Table of Contents

FOREWORD ............................................................... 2
CHAPTER I ...................................................................................................................... 3
INTRODUCTION ................................................................................................. 3
Background......................................................................................................... 3
1.2 Problem Formulationh ............................................................................................. 5

1.3 Purpose of Writingn ............................................................................................... 5

CHAPTER II..................................................................................................................... 6
DISCUSSION ..................................................................................................... 6
2.1. Defenisi Stunting.............................................................................................. 6
2.2. Causes of Stunting............................................................................................ 8
2.3 Factors Affecting the Occurrence of Stunting ............................................. 9
2.4. Stunting Assessment through Anthropometry......................................................... 11
2.5. Impact of Stunting............................................................................................ 12
2.6. How to Prevent Stuntingg ................................................................................ 12
2.7. Mitigation and Prevention of Stunting in Infantsi .14
Addressing stunting in infant growthi .14
2.8. Management ................................................................................................. 18
2.9 Role nurse in children with stuntingg .................................................................. 19
2.10. Government Efforts in the Issue of Stunting................................................. 21
CHAPTER III ................................................................................................................. 26
CLOSING............................................................................................................. 26
3.1 Kesimpulan ..................................................................................................... 26
3.2 Saran................................................................................................................ 27
REFERENCE LIST ................................................................. 28

1
 FOREWORD

With gratitude and praise to the presence of Allah SWT, for the grace and

By His guidance, the author was able to complete the preparation of the paper on '

Child Health Issues in the Health Service System within the limits

the planned time.

This paper is written to fulfill the requirements of the child course.

in the Nursing Profession Study Program at Semarang Health Polytechnic

Kementrian Kesehatan Semarang. Penulis menyadari bahwa kegiatan penulisan

this paper can be completed thanks to the support and input from

various parties, therefore on this occasion the writer expresses feelings

respect and thanks to:

Mr. Marsum BE, S. Pd, MHP as the Director of the Health Polytechnic

Ministry of Health Semarang.

Mr. Suharto, S. Pd., MN as the Head of the Nursing Department of the Polytechnic

Health of the Ministry of Health Semarang.

Mr. Shobirun, MN as the Head of the Nursing Profession Study Program

Semarang Politecnico Health of the Ministry of Health Semarang.

4. Mother Lucia Endang H. YK, [Link], MN as the Lecturer for the Course

A child who has provided insights and useful knowledge.

I hope the results of this paper are beneficial for the development of nursing science.

Semarang, July 2019

Writer

2
 CHAPTER I

INTRODUCTION

1.1 Background

Stunted growth (stunting) is a condition of being short in stature and very

short to extreme deficit-2 SD below the median height or length

Stunting can be diagnosed through the anthropometric index of height.

according to age that reflects the linear growth achieved in pre and

postpartum with indications of long-term malnutrition, as a result of nutrition

that is inadequate. Stunting refers to the failure of linear growth.

reaching genetic potential as a result of poor diet and disease

infection (ACC/SCN, 2000).

Stunting is a major nutrition problem that will impact life.

social and economic within society. There is clear evidence that individuals who

stunting has a higher death rate from various causes and

The increase in diseases such as stunting will affect work performance.

physical and mental and intellectual functions will be disturbed (Mann and Truswell,

2002). This is also supported by Jackson and Calder (2004) who state

often related to immune function disorders and

meningkatkan risiko kematian. Di Indonesia, diperkirakan 7,8 juta anak

stunting data, this is based on a report released by UNICEF

and positioning Indonesia among the top 5 countries with the largest number of children

those experiencing stunting (UNICEF, 2007). The results of the 2010 Riskesdas,

3
The national prevalence of stunting in children aged 2-5 years in Indonesia is

35.6% which consists of 15.1% very short and 20% short.

4
1.2 Problem Formulation

a. What is the definition of stunting?

b. What are the causes of stunting?

c. What are the factors that influence the occurrence of stunting?

d. How is Stunting assessed anthropometrically?

What is the impact of stunting?

f. How to prevent stunting?

What are the measures to address and prevent stunting in infants?

What are the treatments for stunting?

What are the roles of nurses in stunting?

