largely contributes to their growth and pubertal delay.

The adolescent growth phase starts with puberty, which drives linear growth; accrual of bone, muscle, and fat mass; and maturation of biological systems. The onset and duration of puberty differ markedly between adolescents living in environments with varying childhood nutrition.

4.4 Gut Microbiome

Microbial colonisation of the gastrointestinal tract begins at birth and is influenced by multiple factors including maternal microbiota, gestational age, mode of delivery, feeding practices (breastfeeding versus formula), and antibiotic exposure. During the first 1,000 days of life, the gut microbiome undergoes its most rapid period of development, playing a critical role in immune, endocrine, and metabolic functions, and other host developmental processes.

Differences in gut microbial communities between breast-fed and formula-fed infants have been consistently observed and are hypothesised to partially mediate the relationships between breast-feeding and decreased risk for numerous communicable and noncommunicable diseases in early life. Early-life dysbiosis is linked to paediatric diseases including allergies, gastrointestinal disorders, obesity, type 1 diabetes, autism spectrum disorders, and Attention-Deficit/Hyperactivity Disorder (ADHD).

4.5 Socioeconomic and Environmental Factors

Investing in early child development is central to improving the lifelong wellbeing of children. A vast body of evidence suggests that physical growth in the earliest stages of ontogenesis not only sets the pattern for adult size but also establishes a biological scaffold for adult health through the profound effects that nutrition, illness, ecology, and social environment have on early development.

5. Key Nutrients: Scientific Evidence

Micronutrients studied in relation to child growth and development include iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. Evidence suggests that while supplementation can be effective, interventions need to be tailored based on individual nutritional status, age-specific requirements, presence of comorbidities, and local dietary patterns.

5.1 Protein

Protein is a macronutrient that plays an important role in children's growth; protein intake is a factor affecting height, and individuals with low intake have a higher risk of stunting. Children with lower protein intake are four times more likely to experience stunting than children with adequate intake, because protein intake participates in stimulating insulin on IGF-1 since serum tryptophan and IGF-1 levels are positively associated with linear growth.

Even though there is evidence suggesting a correlation between elevated protein consumption in childhood and an augmented risk of obesity later in life, an elevated protein intake may contribute to a higher fat-free mass index (FFMI), which can promote muscle development and total body composition, and greater satiety. The overactivation of growth pathways and elevated insulin-like growth factor-1 (IGF-1) levels may explain this effect. Conversely, although a low protein intake can limit growth, high protein consumption during early childhood can lead to rapid weight gain and an augmented risk of overweight and obesity due to increased body fat mass.

Protein-energy malnutrition in early life can impede adequate brain growth, resulting in smaller brains.

5.2 Zinc

Several micronutrients including zinc, iron, and vitamin A have been shown to play a critical role in normal growth; the most conclusive evidence to date linking the intake of a specific micronutrient to child growth is for zinc, though the mechanisms by which zinc deficiency impairs growth have not been fully elucidated.

Clinical Evidence: A meta-analysis identified 36 studies assessing the effect of zinc supplementation on linear growth in children under five years from developing countries; the conclusion was that zinc supplementation has a significant positive effect on linear growth, especially when administered alone, and should be included in national strategies to reduce stunting.

A 2014 systematic review conducted with the Cochrane Developmental, Psychosocial and Learning Problems Group found that there was moderate-quality evidence of a very small effect on linear growth (standardised mean difference 0.09 [0.06 to 0.13]) and an increase in vomiting (RR 1.29 [1.14 to 1.46]), with no evidence of an effect on iron status. A 2023 updated Cochrane review concluded that zinc supplementation in children aged 6 months to 12 years makes little to no difference to all-cause mortality; zinc deficiency is prevalent in low- and middle-income countries and is considered a significant risk factor for morbidity, mortality, and linear growth failure. Overall, the evidence for zinc's effect on linear growth is considered positive but modest in well-nourished populations; the strongest effects are seen in zinc-deficient children.

5.3 Iron

Iron exists primarily in two forms: heme iron from animal sources with higher bioavailability (15–35%) and non-heme iron from plant sources with lower bioavailability (2–20%); the absorption of non-heme iron is significantly affected by dietary components, with factors such as phytic acid, polyphenols, calcium, and proteins found in milk, eggs, and soybeans inhibiting absorption.

Previous studies have provided strong evidence that protein-energy malnutrition, deficiencies of iron and iodine early on in life led to compromised growth and cognitive functions in young children. Data from the NHANES 2003–2012 survey of US children aged 12–23 months showed that over a quarter had usual iron intakes less than the Recommended Dietary Allowance (RDA), and 11% had usual calcium intakes below the RDA.

