Growth faltering associated with undernutrition in early childhood is endemic in sub- Saharan Africa. Worldwide, over 3 million child deaths annually are attributed to foetal growth restriction, underweight, stunting, wasting, suboptimal breastfeeding and micronutrient deficiencies. Survivors suffer adverse health and socio-economic outcomes. Although rates of stunting have halved worldwide, progress in sub-Saharan Africa has been slow. The prevalence of wasting has not shifted. This work aimed to describe secular trends of growth faltering in early childhood and the hormone correlates of malnourished children during nutritional rehabilitation in rural Gambia. Also, to explore factors associated with severe wasting in infancy. Firstly, secular trends of growth faltering among under 2’s from three rural Gambian villages were described using routinely collected clinic anthropometry data. Over the past four decades, rates of stunting and underweight halved, but significant growth faltering persisted. Secondly, changes in energy regulating hormones during the nutritional rehabilitation of children aged 6-24 months were evaluated. The variations in growth amongst the malnourished children during nutritional rehabilitation were not explained by differences in energy regulating hormones. Baseline C-peptide was the only predictor of future response to nutritional rehabilitation, but would not be a useful clinical marker in isolation. Thirdly, risk factors for severe wasting in infants were explored. Adverse maternal psychosocial circumstances and infant feeding difficulties constrained mothers from practicing the recommended infant feeding practices. The conclusion from these findings is that current nutrition and health interventions are inadequate in mitigating growth faltering in early childhood in rural Gambia, in the face of poor living conditions and adverse maternal psychosocial circumstances. In addition, the missing contributors of variable growth during outpatient nutritional rehabilitation remain unknown. Further research into the development and upscaling of the nutrition-sensitive interventions is required to address growth faltering in childhood in low and middle income settings.