EFFECTS OF INSTITUTIONALIZATION
THE RISKS OF INSTITUTIONALIZATION
Growth delays are common among institutionalized children for many reasons. Wasting and stunting have been reported among 35-64% of orphanage residents in Malawi, Kenya and India and among post-institutionalized children from Russia, China, Romania and other countries. Children may suffer from deficiencies of calories, fat, protein, and micronutrients (vitamins, iron, and iodine). At arrival, height, weight, and head circumference are less than the fifth percentile in nearly 50%, 35% and 40% of post-institutionalized children. The actual number of children with growth delays is considerably greater: many children at the fifth, tenth, or even higher percentiles show rapid recovery after adoption, which suggests that earlier measurements did not reflect their true biologic potential.
Poor growth may have a psychological component. Depression, probably the most under-diagnosed condition among institutionalized children, may cause poor appetite. Furthermore, lack of stimulation results in an inefficient use of ingested nutrients. Many children residing in orphanage care have true psychosocial dwarfism which is disproportionate delays in linear growth. Intriguingly, linear growth delays are quite consistent among several distinct populations of international adoptees. Data derived from children adopted from China, Russia, and Romania produce nearly identical curves demonstrating that for every approximately 3 months of institutional care, children lose approximately 1 month of height age.
From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.