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Early life nutrition and growth: missed opportunities to build a foundation for lifelong health and development

Pediatric Research (2026)Cite this article

In this issue of Pediatric Research, Zheng and colleagues describe the poor nutritional status of 2700 neonates and infants <1 year of age who presented to a large local hospital in Nanjing, China, for surgical care and how poor nutritional negatively impacts surgical hospitalizations.1 The group evaluated infant nutritional status at presentation for inpatient surgery using a modification with three risk groups instead of a threshold risk score of a nutritional assessment tool, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). Using this tool, infants were assessed as low- moderate- or high risk- for malnutrition (less than two standard deviations below the mean for weight-for-age (wasting) or height-for-age (stunting)). Infants in the moderate- and high-risk groups had higher risks of surgical complications, longer hospitalizations, and increased rates of 30-day readmissions. Importantly, the publication reports on both neonates and infants, detailing the specific surgical diagnosis of the patient in addition to their nutritional status. This detail of diagnosis allows insight that patients were diagnosed with moderate and high-risk malnutrition even when the surgical diagnosis was minor and would not likely be associated with failure to thrive (weight and height fallowing below the 5th percentile). This study showed a general risk of nutritional deficits that may not be entirely medical in origin in this large population of infants in China and opens the conversation about nurtrition and health for infants across the globe in 2026.

The article discussed the need for nutritional screening for the neonate or infant. Ages 0–30 days are considered a very vulnerable period with an increased risk for illness with poor outcomes such as acute malnourishment. This, coupled with to baseline malnutrition can lead to increased morbidity and mortality. An additional policy concern for exclusively breastfed neonates worldwide is the health and nutritional status of the mother. When the mother is well and nuorished, the protective nature of breastfeeding as compared to formula feeding is well described. It is important to note that for most infants, breastfeeding through the first year of life is optimal and safe for nutrition across countries with a wide range of socioeconomic development. In the Zheng article, bottle feeding was associated with the highest rates of risk for malnutrition. (1) This outcome highlights both the benefits of breastfeeding and the difficulties that some infants have with enteral nutrition despite available elemental and other medical formulas. Another etiology of the described malnutrition must be explored, we know that in low-, middle-, and high-income countries access to adequate amounts of formula may be contributing to the risk of poor nutritional status of infants in the first year of life.

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Acknowledgements

The authors would like to acknowledge this commentary is submitted On behalf of the Pediatric Policy Council: David Keller (Chair), Mona Patela, Maya Ragavana, Scott Lorchb, Lisa Chamberlainb, Tina Chengc, Joseph St. Gemec, Ashwini Lakshmanand, & Tom Marianid. a Academic Pediatric Association, b American Pediatric Society, c Association of Medical School Department Chairs, d Society for Pediatric Research.

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  1. University of Colorado, School of Medicine, Anschutz Medical Campus, Department of Pediatrics, Aurora, CO, USA

    Rochelle L. Cason-Wilkerson

  2. University of Nebraska Medical Center, Omaha, NE, USA

    Ann L. Anderson-Berry

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  1. Rochelle L. Cason-Wilkerson
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Correspondence to Ann L. Anderson-Berry.

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Cason-Wilkerson, R.L., Anderson-Berry, A.L. Early life nutrition and growth: missed opportunities to build a foundation for lifelong health and development. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04806-x

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