Title of Paper: Health of children adopted from China
Type of Paper: Original Article; Medical Evaluations and Chart Review
Purpose: To describe the health and development of children adopted from China at the time of arrival.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using the World Health Organization standards and for OFC using data from American children because the World Health Organization did not have published standards for OFC at the time.
- Anemia: complete blood cell count
- Thyroid function: thyroid stimulating hormone and thyroxine
- Intestinal Parasites: stool examination for ova and parasites
- Serum lead levels (lead poisoning)
Participants: 452 children (443 girls) adopted from China between the ages of 2 months and 12 years at arrival into the U. S.
Methods: Data was collected from two groups of children. Medical and development examinations were completed in an international adoption clinic soon after arrival into the U. S. for 192 children (average age: 14. 2 months). The majority (88%) were seen within 2 months of arrival. The health of 260 children (average age: 6. 5 months) was reported via questionnaires completed by the family physicians.
Developmental testing was done for all of the 192 children who were seen in the international adoption clinic (Peabody Developmental Motor Scales, University of Michigan Early Intervention, Development Profile, and clinical assessment).
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -1. 51 (range: -8. 64 to 2. 9)
- Weight for age (WAZ): -1. 17 (range: -3. 77 to 2. 4)
- Head circumference for age (OFCZ): -1. 43 (range: -5. 2 to 1. 37)
- The following number of children were below -2 z scores for growth (-2 z score is equivalent to approximately the 5th percentile):
- HAZ: 39%
- WAZ: 18%
- OFCZ: 24%
- The duration of time spent in orphanage care was negatively associated with growth lag in height. For approximately every 3 months spent in orphanage care, 1 month of height was lost.
- Height, weight, and OFC delays were more severe in children with developmental delays compared to developmentally normal children.
- Anemia: 35% had anemia (hematocrit <35%). There was no difference in the presence of anemia between children with and without developmental delay.
- Thyroid Function: 10% had abnormal thyroid functioning.
- Intestinal Parasites: 9% had intestinal parasites.
- Lead Poisoning: 14% had lead poisoning (10µg/dL). Approximately 41% of those with lead poisoning were anemic (hematocrit <35%).
- Other medical conditions related to nutrition: 1 child had rickets; 2 children had cleft lip.
Conclusions & Clinical Implications: Children adopted from China show similar growth suppression to children adopted from other regions. Height, weight, and OFC delays were associated with developmental delays. Anemia and lead poisoning were common. Although, not analyzed statistically or discussed in the study, the rate of anemia in children with elevated lead levels was high, perhaps due to the potential interference of lead on iron metabolism. Infection with intestinal parasites was found in 9% of the children, and although not discussed in this paper, intestinal parasites could interfere with proper nutrient absorption and may increase the risk for both macronutrient (e. g. , physical growth) and micronutrient (vitamins and minerals) malnutrition. Abnormal thyroid functioning was reported in 10% of the adoptees, and rickets and cleft palate were reported in 1 and 2 children respectively.
Limitations of the Nutritional Results: The birthdates of children adopted from China are often uncertain and assigned by orphanage staff. Uncertain ages may affect the physical and developmental evaluations after adoption as interpretation of these evaluations are age-dependent. However, ages were not reassigned based on the post-adoption evaluations (except for 2 children). Also, the only marker used to identify anemia was hematocrit, and it was not reported whether the anemia was due to iron deficiency or another etiology.
Reference: Miller LC, Hendrie NW. Health of children adopted from China. Pediatrics. 2000; 105 (6): e76. http://www.ncbi.nlm.nih.gov/pubmed/10835089