Title of Paper: The health of children adopted from Romania
Type of Paper: Original Article; Prospective Medical Evaluations
Purpose: To evaluate the health of children adopted from Romania into the U. S.
- 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
- Intestinal Parasites: stool examination for ova and parasites
Participants: 65 children adopted from Romania, ranging in age from 6 weeks to 73 months. Two-thirds had spent their entire lives prior to adoption in the Romanian orphanage system.
Methods: Medical and developmental examinations were completed in 2 international adoption clinics soon after arrival into the U. S. (the majority were completed within three weeks of arrival).
- Physical growth:
- 34% of all the children in the study exhibited growth failure. Of the four growth parameters (height for age, weight for age, weight for height, and head circumference), weight for height was the only one within normal limits.
- Head size was most affected in older infants and children. 41% of those older than 10 months had small head size [head circumference (OFCZ) < -2 z scores) compared to 7% of those younger than 10 months.
- In children under 15 months of age:
- The length of institutionalization was negatively correlated with length/height, weight, head circumference, and weight for height z scores (i.e., the more time spent in institutional care, the more the z scores for these measures decreased). Weight for height was least affected.
- In children 15 months and older:
- The length of institutionalization was negatively correlated with only length/height.
- Intestinal parasites: 33% of those screened for intestinal parasites were infected. Infected children were older than non-infected children
Conclusions & Clinical Implications: About one-third (34%) of the Romanian adoptees exhibited growth failure at arrival. Length/height, weight, head circumference and weight for height were all affected; however, weight for height was least affected and within the normal range. The severity of growth failure was correlated with the amount of time spent in institutional care. In the younger adoptees (younger than 15 months of age), as the length of time spent in orphanage care increased, all measures of physical growth decreased. In the older adoptees (15 months and older), the length of institutional care was only associated with length/height. The authors discuss that these growth findings fit with the two subtypes of psychosocial short stature in which growth failure is associated with continued psychological and/or emotional deprivation. In the infantile subtype of psychosocial short stature, there is general failure to thrive and short stature. In the childhood subtype, short stature is the primary growth effect. Almost half of the adoptees over 10 months of age had small head sizes. The authors discuss the concern about the effects of the early nutritional insults and emotional deprivation on brain growth and subsequent development in these children.
Intestinal parasites were common (especially in older adoptees), 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.
Limitations of the Nutritional Results: Although measured, the rate of anemia at arrival was not reported. The authors also note that the children adopted into the U. S. represent the healthiest of the children living in orphanage care, and these findings may not represent the health of the children who remained in the orphanages. This study was also undertaken 20 years ago and may not represent the current health of similar children or the current conditions of orphanages providing institutional care.
Reference: Johnson DE, Miller LC, Iverson SL, et al. The health of children adopted from Romania. JAMA. 1992; 268: 3446-3451. http://www.ncbi.nlm.nih.gov/pubmed/1281241