1.3 Purpose of writing

a. To explain the meaning of editing.

b. For knowing the causes of stunting.

c. To determine the factors influencing the occurrence of stunting.

d. For knowing how the assessment of stunting is done through anthropometry.

e. To assess the impact of stunting.

f. To find out how to prevent stunting.

g. To understand the methods of addressing and preventing stunting on

baby.

h. For knowing the treatment for stunting.

i. To understand the role of nurses in stunting

5
 CHAPTER II

DISCUSSION

2.1. Definition of Stunting

Stunting is the term used by nutritionists to refer to children who

grows not according to the proper size (short baby). Stunting

(short body) is a condition of the body that is very short to the extent of exceeding

deficit 2 standard deviations below the median height or length of the population that becomes

international reference. Stunting is a condition where height does not meet the standards based on

short stature, or a condition where a child's body is shorter compared to

children of the same age (MCN, 2009). Stunting is a height that

below age (2SD), marked by delayed growth of children

which results in failure to achieve normal height and

Health according to a child's age. Stunting is chronic malnutrition or failure

growth in the past and used as a long-term indicator for

malnutrition in children.

6
 Stunting can be diagnosed through anthropometric index of height.

according to age which reflects the linear growth achieved in pre and

postpartum with indications of long-term malnutrition, as a result of nutrition

that is inadequate and/or health. Stunting is a linear growth

that fails to reach genetic potential due to dietary patterns that

bad and disease (ACC/SCN, 2000). Stunting is defined as an indicator

nutritional status TB/U is less than or equal to minus two standard deviations (-2 SD)

below average standard or a condition where a child's body is shorter

compared to other children of the same age (MCN, 2009) (WHO, 2006). This

is an indicator of child health that suffers from chronic malnutrition that provides

nutritional representation in the past and influenced by the environment and conditions

socio-economic.

The prevalence of stunting in children under five years old (toddlers) in Indonesia

in 2015 was 36.4%. This means more than a third or about 8.8 million toddlers.

experiencing nutritional issues where height is below the standard

stunting is above the threshold set by WHO of

20%. The prevalence of stunting/short stature in Indonesian children is the second highest in the region.

Southeast Asia below Laos, which reaches 43.8%. However, based on

Nutritional Status Monitoring (PSG) 2017, the number of toddlers experiencing stunting was recorded as

26.6%. This figure consists of 9.8% in the very short category and 19.8%

Short category. The first 1,000 days actually represent the golden age of a baby.

but in reality, there are still many toddlers aged 0-59 months who are actually

experiencing nutritional problems. In order to address the issue of malnutrition in toddlers, the government

conducting a national movement to prevent stunting and multi-partnership cooperation

7
sector. National Team for the Acceleration of Poverty Alleviation (TNP2K)

implementing 160 priority districts for stunting reduction. Based on Research

According to the Basic Health Research (Riskesdas) 2013, there are 15 regencies/cities with prevalence

stunting above 50%.

However, based on the Nutrition Status Monitoring (PSG) 2017, toddlers who

Stunting prevalence is recorded at 26.6%. This figure consists of 9.8%

enter the very short category and 19.8% short category. In 1,000 days

First, it actually represents the golden age of a baby, but in reality, there are still many

news for children aged 0-59 months initially experience nutritional problems. In order to reduce

child nutrition problems, the government is launching a national movement to prevent stunting

and multi-sector partnership cooperation. National Team for Acceleration of Disaster Response

Poverty (TNP2K) implements 160 priority districts for reducing stunting.

Based on the Basic Health Research (Riskesdas) 2013, there are 15 districts/cities.

with a stunting prevalence of over 50%.

2.2. Causes of Stunting

According to several studies, the incidence of stunting in children is a

the cumulative process that occurs from pregnancy, childhood, and throughout

life cycle. This period is the process of stunting occurring in children.

and the opportunity for stunting to increase occurs in the first 2 years of life. Factors

a mother's nutrition before and during pregnancy is an indirect cause that

contributes to the growth and development of the fetus. Pregnant mothers

Insufficient nutrition will cause the fetus to experience intrauterine growth.

retardation (IUGR), so the baby will be born undernourished and experience

disorders of growth and development.

8
 Children who experience growth delays are caused by

the lack of adequate food intake and recurrent infectious diseases,

and the increased metabolic needs as well as reducing appetite, so

the increasing malnutrition in children. This situation is becoming more complicated

to address growth disturbances that could ultimately lead to the occurrence of

chronic malnutrition (stunting) is not only

due to only one factor as explained above, but

caused by many factors, where these factors are interconnected

each other.

There are three main factors causing stunting, namely as follows:

1. Unbalanced food intake (related to the content of nutrients in

Food consists of carbohydrates, proteins, fats, minerals, vitamins, and water.

