Type of Paper: Original Article; Prospective Study
Purpose: To examine catch-up growth during the early post-adoption period and to identify factors associated with catch-up growth in children adopted from Eastern Europe.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores were calculated using CDC 2000 as a reference and z scores for OFC in children over 36 months of age from data on American children (Roche et al, 1987) because the CDC only has standards for OFC in children under 36 months of age.
- Caloric intake: three day food diaries in which parents reported everything their child ate for three days.
Participants: 148 children adopted from Eastern Europe between the ages of 6 and 59 months at adoption (average age was 20 months).
Methods: Children were seen in two international adoption clinics soon after arrival into the U. S. (within 3 weeks of arrival) and again six months later.
- Physical growth:
- At arrival:
- The following number of children were below -2 z scores for growth at arrival (-2 z scores is equivalent to approximately the 5th percentile):
- Height for age (HAZ): 22%
- Weight for age (WAZ): 34%
- Head circumference for age (OFCZ): 12%
- Weight for height (WHZ): 10%
- Growth failure was more severe in children with low birth weight and in children with a high risk for fetal alcohol syndrome (FAS).
- At the six month follow-up:
- There was significant improvement over the six month in all areas of physical growth. 62% experienced catch-up growth (gain in height of 0. 5 z scores).
- Significant predictors of improvements in the growth parameters are described below:
- HAZ: younger age, lower height at arrival, greater caloric intake (kcal/kg)
- WAZ: greater caloric intake,lower weight at arrival, lower birth weight, lower insulin-like growth factor binding protein-3 (IGFBP-3; involved in the growth hormone system) at arrival
- OFCZ: better height at arrival, smaller OFCZ at arrival
- Caloric intake: Average caloric intake exceeded the national recommendations [US Dietary Reference Intake (DRI)] for children of this age range. At arrival, 76% had caloric intake higher than the recommendation and 93% at the six month follow-up.
Conclusions & Clinical Implications: Similar to other cohorts, international adoptees have growth failure in height, weight, and head size at adoption followed by significant improvements in all these areas. Special attention may be needed for children with low birth weight, high risk for FAS, greater height suppression, or older age, as they are at risk for increase growth suppression and less catch-up. During the catch-up phase, these children had unusually high caloric intakes. Higher caloric intake was associated with greater catch-up in height and weight. These findings suggest that improved nutrition is important for growth recovery in this population, and there is a need for higher caloric intake beyond typical age requirements. The authors note that nutritional demands depend on the growth rate and any pre-existing nutrient deficits.
Limitations of the Nutritional Results: As the authors discuss, although improved catch-up growth is associated with improved nutrition (i.e., high caloric intake), other changes in the post-adoption environment which were not addressed in this study, such as improved nurturing care, may influence the growth hormone system and catch-up growth. Improved nutrition may be inadequate without concurrent improvements in nurturing care for growth recovery.
Reference: Miller BS, Kroupina MG, Mason P, et al. Determinants of catch-Up growth in international adoptees from Eastern Europe. International Journal of Pediatric Endocrinology. 2010; 2010. http://www.ncbi.nlm.nih.gov/pubmed/21234323