Brain stunting – a crisis threatening many Filipino children

MANILA – At a Quezon City health centre in Metro Manila one hot May morning, Sean Cabanban walked through the entrance holding his mother’s hand. He was wearing a Scooby-Doo shirt, red shorts and small cream Crocs on his feet.

His frame was small, even for a three-year-old. At 82cm, he stood 8cm shorter than a child his age should typically be, according to international health guidelines.

His mother Erika Cabanban, 25, said she had done everything she thought a mother should do when she was pregnant with Sean: She ate fruits, slept early and avoided stress. After he was born, she breastfed him and checked on his weight when she could.

Sean’s growth kept falling behind anyway. During a community check-up by local health workers in 2025, he was diagnosed with severe stunting – he weighed just 8.4kg, well below what a child his age should weigh.

When he starts school in a year, he will be tested to see if the chronic undernutrition of his earliest months has already quietly impaired the cognitive development that no intervention can fully reverse.

“Brain stunting” is what Filipino health professionals call it, even though it is not a clinical diagnosis, health professionals told The Straits Times. It is a term used to describe one of malnutrition’s most consequential and irreversible effects.

The cognitive damage can begin in infancy, with symptoms such as impaired motor skills, limited attention span and behavioural problems. It is compounded during childhood and adolescence.

Sean has not yet started school. The longer shadow of his early malnutrition – affecting his focus, learning and analytical thinking – will not become visible for another year or two, if it manifests at all.

But children affected may never reach their full cognitive potential, facing learning difficulties in school and, later in life, diminished earning capacity.

And in the Philippines, Sean is far from alone.

The country has long framed child health as a hunger problem: visible, acute and solvable with food.

Sean’s mother works the morning shift at a nearby McDonald’s outlet and earns the minimum wage, as does her husband, a tricycle driver. About 1,400 pesos (S$30) is what the family – the couple and their three children – has to live on each day. Sean’s older sisters are 10 and five, respectively.

But Health Secretary Teodoro Herbosa has, in the last few months, been increasingly warning of a quieter, more permanent threat. Brain stunting, he has said in public speeches, is caused by chronic undernutrition during pregnancy and a child’s first 1,000 days of life.

“The high-impact consequence of physical stunting is the cognitive (aspect), the brain stunting,” said Mr Emmanuel Jay Dimal, chief of the nutrition information and education division at the National Nutrition Council (NNC).

He said children affected may struggle to focus, fall behind academically and face higher risks of chronic disease in adulthood.

Latest data from the NNC shows that 23.6 per cent of Filipinos under five, or about 2.6 million, were physically stunted in 2023.

Nearly one in five pregnant women, or 19.1 per cent in 2023, also remains nutritionally at risk, missing the government’s target of bringing that figure down to 15.8 per cent by that year.

“There is still much work to be done,” Mr Dimal said. “The implementation of nutrition programmes is not the responsibility of one agency alone. Many government bodies must work together if we are to truly solve this problem.”

A deficit set before birth

Sean’s malnutrition diagnosis came not from a hospital but from a knock on the door.

In January 2025, community health workers conducting a nationwide annual weighing and measuring programme for children visited the Cabanban family’s village in Quezon City.

When Sean’s measurements were entered into the assessment tool, the result was clear: He was severely underweight, severely stunted. He was just over two years old then. At 8.4kg, he was at least 4kg below what he should have been, according to recommended health guidelines.

Ms Mary Grace Cruz, a community health worker handling Sean’s case, said parents often push back when told their child is malnourished.

“They say, ‘My child is not sickly. He eats well,’” she said. “But malnutrition is not about whether a child looks ill. It is about whether their weight and height are right for their age.”

But Sean was at risk even before he had been born. A severe skin condition during Ms Cabanban’s pregnancy kept her housebound for nearly three months, causing her to miss several prenatal check-ups.

Also, without realising she was already pregnant with Sean, she continued breastfeeding her second child. She was nourishing three people at once, but was not eating enough. Unlike their brother, Sean’s sisters have not been diagnosed with malnutrition.

When he was just three months old, Sean was rushed to the hospital, lethargic and barely feeding; his haemoglobin levels were dangerously low. He was in and out of the hospital throughout his first year.

“I was anaemic too,” Ms Cabanban said. “So maybe he got it from me.”

She said finances were the biggest constraint for the family.

“I really think it had to do with our finances. I had to prioritise buying milk and diapers for my toddler, and then for Sean, too, when he was born,” she said. Vegetables and fruits were among the first things cut when the household budget ran low.

Quezon City chief nutritionist Jai Sideco said the pattern is familiar and the consequences are predictable.

“When the child starts schooling, that is where you see it,” she said. “They find it hard to focus. Their performance is low. They get sick more often because their immune system is also compromised.”

The damage, she said, begins far earlier than most families realise. Proper nutrition during the first six months requires exclusive breastfeeding. After that, complementary feeding must meet precise standards for quality and quantity.

Most households in low-income communities do neither – not out of neglect, but because cheap food like canned goods and fried meat sold on the streets is often carbohydrate-heavy and nutrient-poor.

After Sean’s diagnosis in 2025, the community health workers provided him with “Nutribun”, a bread enriched with sweet potato, squash and carrots, and milk for three months. They also gave the family fruits and vegetables and advised Sean’s parents that they must aim to eat nutritious meals every day.

By August that year, around seven months later, he had gained nearly 4kg, reaching 12.2kg.

Ms Cruz, who monitors Sean’s monthly weight, said his recovery has been encouraging.

“He responded well. His mother followed everything we told her (to do). Not all parents do,” she said.

No developmental delays have been flagged by health workers so far.

Limits on government support

The Philippine government has intervention programmes for malnutrition, but the assistance is limited.

Under a law signed in 2018, the government is mandated to scale up nutrition services for pregnant women and children in their first 1,000 days. But the Department of Health has no dedicated budget line for these groups, said Mr Dimal.

The NNC’s dietary supplementation programme – which provides 90 days of nutritional support to pregnant women and 180 days for children aged six to 23 months – has stepped into that gap, reaching more than 31,000 pregnant women since 2020.

The programme’s coverage, however, remains limited to the highest-prevalence regions, leaving communities with moderate but rising stunting rates largely unserved, unless their city or town governments can afford to give assistance.

Mr Dimal said the NNC is requesting additional funding in 2027 to achieve full national coverage for its dietary supplementation programme, which currently has a budget of 50 million pesos (S$1.04 million).

The challenge is compounded by adolescent pregnancy. One in five Filipino adolescents aged 10 to 19 remains stunted. These are girls whose own bodies are still nutritionally depleted when they conceive. Theirs are high-risk pregnancies almost by definition: more likely to result in low birth weight, and more likely to produce children who begin life already behind.

Ms Cabanban was 15 when she had her first child.

“When they are teenage mothers, their own nutrient needs are still very high,” Ms Sideco said. “It is very hard for them to catch up. And so (the problem) passes on to their babies.”

Hope for the future

On the stone bench outside the health centre, Sean climbed into his mother’s lap and put his hand on her face. She laughed and held him close.

Ms Cabanban’s dream is simple: that all three of her children finish college. She did not get the chance. Senior high was only what she could manage between pregnancies, work and a fire in March 2026 that burned their home and forced the family to start again in a rented room.

Sean is doing better. He eats with gusto now. He asks for different kinds of food, not just soup. What happens when he starts school, no one can say with certainty. The window that mattered most, those first 1,000 days, is behind him.