5.4 Calcium and Vitamin D

Vitamin D and calcium are the most critical pairing for bone growth. Calcium and phosphorus form the mineral crystals (called hydroxyapatite) that make bones hard and strong, but the body can only absorb calcium efficiently from the gut when vitamin D is present; without adequate vitamin D, a child could drink plenty of milk and still not get enough calcium into their bones.

A dietary pattern characterised by high intakes of whole grains, dairy and cheese, and eggs is beneficial for bone outcomes; key nutrients supplied by dairy foods are calcium, magnesium, vitamin D (especially if fortified), and high-quality proteins.

Decades of work on mass balance and isotope studies have characterised calcium absorption, retention, and loss to understand and assess calcium metabolism in healthy paediatric populations; much of this available balance data has served as valuable evidence for establishing Dietary Reference Intakes (DRIs) in young children.

5.5 Vitamin A

Severe as well as marginal vitamin A deficiency were shown to lead to an increased risk of morbidity and mortality in children; a meta-analysis of vitamin A intervention trials indicated an overall reduction of 23% in all-cause mortality rate. Delayed growth, especially stunting, was reported in children with clinical signs of vitamin A deficiency. Vitamin A plays a critical role in visual function. Evidence strength: this evidence is considered robust, particularly for populations at high risk of deficiency.

5.6 Iodine

Iodine is an essential mineral for thyroid hormone synthesis and is required for brain development; iodine deficiency can have detrimental effects on cognitive function and is the primary cause of intellectual disability around the world. The evidence base linking iodine to neurodevelopment is considered among the strongest in nutritional science, supported by decades of population-level and interventional data.

5.7 Folate and B Vitamins

Folate is a water-soluble vitamin needed for DNA and RNA synthesis and the formation of the nervous system; maternal folate deficiency during the early stages of pregnancy is associated with an increased incidence of congenital malformations, including spina bifida and anencephaly. Vitamin B12 is a cofactor in numerous catalytic reactions required for neurotransmitter synthesis and functioning; studies have linked B12 deficiency to cerebral atrophy and neurological disorders.

5.8 Omega-3 Fatty Acids (DHA and EPA)

Decreased DHA in the developing brain leads to deficits in neurogenesis, neurotransmitter metabolism, and altered learning and visual function in animals. Western diets are low in omega-3 fatty acids, including the 18-carbon omega-3 fatty acid alpha-linolenic acid found mainly in plant oils, and DHA, which is found mainly in fish; the DHA status of the newborn and breast-fed infant depends on the maternal intake of DHA and varies widely.

Epidemiological studies have linked low maternal DHA to increased risk of poor child neural development; intervention studies have shown that improving maternal DHA nutrition decreases the risk of poor infant and child visual and neural development. Thus, sufficient evidence is available to conclude that maternal fatty acid nutrition is important to DHA transfer to the infant before and after birth, with short and long-term implications for neural function.

LC-PUFAs, specifically DHA and EPA, are required for brain growth and development. Inadequate intake of these fatty acids is associated with impaired neurodevelopment, visual recognition, and memory.

Clinical trial evidence is mixed: A randomised controlled trial (the DOLAB I study) found that a 16-week dietary intervention with 600 mg/day of algal-source DHA led to significant improvement over placebo for behaviour and learning among healthy but under-performing children aged 7–9 years from mainstream UK schools. However, a follow-up RCT (DOLAB II) found that reading, working memory, and behaviour change scores showed no consistent differences between the intervention and placebo groups, and the study did not replicate the results of DOLAB I on the effectiveness of nutritional supplementation with DHA for learning and behaviour.

A cross-sectional study of healthy children (5–6 years) found that child red blood cell DHA status was associated with neurodevelopment test scores, including language and short-term memory, but only short-term memory was associated with dietary DHA intake; child RBC DHA but not dietary DHA was associated with multiple tests of cognitive performance, and DHA intake was only moderately associated with RBC DHA, raising complex questions on the relation between diet, DHA transfer to membrane lipids, and neural function. Evidence strength: association between DHA status and neurodevelopment is biologically plausible and supported by observational data; evidence from interventional RCTs in healthy children remains mixed and inconclusive.

