Type of Paper: Original Article; Medical Chart Review
Purpose: To describe the health and development of children adopted from Guatemala at the time of arrival into the U. S. and to compare the health of these children based on whether they received foster care or orphanage care prior to adoption.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores were calculated using CDC 2000 as a reference.
- Anemia: complete blood cell count
- Thyroid function: thyroid stimulating hormone and thyroxine
- Intestinal Parasites: stool examination for ova and parasites
- Lead Poisoning: Serum lead levels
Participants: 103 children adopted from Guatemala between the ages of 3 months and 9 years (62% were less than 4 years old). 56 children were in the foster care group, 25 in the orphanage care group, and 22 in the mixed care group (receiving a combination of care: living with the birth family, in orphanage care, and/or in foster care).
- There were age differences between the groups. The average ages at arrival were:
- Foster Care: 7 months
- Orphanage Care: 13 months
- Mixed Care: 42 months
Methods: Chart review of medical evaluations that had been completed soon after arrival. The majority (71%) were seen within 2 months of arrival into the U. S.
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -1. 04 (range: -3. 64 to 1. 18)
- Weight for age (WAZ): -1. 00 (range: -4. 66 to 1. 75)
- Head circumference for age (OFCZ): -1. 08 (range: -4. 27 to 1. 37)
- The following number of children were below -2 z scores for growth (-2 z scores is equivalent to approximately the 5th percentile):
- HAZ (short stature): 16%
- WAZ (underweight): 20%
- OFCZ (microcephaly; small head size): 17%
- Children living in orphanages were smaller in all areas of physical growth compared to children coming from foster care. Children who were in the mixed care group had measurements between the foster care and orphanage care groups.
- Note : these results did not change when only age- and sex-matched pairs between the foster care and orphanage care were included, suggesting that the growth differences were due to type of care rather than age at adoption.
- For children under 2 years old at arrival, all three areas of physical growth worsened with older age at of arrival (regardless of type of pre-adoption care).
- There were no differences between the groups based on type of pre-adoption care in the prevalence of other nutrition-related findings. Other nutrition-related results included:
- 30% had anemia (hematocrit <30%)
- 8% had intestinal parasites
- 6% had diarrhea (1 with rotavirus)
- 3% had elevated lead levels
- 6% had minor, temporary thyroid abnormalities
- One child had rickets.
Conclusions & Clinical Implications: Children adopted from Guatemala show similar growth suppression at arrival to children adopted from other regions. Compared to a similar study on the health of children adopted from China, adoptees from Guatemala have better height and head circumference measurements than children coming from China. For children under 2 years at arrival, height, weight, and head circumference worsened with older age at adoption. Although still delayed, children coming from foster care had better growth than children who resided in orphanages prior to adoption. Children who received mixed care prior to adoption (living with the birth family, in orphanage care, and/or in foster care) had intermediate growth. Although the quality of care of the pre-adoption environments was not directly assessed, this study emphasizes the importance of quality care (foster care compared to orphanage care) for better physical growth outcomes.
There were no differences between the groups in other nutrition-related measures. Almost one-third were anemic, and other diagnoses included infection with intestinal parasites, thyroid abnormalities, and diarrhea. Very few children had elevated lead levels (which could interfere with mineral metabolism) or rickets. 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.
Limitations of the Nutritional Results: 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 L, Chan W, Comfort K, Tirella L. Health of children adopted from Guatemala: Comparison of orphanage and foster Care. Pediatrics. 2005; 115 (6): e710-e717. http://www.ncbi.nlm.nih.gov/pubmed/15930199