2. History of low birth weight (LBW),

3. Medical history.

2.3 Factors Influencing the Occurrence of Stunting

Several factors associated with the occurrence of stunting include

energy and protein deficiency, often experiencing chronic diseases, practice

inappropriate feeding and poverty factors. Prevalence of stunted

increases with age, the increase occurs over two years

the first life, the growth process of children in the past reflects the standards

nutrition and health.

According to a UNICEF report (1998), several facts related to stunted and

its effects include the following:

9
Children who experience stunting at an early age, that is, before the age of six.

infants will experience more severe stunting as they approach the age of two.

Severe stunting in children will result in long-term deficits.

in physical and mental development so that it does not able to

optimal learning at school, compared to children with height

normal body. Children with stunted growth tend to take longer to enter.

school and more often absent from school compared to other children

with good nutritional status. This has consequences for

the success of a child in their future life.

Stunting will greatly affect the health and development of children.

The basic factors that cause stunting can disrupt growth.

and intellectual development. The cause of stunted growth is low birth weight.

low birth weight, inadequate breast milk, insufficient supplementary food

recurrent diarrhea, and respiratory infections. Based on research

most children with stunted growth consume foods that

under the provisions of nutritional guidelines, coming from a family

poor with a large family, residing in the area

suburban areas and rural communities.

3. The influence of nutrition on children in early age who experience stunted growth can

disrupting cognitive growth and development that is lacking. Child

stunted at the age of five tends to persist throughout life,

failure of early childhood growth continues into adolescence and

then grow into a stunted adult woman and affect

directly on health and productivity, thereby increasing

10
 the chance of giving birth to an underweight baby. Stunting is particularly dangerous for

women, because they tend to hinder the process

growth and a higher risk of death during childbirth.

2.4. Anthropometric Assessment of Stunting

To determine stunting in children, measurements are taken.

Height measurement according to age is done on children over 2 years old.

Anthropometry is the measurement of the body, while nutritional anthropometry is

types of measurements of various body shapes and body composition according to age

and levels of nutrition, which are used to determine protein imbalance

and energy. Anthropometry is conducted for measuring growth in height.

and body weight (Gibson, 2005).

Standards used for the standardization of measurements based on

NCHS and WHO recommendations. Standardization of this measurement compares

measurement of children with median, and standard deviation or Z-score for age and

the same gender in children. Z-score is a unit of standard deviation

to understand the difference between individual values and the median

reference population for the same age/height, divided by the standard deviation of

reference population value. Some advantages of using Z-score include

to identify the correct value in the distribution of index differences and

age differences also provide benefits for drawing conclusions in a

statistics from anthropometric measurements.

Anthropometric indicators such as height according to age (stunted)

it is important to evaluate the health and nutritional status of children in

areas with many malnutrition problems. In determining nutrition classification

11
deficient with stunted according to 'Cut off point', with Z-score assessment,

and measurement in toddlers based on height according to Age (Height/Age)

The following WHO-NCHS reference standard (Source WHO 2006).

2.5. The Impact of Stunting

Stunting can lead to a decrease in intelligence (IQ), thus

learning achievement becomes low and cannot continue school. When

mencari pekerjaan, peluang gagal tes wawancara pekerjaan menjadi besar dan

not getting a good job, resulting in low income

(economic productivity hypothesis) and cannot meet the needs

food. Therefore, children suffering from stunting are impacted not only on

just shorter physically, but also in intelligence, productivity and

its performance later in adulthood, which will become a burden on the state. In addition

from an aesthetic aspect, a proportionally grown person will look more

interesting from those with short bodies.

Stunting that occurs during childhood is a risk factor

the rise in mortality rates, cognitive abilities, and motor development

which are low and bodily functions that are unbalanced (Allen & Gillespie,

Growth failure that occurs due to malnutrition during these golden times.

will have negative consequences for the next life and will be difficult to fix. Problems

stunting indicates long-term nutritional deficiency, namely

lacking energy and protein, as well as some micronutrients.

