Type of Paper: Original Article; Longitudinal Prospective Study
Purpose: To compare growth and development in children adopted from China coming from either orphanage care or foster care
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using the World Health Organization 2010 standards.
Participants: 92 girls adopted from China into the Netherlands who were between the ages of 10. 8 and 16. 5 months at arrival (average age was 13 months). 50 were included in the institutionalized group (spending no more than one month of their pre-adoptive life in care other than institutional care), and 42 were included in the foster care group (spending at least one month of their pre-adoption life in foster care).
Methods: Growth and developmental data were collected at two time points. Time 1 was completed at 2 months after arrival and time 2 at 6 months after arrival (4 months after time 1). Growth measures were obtained from the parents. Development was assessed using the Dutch Bayley Scales of Infant Development-II.
- Physical growth:
- There were no differences in physical growth or catch-up in growth during the 4 months between children coming from institutional care and children coming from foster care.
- At time 1, average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -0. 75
- Weight for age (WAZ): -0. 42
- Head circumference for age (OFCZ): -0. 50
- There was significant catch-up in weight and head size, and this catch-up growth was greater for earlier adopted children compared to later adopted children. There was no significant improvement in height.
- Despite improved growth for weight and head circumference,average z scoresremained below average at time 2:
- HAZ: -0. 69
- WAZ: -0. 26
- OFCZ: -0. 24
- Physical growth was not associated with either cognitive or motor development.
Conclusions & Clinical Implications: There were moderate growth delays in girls adopted from China, followed by catch-up in weight and head circumference but not height. There were no differences in any of the physical growth measures or catch-up growth between the institutionalized and foster care groups (however, foster care was associated with better cognitive and motor development). However, children who were younger at arrival experienced greater catch-up on weight and head circumference, emphasizing the importance of improving care as early as possible. The authors suggest that there may be a sensitive period when growth recovery is easier. There was recovery in weight but not in height. The authors suggest that this may be because weight recovers quickly due to improved dietary intakes whereas height relies on bone growth and the growth hormone system which may take longer.
Limitations of the Nutritional Results: The authors suggest that the growth delays are not very severe because conditions in China have improved for these children. One caveat the authors did not discuss is that the adoptees were not measured until two months after arrival, and some catch-up in growth may have already taken place. Also, growth measures were obtained from the parents. The authors did not describe who measured or what methods were used to measure growth; therefore, the accuracy of these measurements is unknown. Finally, this study found no differences in physical growth based on the type of pre-adoption care experienced (orphanage-care vs foster care). This could reflect improved orphanage conditions as the authors discuss. However, the lack of difference could be that the care the foster care group received was not much improved over that of the institutionalized group; the majority (62%) of the foster care group spent some time in orphanage care and/or experienced transitions in care. The authors however did not find a difference in their results when they included children who only experienced foster care in the foster care group.
Reference: van den Dries L, Juffer F, van Ijzendoorn MH, Bakermans-Kranenburg MJ. Infants’ physical and cognitive development after international adoption from foster care or institutions in China. J Dev Behav Pediatr. 2010; 31 (2): 144-150. http://www.ncbi.nlm.nih.gov/pubmed/20110827