5.9 Magnesium, Phosphorus, and Other Minerals

Other nutrients, including vitamin D, vitamin K, magnesium, zinc, and fluoride, are also involved in bone metabolism. Whole grain products contain magnesium, iron, B vitamins, and other bioactive compounds such as phytochemicals and antioxidants, which may benefit bone health. Females in the 15–19-year-old age segment especially show higher nutrient intake gaps for vitamin D, thiamin, riboflavin, vitamin B12, folate, iron, calcium, magnesium, phosphorus, and potassium compared to males.

6. Herbs and Natural Ingredients: Traditional Use and Scientific Evidence

The following section strictly separates traditional use — as documented in historical and ethnobotanical literature — from available scientific (clinical or preclinical) evidence. Unless otherwise stated, the scientific evidence for most botanicals in the specific context of healthy paediatric growth remains preliminary.

6.1 Ashwagandha (Withania somnifera)

Traditional Use

Ashwagandha (Withania somnifera, family Solanaceae), commonly known as "Indian Winter Cherry" or "Indian Ginseng," is one of the most important herbs of Ayurveda — the traditional system of medicine in India — used for millennia as a Rasayana for its wide-ranging health benefits. Rasayana is described as an herbal or metallic preparation that promotes a youthful state of physical and mental health and expands happiness; these types of remedies are given to small children as tonics, and are also taken by the middle-aged and elderly to increase longevity. Ashwagandha is a well-known Ayurvedic Rasayana and belongs to a sub-group known as Medhyarasayanas — formulations used to promote intellect and memory. Ashwagandha is commonly available as a churna, a fine sieved powder that can be mixed with water, ghee (clarified butter), or honey.

Scientific Evidence

Considering its traditional uses, many scientific studies have been carried out and its adaptogenic and anti-stress activities have been studied in detail. However, most clinical research on ashwagandha has been conducted in adults, focused on stress, anxiety, and reproductive outcomes, not specifically on paediatric growth. Evidence in the paediatric growth context is currently insufficient; claims regarding its use for child growth remain in the realm of tradition rather than established clinical science.

6.2 Shatavari (Asparagus racemosus)

Traditional Use

Shatavari is traditionally useful for breastfeeding mothers as it helps increase milk production; it is also said to enhance immunity, growth, and development in babies and children, and is valued for promoting memory and mental clarity in Ayurvedic practice. Shatavari is also described in Ayurveda as effective at reducing gut bacteria that in excess cause gas, bloating, and colic pain.

Scientific Evidence

Published clinical research on shatavari's effects in children's growth specifically is limited. In the broader Ayurvedic literature, these botanical agents have been traditionally employed to address an array of reproductive and developmental health concerns. The evidence base for shatavari's paediatric growth effects remains at the level of traditional and in-vitro or animal models; well-designed human clinical trials in children are lacking.

6.3 Amalaki / Amla (Emblica officinalis / Phyllanthus emblica)

Traditional Use

Amalaki (Amla) is one of the richest natural sources of vitamin C and one of the most valued rejuvenating tonics in Ayurvedic medicine; it is particularly used as a rejuvenator following illness or stress, balances all three doshas but primarily pitta, and is a considered herb for children's coughs, colds, chest infections, and asthma.

Scientific Evidence

Amla (Indian gooseberry) is rich in vitamin C and antioxidants, which have established roles in helping improve digestion and boost immunity. The documented vitamin C content of amla is a biochemically verifiable property. However, high-quality clinical trials specifically assessing amla's contribution to healthy child growth outcomes are currently lacking in the peer-reviewed literature.

6.4 Brahmi (Bacopa monnieri)

Traditional Use

Brahmi is a prominent herb in the Ayurvedic Medhya Rasayana category — herbs attributed with enhancing memory and cognitive function. It is traditionally used in children to support attention and learning, often in combination with other nervine herbs. This use is documented across classical Ayurvedic texts as a tonic for the brain and nervous system.

Scientific Evidence

Several small human trials have examined Bacopa monnieri for cognitive outcomes. Evidence is preliminary — most studies are short in duration, small in sample size, and conducted in adult populations or specific clinical contexts. Effects on healthy paediatric neurodevelopment in the growth context have not been established in large, well-controlled RCTs. Evidence is characterised as preliminary and insufficient to make definitive claims for its use in paediatric growth.

6.5 Guduchi / Giloy (Tinospora cordifolia)

Traditional Use

In Ayurvedic tradition, Guduchi (Tinospora cordifolia) is classified as a Rasayana herb and is traditionally used to strengthen the immune system, support digestion, and enhance overall vitality in children. It is described as a bitter tonic used to manage fevers and support recovery from illness.

