MALNUTRITION AND INTERNATIONAL ADOPTION: PRACTICAL CONSIDERATIONS
When caring for the malnourished or under-nourished new arrival, the pediatrician should explicitly discuss feeding practices with the family. Voracious or ravenous children should be allowed to eat freely. Rapid weight gain allows a quicker return to normal body composition in malnourished children, and free access to food is important psychologically for the hungry child. Vitamin and mineral supplements should be discussed with the child's pediatrician.
Rapid growth recovery is the rule in malnourished children after adoption. If substantial physical catch-up does not occur within the first 6 months, medical or behavioral causes preventing recovery should be sought. The number of possibilities is substantial, and a comprehensive approach must be taken. Curiously, some children with growth retardation from malnutrition and neglect become accustomed to low-caloric intakes, and do not appear to be hungry even if presented with adequate amounts of food. This may reflect disordered regulation of the complex pathways that determine appetite and satiety. However, until these pathways are more clearly elucidated, a behavioral approach to nutritional rehabilitation is necessary for these children.