Maternal Perceptions of Children's Linear Growth in Bangladesh: Perspectives from Urban and Rural Caregivers of Diverse Parenting Experience

Background Linear growth faltering often begins in utero and results in stunting (height‐for age Z score < −2), which increases the risk for mortality and chronic diseases, and contributes to reductions in school attainment, and lifetime earning potential. In South Asia, nearly 40% of children are stunted, creating a context where impaired linear growth is normative, and may be imperceptible to caregivers. Objective To 1) understand the information that caregivers use to interpret their children's linear growth, and to 2) identify the cultural meaning and risks associated with poor height attainment among children by their caregivers. Methods We conducted 12 focus groups among mothers and alternate caregivers (n=81) in a rural and an urban slum setting in Bangladesh. Results Caregivers recognize that as a child ages, weight gain coincides with linear growth and is related to proper feeding and avoiding illness. Mothers mainly use visual cues, such as comparing children to siblings and other similarly aged children from the community, to understand if their children have appropriate linear growth. No concern was expressed about children failing to attain a “growth potential.” Further, caregivers did not clearly differentiate between stunting and familial short stature, highlighting the difficulty that many mothers face in interpreting appropriate linear growth in young children. Experience with growth monitoring services from the health system was not common among participants. “Genetics” and “hidden illness” were frequently cited reasons for poor height attainment. However, parents interpreted the risks of poor height attainment to be mainly social (unattractive physical appearance, limited marriage prospects) and economic (fewer job opportunities), and cite few health risks. Urban mothers were more likely to connect linear growth to poor nutrition during pregnancy. Alternate caregivers who had more parenting experience deemed themselves more equipped to detect appropriate linear growth according to age compared to mothers who, due mainly to employment or being first time mothers, have limited feeding engagement with their children. Conclusions The interpretation of linear growth among Bangladeshi caregivers is determined more by community norms, than by guidance from nutrition programming or the health system concerning children's growth potential. The practice of assessing the appropriateness of children's linear growth by comparing children to peers and siblings is problematic in settings where the average child is stunted. Efforts to raise awareness about the risks of linear growth faltering may consider messaging that emphasize factors that resonate with caregivers, such as the social and economic outcomes of stunting. Support or Funding Information Supported by the Bill and Melinda Gates Foundation (OPP1136759).