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Delays in cognitive development are also common among institutionalized children. Because cognitive function in young children is critically dependent on experience, it is not surprising that most children display significant developmental delays. Even children in clean, well-kept orphanages with lots of toys and games suffer from a scarcity of experiences of the outside world. Most have never been off the grounds of the orphanages (except perhaps for frightening trips to the hospital where they may be abandoned without familiar caregivers for weeks or months). Children lack the experience of going to parks, stores and different homes and of the life of their village or town. Indeed, many exist as virtual prisoners of the orphanage.

Perhaps the most critical risk faced by institutionalized children is emotional neglect. Caregivers of young infants may all wear masks, depriving children of the experience of seeing human faces. Depression is common in orphanages. In virtually all institutional settings, children lack a one-to-one or 'primary' caretaker. A common schedule for caregivers is a 24-hour shift every 3 or 4 days. Thus, each day the child is faced with a different caregiver's style of feeding, baths, bedtime and emotional responses. As a result, the child experiences inconsistent responses to his or her needs. The problem is exacerbated by the common practice in most orphanages of moving children from group to group, depending on age and developmental skills. Thus, when the child learns to sit, he is taken from caregivers he has known and loved for many months. When the child walks, he is moved again.

In well-staffed orphanages in the United Kingdom in the 1960s and 1970s, by 2 years of age, children had been cared for by 24 different adults, by 4 years by 40 different adults; and by 8 years of age by more than 80 different adults. Of course, emotional neglect of a different type occurs in understaffed orphanages. Although it is hoped that this type of institution no longer exists, the 170 residents of the Romanian Babeni Orphanage for 'unsalvageables' were cared for by one pediatrician and six attendants during the day, and three attendants at night. Not surprisingly, 75% of children did not know their names or ages, 55% had failure to thrive and 15% had obvious evidence of physical and sexual abuse.


From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.


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