2.6. How to Prevent Stunting

Preventing Stunting in Toddlers

12
 Various efforts have been made to prevent and address the issues.

nutrition in the community. Indeed there are results, but we still have to work hard.

to reduce the prevalence of stunted children by 2.9% to meet the MDGs target for the year

In 2014, it was achieved which impacted the decrease in the prevalence of malnutrition among toddlers.

we

Under normal circumstances, height grows together with

As age increases, the increase in height is relatively less sensitive.

toward malnutrition in a short period of time. If there is a growth disturbance

height in toddlers, thus to catch up on height growth

The optimal can still be pursued, while school-age children to teenagers.

the possibility is relatively small. Therefore, there is a great opportunity to prevent stunting.

done as early as possible. by preventing the risk factors of poor nutrition on

adolescent girls, women of childbearing age (WUS), pregnant women, and toddlers. In addition,

handling toddlers with low height and weight who are at risk of occurrence

stunting, as well as for toddlers who have already experienced stunting to prevent it from getting worse.

The incidence of stunting in children can break its chain starting from the fetus.

content by fulfilling the nutrient requirements for pregnant women,

This means that every pregnant woman must receive adequate nutritional food.

receiving nutrient supplementation (iron tablets), and health is monitored. Besides

every newborn baby should only receive breast milk until the age of 6 months

(exclusive) and after 6 months of age given complementary food alongside breast milk (MPASI)

that is sufficient in quantity and quality. A postpartum mother not only receives adequate food

nutrition, also provided with nutritional supplementation in the form of vitamin A capsules. The incidence of stunting

chronic conditions in toddlers should be monitored and prevented if

13
Monitoring of toddler growth is carried out routinely and correctly. To monitor

pertumbuhan balita di posyandu merupakan upaya yang sangat strategis untuk

early detection of growth disturbances can be carried out

prevention of stunting in toddlers.

Together with other sectors, improve the quality of environmental sanitation and

provision of infrastructure and family access to protected water sources,

decent settlements. Also improving families' access to electricity

buying food and medical expenses when sick through job creation and

increased income. The improvement in the education of fathers and mothers that has an impact

on knowledge and skills in the application of health and nutrition

his family, so that the child is in a good nutritional status.

Facilitating family access to information and information provision

about children's health and nutrition that is easy to understand and implement by

every family is also an effective way to prevent the occurrence of

stunting news.

2.7. Addressing and Preventing Stunting in Infants

a. Addressing stunting in baby growth

The most effective stunting mitigation is carried out in the first thousand days.

the first life, namely:

1. In pregnant women

Improving the nutrition and health of pregnant women is the best way

in addressing stunting. Pregnant mothers need to receive food that

well, so if a pregnant woman is very thin or

has experienced Chronic Energy Deficiency (CED), so it needs to be provided

14
 supplements for the pregnant mother. Every pregnant mother needs to

receive iron supplement tablets, at least 90 tablets during pregnancy.

The health of the mother must be maintained so that she does not fall ill.

2. At the time the baby is born

Childbirth is assisted by a midwife or trained doctor, and as soon as the baby is born

initiate early breastfeeding (IMD). Babies up to 6 months old

infants are given only breast milk (exclusive breastfeeding).

3. Infants aged 6 months to 2 years

4. Starting from 6 months of age, in addition to breast milk, babies are given Complementary Foods.

Breastfeeding (MP-ASI) continues until the baby is 2 years old.

year or more. Babies and children receive vitamin A capsules, tablets,

complete basic immunization.

b. Prevention of stunting in infant growth

Nutritional needs during pregnancy

In an adult woman who is pregnant, the needs

its nutrients are used for routine activities in the metabolic process

the body, physical activity, and maintaining balance of all processes

in the body. In addition to routine processes, energy is also needed and

additional nutrition for the formation of new tissue, namely the fetus, placenta,

the uterus and mammary glands. Pregnant women are advised to eat adequately.

varied so that the need for a variety of nutrients can

fulfilled. The food needed for growth is

foods that contain growth or building substances are

15
 protein, during that time also needs additional vitamins and minerals for

help the growth process.

2. Nutritional Needs of Mothers while Breastfeeding

The amount of food for breastfeeding mothers is greater.

compared to pregnant women, but the quality remains the same. On

breastfeeding mothers are expected to consume nutritious food and

high energy, such as recommended to drink cow's milk, which

beneficial for preventing tooth and bone damage. Milk for

meeting the needs of calcium and flour in breast milk. If there is a deficiency

this element caused the dismantling of the network (deposit) in

the body earlier, as a result the mother will experience dental damage. Water content

In breast milk, it is around 88 grams %. Therefore, mothers who are breastfeeding are advised to

to drink about 2–2.5 liters (8-10 glasses) of water a day, in addition to

You can also add by drinking fruit water.

