Diet, disease, and development: growth and physiological stress in Medieval central Italy

Childhood in Medieval Italy was marked by high mortality and frequent physiological stress, shaped not only by disease and malnutrition but also by household, community, and societal conditions. This study investigates disease and physiological stress in relation to growth disruptions and childhood mortality in preadult skeletal remains from Medieval Italy. Previous research on the rural 10th-12th century CE cemetery of Pieve di Pava (Tuscany, Italy) indicates that inhabitants practised agriculture, livestock farming, and artisan activities. Skeletal remains of 91 preadult individuals (< 20 years) were macroscopically assessed to reconstruct their biological profiles (age at death, sex, stature) and evaluate stunted growth, physiological stress markers (cribra cranii and orbitalia, long bones subperiosteal new bone formation, enamel hypoplasia), metabolic diseases, and granular impressions as indicator of TB infection. Sex estimates include 29 males, 15 females, and 48 individuals of unknown sex. The adolescent age group (13-19 years) was most frequently represented (32.9%, 30/91). Stunted growth affected 46.9% (23/49) of preadults (38.1% moderate, 14.3% severe). Active cribra orbitalia occurred in 45% (23/51) of individuals and cribra cranii in 7.8% (4/51). Preadults exhibited active long bones subperiosteal new bone formation in 52% (26/50) and enamel hypoplasia in 60% (33/55). Scurvy occurred in 50% (21/42) of preadults and granular impressions in 47.05% (24/51). Among individuals with stunting, 65.2% (15/23) also had scurvy or granular impressions. The results position childhood in rural Medieval Italy as shaped by structural, environmental, and social constraints, leading to repeated periods of physiological stress, growth disruptions, and disease. Children’s development and survival likely reflected agrarian economies, household resource allocation, and child-rearing practices, contributing to the burden of stress and disease observed in the rural skeletal assemblage from Pava. Future research will investigate weaning practices through biochemical analysis of incremental dentine.