Background: Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy.Objective: We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y.Design: We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y.Results: The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80–0.84) and positively associated with mathematics achievement (effect-size range: 0.05–0.10), reading comprehension (0.02–0.10), and receptive vocabulary (0.04–0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering.Conclusions: Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school–age children also merit consideration.

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Objective We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting. Design Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries. Setting We analysed length/height measurements for children at ages 1, 5 and 8 years. Subjects Children (n 7171) in Ethiopia, India, Peru and Vietnam. Results Mean height-for-age Z-score (HAZ) at age 1 year ranged from −1·51 (Ethiopia) to −1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P<0·001) and decreased among the other cohorts (range: −0·19 (Peru) to −0·32 (India); all P<0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P<0·001). Prevalence of stunting (HAZ<−2·0) at 1 year ranged from 21% (Vietnam) to 46% (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P<0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P≤0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P<0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11% (Vietnam) to 22% (India); between ages 5 to 8 years, it ranged from 3% (Peru) to 6% (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27% (Vietnam) to 53% (Ethiopia); between ages 5 and 8 years, it ranged from 30% (India) to 47% (Ethiopia). Conclusions We found substantial recovery from early stunting among children in four low- and middle-income countries.