3. Nutritional Needs of Infants 0–12 Months

At the age of 0–6 months, it is best for babies to be given enough Breast Milk.

(ASI). Breast milk is the best food for babies from birth onwards.

Approximately 6 months old. Breastfeeding should be done as soon as possible.

perhaps after giving birth. At this age, the baby should be breastfed

at least 20 minutes on each breast until

the breast is completely empty. If this is done without

limiting the time and frequency of breastfeeding will cause the breasts to

producing breast milk up to 800 ml even up to 1.5–2 liters

per day.

16
4. Nutritional Needs of Children Aged 1–2 Years

When reaching the age of 1 year, the growth rate begins to slow down.

but motor skills are improving, the child starts to explore

the surrounding environment by walking around, jumping, running

and so on. However, at this age, children also begin to often

experiencing health issues and vulnerable to infectious diseases

such as ARI and diarrhea so that children need high nutrients and nutrition

balanced for optimal growth and development. At this age, breast milk remains

given. At this time also provide food for the family in a

gradually according to the child's abilities. Food variations must be

It is noted. The food provided does not use flavoring.

sharp spices, preservatives, and coloring agents. from breast milk because currently

only the best milk for your beloved child without side effects

5. Micronutrients that Play a Role in Preventing Stunting

a. Calcium

Calcium functions in the formation of bones and teeth, and in coagulation.

blood and muscle contractions. Food sources of calcium include:

dried anchovies, eel, milk, cheese, nuts.

Iodine

Iodine is very useful for thyroid hormones where thyroid hormones

regulating metabolism, growth, and development of the body.

17
 Iodine is also important for preventing goiter and dwarfism. Ingredient

foods that are sources of iodine: sea fish, shrimp, and shellfish.

c. Zinc

Zinc functions in bone metabolism, wound healing, function

Immunity and development of male reproductive functions. Materials

food sources of zinc: liver, shellfish, eggs, and legumes.

Iron

Iron functions in the immune system, brain growth,

and energy metabolism. Sources of iron include: liver, eggs, fish,

legumes, green vegetables, and fruits.

e. Folic Acid

Folic acid mainly functions during the division period and

cell growth, producing red blood cells and preventing

anemia. Sources of folic acid include: spinach, radishes, beans-

nuts, cereals, and vegetables.

2.8. Management

Treatment for stunting includes:

a. Calcium

Calcium functions in the formation of bones and teeth, and in blood clotting.

and muscle contraction. Food sources of calcium include anchovies.

dry, eel, milk, cheese, nuts.

18
 b. Iodine

Iodine is very useful for thyroid hormones where thyroid hormones

regulating metabolism, growth and development of the body. Iodine

It is also important to prevent goiter and dwarfism. Food ingredients

sources of iodine: sea fish, shrimp, and shellfish.

c. Zinc

Zinc functions in bone metabolism, wound healing, function

immunity and the development of male reproductive functions. Food ingredients

Sources of zinc: liver, shellfish, eggs, and legumes.

d. Iron

Iron functions in the immune system, brain growth, and

energy metabolism. Sources of iron include: liver, eggs, fish, beans-

nuts, green vegetables, and fruits.

e. Folic Acid

Folic acid mainly functions during periods of division and growth.

iron, produces red blood cells and prevents anemia. Source of acid

Folate includes: spinach, radishes, legumes, cereals, and vegetables.

vegetables.

2.9 The role of nurses in stunting children

a. Caregiver

The primary role of a nurse is to provide care.

nursing to individuals, families, groups, or communities

in accordance with the problems that arose starting from the issues that are of a nature

simple to complex. Example of the role of a nurse as

19
 The caregiver is a role when the nurse meets the needs.

basic tasks such as feeding, assisting patients with ambulation

religious.

b. As a family Advocate

As a client advocate, the nurse is responsible for

assist clients and families in interpreting information

from various service providers and the information needed to

obtaining consent (informed consent) for nursing actions

given to him. The role of the nurse as a family advocate

It should be demonstrated by providing an explanation of the procedure.

linear growth measurement actions achieved in pre and

postpartum with indications of long-term malnutrition,

the consequences of inadequate nutrition.

c. Educator

Nurses are responsible for education and teaching.

nursing knowledge to clients, nursing staff, and personnel

other health. One aspect that needs to be considered in

nursing is an aspect of education, because of behavior change

is one of the targets of nursing services. Nurse

must be able to act as an educator for individuals, families,

groups and communities. Providing health education about

handling stunting (short infants) is one example of a role

nurse as an educator (health educator).