Scientific Evidence

Research on Guduchi has primarily been conducted in cell culture and animal models, with some preliminary human trials focused on its immunomodulatory properties. Clinical evidence specifically relating Guduchi to healthy growth outcomes in children is not currently established in peer-reviewed literature. Evidence strength: preliminary, predominantly preclinical.

7. Dietary Factors

7.1 Breastfeeding

Breastfeeding status and the timing of solid food introduction have been associated with long-term metabolic health. The unique nutrients found in breastmilk, along with the microbial transfer associated with breastfeeding, could shape the infant's gut microbiome; breastfed infants exhibit a different gut microbiome composition than formula-fed infants. Differences in gut microbial communities between breast-fed and formula-fed infants have been consistently observed and are hypothesised to partially mediate the relationships between breast-feeding and decreased risk for numerous communicable and noncommunicable diseases in early life.

7.2 Diet Quality and Food Diversity

Consuming an adequate and balanced healthy diet during all phases of growth — infancy, childhood, and puberty — appears necessary both for proper growth and normal pubertal development. Animal-based foods are crucial for providing vital nutrients necessary for growth and development during childhood, including iron, calcium, zinc, selenium, riboflavin, vitamin A, and B12. Fish and seafood are particularly rich in vitamin D, iodine, and long-chain omega-3 fatty acids such as EPA and DHA. On the other hand, plant-based foods offer valuable polyunsaturated fatty acids, especially the essential fatty acids α-linolenic acid (ALA) and linoleic acid (LA).

Healthy eating, active living, and healthy development are fundamentally intertwined and linked to parenting and caregiving, with particular reference to practices that influence children's dietary intake and participation in physical activity.

7.3 Dietary Patterns and Bone Health

The questions of most concern to parents and policy makers are what children's diets should be to optimise bone growth and development, and what aspects of modern Western diets are unfavourable to optimal bone health. There are concerns that the intakes of key nutrients by children are too low or too high, and that there are interactions between dietary components that render some food patterns more or less desirable; many nutrients receive attention for their involvement directly in bone metabolism or for their actions on growth modulators.

8. Lifestyle Factors

8.1 Physical Activity

Despite the small number of studies with adequate methodology, especially randomised clinical trials, evidence appears to indicate that physical exercise is safe for both the pregnant woman and the child, from fetal life to adolescence; physical exercise does not appear to impair the child's linear growth and contributes to the ideal shaping of bone and muscle tissues, ensuring possible beneficial effects throughout life.

Prospectively, moderate-to-vigorous physical activity (MVPA), total energy expenditure (TEE), and activity energy expenditure (AEE) promote normal growth and accretion of fat-free mass, whereas sleep duration inversely predicts changes in adiposity in preschool-aged children.

8.2 Sleep

Evidence is emerging that sleep, as well as diet and physical activity, may play a critical role in the metabolic and hormonal milieu affecting growth and development of children. Sufficient and high-quality sleep in infancy is important for optimal cognitive development, physical growth, and future health trajectories. The relationship between sleep and growth is partly mediated by growth hormone (GH) secretion, which is predominantly pulsatile and linked to slow-wave sleep.

8.3 Gut Microbiome and Early-Life Practices

The maturation of gut microbial communities is influenced by delivery mode, breastfeeding, diet, antibiotic exposure, physical activity, and environment. Therapeutic strategies such as balanced nutrition, prebiotics, probiotics, synbiotics, postbiotics, and healthy lifestyle interventions may restore microbial balance and reduce disease risk, improving long-term health outcomes.

8.4 Psychosocial Environment

Rigorous evidence shows clear links between adequate nutrition and physical activity — provided in the context of responsive emotionally supportive care, safety, security, play, and learning — and optimal physical, cognitive, and socio-emotional growth and development. Scores in gross motor, fine motor, language, and individual-social aspects of development were shown to be higher in children receiving structured nutritional intervention compared to those receiving only routine care.

9. Monitoring Healthy Growth: Standards and Tools

The WHO growth charts for children under five were developed in 2006 based on the Multicenter Growth Reference Study and remain a global standard for assessing nutritional status. Tracking the growth trajectories of children is important, as they provide essential indicators of infant and childhood development and can predict potential adult health outcomes; a vast body of evidence suggests that physical growth in the earliest stages of ontogenesis not only sets the pattern for adult size but also establishes a biological scaffold for adult health.

The Fels Longitudinal Study, which began in 1929 to evaluate human growth and body composition changes over the lifespan, enrolled more than 1,400 individuals at birth; the North American Standard Tables of Height and Weight and other standards of bone age and skeletal development used Fels data and are in widespread use in the United States and abroad.

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