Type of Paper: Original Article; Prospective Medical Evaluations
Purpose: To assess the relationship between nutritional status and developmental status in international adoptees 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.
Participants: 122 children adopted from 22 different countries between the ages of 6 week and 10. 5 years at adoption. The median age was 12 months (half of the kids were younger than 12 months and half were older than 12 months at adoption). The most frequent countries of origin were Romania, China, Korea, and Paraguay.
Methods: Children were seen in one international adoption clinic soon after arrival into the U. S. The majority (70%) were seen during the first six weeks. Medical and developmental assessments were completed. The developmental testing included several developmental assessments to measure cognitive, motor, and language functioning (Peabody Developmental Motor Scales, Early Intervention Developmental Profile, Bruininks-Oseretsky Test of Motor Proficiency, Beery Developmental Test of Visual-Motor Integration) .
- Physical growth: Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -1. 36 (range: -5. 66 to 2. 44)
- Weight for age (WAZ): -0. 76 (range: -3. 49 to 2. 66)
- Head circumference for age (OFCZ): -1. 03 (range: -5. 31 to 1. 37)
- Other nutrition-related results included:
- 31% had anemia (hematocrit ≤0. 33).
- Intestinal parasites were found in 21%.
- 3% had craniofacial abnormalities.
- One child had severe rickets.
- Motor development: Poorer motor development was associated with lower z scores for height, weight, and head circumference. Children with both severe and moderate delays had smaller growth measures compared to developmentally normal adoptees.
- Cognitive and language development: Children with severe cognitive or language delays had lower z scores for height, weight, and head circumference compared to developmentally normal adoptees.
- Overall, children with one or more developmental delay had lower z scores for all growth measures compared to those with no developmental delay.
- Anemia (hematocrit) was not associated with developmental functioning.
Conclusions & Clinical Implications: Poorer nutritional status, specifically physical growth, was associated with delays in motor, cognitive, and language development at the time of arrival in international adoptees. This was true for all areas of physical growth, including height, weight, and head size. The authors discuss this association in regard to previous studies on malnutrition in which malnutrition and environmental deprivation work together to delay development.
Limitations of the Nutritional Results: The authors discuss that the long-term effects of early malnutrition, specifically delayed growth, in international adoptees are unknown. This study did not address whether or not the developmental delays improved in children with lower physical growth z scores. 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, Kiernan MT, Mathers MI, Klein-Gitelman M. Developmental and nutritional status of internationally adopted children. Arch Pediatr Adolesc Med. 1995;149(1): 40-44. http://www.ncbi.nlm.nih.gov/pubmed/7827658