20
 d. Counseling

The main task of the nurse is to identify changes in patterns.

client interaction regarding their health condition. The existence of changes

this interaction pattern is the basis for action planning

nursing. Counseling is provided to individuals, families in

integrating health experiences with time experiences

then. Problem solving is focused on; nursing problems,

changing healthy lifestyle behaviors (changes in interaction patterns).

2.10. Government Efforts in the Stunting Issue

So far, the government has been trying to reduce malnutrition, especially

stunted growth is a public health issue

the main one in Indonesia. To address that challenge, UNICEF supports

a number of initiatives in 2012 to create a national environment that

conducive to nutrition. This includes the launch of the National Nutrition Awareness Movement.

(Scaling Up Nutrition–SUN) and supporting the development of regulations on

exclusive breastfeeding, national plan to control disorders

iodine deficiency, guidelines on the prevention and control of parasites

intestinal and guidelines on multi-nutrient supplementation for women and children in

Klaten, Central Java.

Community management on acute malnutrition and feeding

infants and children are transformed into a holistic package to address nutrition

poor, while child nutrition control and malaria are handled together for

preventing stunted growth (stunting) (UNICEF Annual Report

Indonesia, 2012). To assist the government in improving nutrition

21
In stunting in young children, according to Unicef Indonesia, special attention must be given.

on:

Creation and strengthening of national and regional coordination mechanisms

to implement the National Food and Nutrition Action Plan, and to

coordinate with non-nutrition sectors.

Development, monitoring, and enforcement of national regulations to oversee

marketing of breast milk substitute products. Revision of minimum health service standards

to encompass actions and nutrition targets, such as actions related to

with nutritional counseling, complementary foods for breastfeeding, and maternal nutrition.

Strengthening health information systems to enhance reliability

data, promotion of supportive supervision for health and nutrition programs, and

the continuous promotion of data usage by health workers for

increasing the impact of the program.

Strengthening the national food fortification program by updating standards

fortification for flour, mandatory fortification of oil, and improvement

enforcement of existing legislation; regarding salt iodization. Implementation of steps-

steps to recruit, develop, and retain nutritionists

meeting the requirements, including incentives for those working in the regions

the underserved.

The national strategy for accelerating stunting prevention is through interventions.

specific nutrition, sensitive nutrition intervention and enabling environment

specific nutritional interventions contribute 30% to

reducing stunting cases, this intervention is directed at households in

The first 1000 days of life (HPK), carried out by the health sector, are characterized by

22
short term, and the results can be noted in a relatively short time. Meanwhile,

sensitive nutritional intervention contributes 70% to reducing the rate

stunting, carried out by sectors outside of health, and its target is

the general public. Additionally, a supportive environment aimed at factors-

fundamental factors related to nutritional status such as the government,

income and equity.

Posyandu is the main frontline for healthcare services for infants and toddlers in

society. In accordance with the purpose of establishing posyandu is for acceleration

reducing the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) through

community empowerment, therefore the target of posyandu activities is not only children

Just news, but also starting from pregnant mothers, breastfeeding mothers, and postpartum mothers. Activities

what is done at the posyandu is focused on maternal and child health services

(KIA), Family Planning (FP), immunization, nutrition and prevention and

diarrhea management.

The role of posyandu in tackling stunting in Indonesia is very

important, especially efforts to prevent stunting in early childhood. Through

monitoring the growth and development of infants and toddlers conducted by one

once a month through the filling of the KMS curve, toddlers experiencing issues

growth can be detected as early as possible, so it does not fall into

the issue of chronic growth or stunting.

A child detected with growth disturbances should be addressed immediately.

followed up through referral to health facilities such as community health centers/hospitals, or

immediately receive Counseling, Information, and Education (KIE) related to

management of growth disorders experienced by officers or cadres

23
posyandu, and provided with Supplementary Food (PMT). Children who

potentially experiencing stunting, will certainly be evaluated to be investigated

causal factors and risks. The analysis of causal factors certainly requires a role

sector and program cross, therefore toddlers who have the potential for disturbances

Further growth will involve home visits to assess factors.

What factors influence it, including family and environmental factors.

In addition to monitoring growth and development activities, other activities are also provided.

which is focused on the dissemination of information about balanced nutrition and exclusive breastfeeding in

posyandu, among others, are activities of the Mother Support Group (KP Mother),

baby and child food provision (PMBA), or the Love Mother Movement (GSI) that

aimed at improving the knowledge, attitudes, and positive behaviors of mothers with toddlers in

prevent stunting in their toddlers.

The overall activities represent a form of empowerment.

the community that encompasses health services throughout the cycle of life, starting from

from a quality pregnancy process, the Birth Planning Program and

Prevention of Complications (P4K), exclusive breastfeeding (including Initiation

Early breastfeeding (Dini), as well as adequate complementary feeding. In addition, at the posyandu

there is an Active Oral Rehydration Service (LROA), which is a service

prevention of dehydration in toddlers experiencing diarrhea. Form of LROA services

consists of administering oral rehydration salts, zinc tablets for 10 days, and educating about diarrhea and

The dangers of dehydration in toddlers. As is already known, there is a relationship

significant between the occurrence of diarrhea (especially recurrent) and the occurrence

stunting in toddlers.

24
 The effective implementation of posyandu in accordance with technical guidelines, of course.

will reduce the incidence of stunting in toddlers, especially optimization in steps

IV dan V posyandu, yaitu pemberian penyuluhan kesehatan oleh kader dan

health services by health personnel. However, the achievement of performance indicators

Posyandu in Indonesia is still not optimal, including the low

number of visits by toddlers to Posyandu.

One of the reasons is the lack of interest of parents to take their toddlers to

posyandu, especially in urban areas due to busy factors or

the ignorance of parents regarding activities at the posyandu. Therefore, it is necessary

an effort to revitalize cross-program and sectoral collaboration in improving performance

posyandu in the region, so that posyandu can visibly encourage

stunting mitigation in Indonesia.

25
 CHAPTER III

CLOSING

3.1 Conclusion
Stunting is a term used by nutritionists to refer to children who

growth not according to the proper size (short baby). Children

those experiencing growth barriers due to lack of intake

adequate food and recurrent infectious diseases, and increasing

metabolic needs as well as reducing appetite, thus increasing

nutritional deficiencies in children, history of low birth weight (LBW) and

medical history. To determine stunted growth in children, it is done by ways of

Measurement. Measurement of height according to age is performed on children aged

over 2 years. The standardization is measurement of WHO uses

standard deviation measurement or Z-score for the same age and gender

to children.

Stunting can result in a decrease in intelligence (IQ), thus

academic achievement becomes low and cannot continue school. If

looking for a job, the chance of failing the job interview becomes greater and

not getting a good job, which results in low income

(economic productivity hypothesis) and cannot meet the needs

food. Therefore, children suffering from stunting are affected not only by

shorter physically, but also on intelligence, productivity and

his future performance after adulthood, which will become a burden on the state.

Nutritional Status Monitoring (PSG) 2017, the number of toddlers experiencing stunting is recorded.

as much as 26.6%. This figure consists of 9.8% in the very short category.

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and 19.8% of the short category. Nurses as professional health workers

it is hoped to be a good caregiver, as a family advocate

who has a child with Stunting issues and is also an educator can

providing counseling that can solve problems within families so that

The incidence of stunting in Indonesia has decreased.

3.2 Suggestions

National Team for the Acceleration of Poverty Reduction (TNP2K)

implementing 160 priority districts for stunting reduction. Based on research

Basic Health Research (Riskesdas) 2013, there are 15 regencies/cities with prevalence

stunting above 50%. It is not an easy task to conquer all of that. Children

With stunting increasing year by year, especially in remote areas.

Not because healthcare workers have not yet been translated, nurses, midwives, doctors have

hard work may be, the role and unity of the family, especially the mother, is also very

means and the role of all parties can help for our hopes in

Reducing the incidence of stunting in children in Indonesia can be realized.

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 REFERENCES

UNICEF Indonesia Annual Report. 2012. Summary of UNICEF Health Study

Indonesia. October 2012.
Indonesia Annual Report. 2013. Presentation of Key Findings from Health Research
Basic 2013.
Ministry of Health of the Republic of Indonesia. 2018. Prevent Stunting with Patterns

Food, Parenting, and Sanitation.

Hidayah, F. 2013. Exclusive breastfeeding as a risk factor for the incidence of stunting.

Children Aged 6-24 Months in Yogyakarta City. Gadjah Mada University Journal

Mad. Downloaded already[Link]

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Indonesia second highest in ASEAN
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