Title of Paper: Self-regulation in newly arrived international adoptees
Type of Paper: Original Article; Medical Chart Review
Purpose: To document the prevalence of and risk factors for difficulties with eating, sleeping, and self-soothing behaviors in newly arrived internationally adopted children under the age of 3 years.
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores were calculated using CDC 2000 as a reference.
- Feeding and eating behaviors
Participants: 387 international adoptees from 17 countries between the ages of 3 and 36 months at arrival. The majority of children (87%) were adopted from China, Russia, Guatemala, and Kazakhstan. Prior to adoption, 59% resided in orphanage care, 15% in foster care only, 19% in mixed care (combination of orphanage, foster, and family care), and for 7%, pre-adoption care was unknown.
Methods: Chart review of medical examinations that had been completed in one international adoption clinic soon after arrival into the U. S. (86% of the children were seen within 2 months of arrival). During the medical evaluation, information regarding self-regulation behaviors was collected through standardized interviews with the adoptive parents.
- Physical growth:
- Average z scores were below the mean (i.e., z score of 0). Average z scores were:
- Height for age (HAZ): -0. 74 (range: -4. 0 to 2. 5)
- Weight for age (WAZ): -1. 17 (range: -4. 5 to 3. 0)
- Head circumference for age (OFCZ): 0. 80 (range: -4. 0 to 2. 5)
- 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): 13%
- WAZ (underweight): 27%
- OFCZ [microcephalic (small head circumference)]: 14%
- Feeding and eating behaviors:
- 35% had at least one eating issue. Prevalence of eating issues were:
- Food intolerances (food consistency delays, accepts limited food variety): 23%
- Food anxieties (ravenous/insatiable, stuffs food in cheeks, hoards or hides food): 15%
- Ravenous/insatiable appetite was the most common food anxiety: 12%
- Other feeding problems (delayed feeding skills, weak muscles of mastication): 8%
- Children with eating problems had lower weight z scores.
- Ravenous appetite was associated with being home for less time.
Conclusions & Clinical Implications: More than one-third of newly arrived international adoptees had difficulties with eating behaviors as reported by their parents. The most common eating disturbances were related to food anxieties or the inability to tolerate certain foods. Lower weight z scores were associated with eating behaviors. A ravenous/insatiable appetite may be expected in children who have experienced food insecurity, and these behaviors seemed to subside the longer children were in their new homes. The authors speculate that the food intolerances are likely due to the soft and bland food provided in typical orphanage diets. Newly adopted children then have a difficult time transitioning to more flavorful and textured foods in their new adoptive homes. These children may also experience oral defensiveness due to little opportunity for oral exploration while in the orphanages.
Limitations of the Nutritional Results: The eating behaviors in this study relied on parent report and their perceived eating problems. Parents may have either under- or over-reported eating issues. The inclusion of a comparison group of non-internationally adopted families who received the same standardized interview would be helpful in determining whether the prevalence of these eating behaviors is typical for children in this age range. The authors recognize that follow-up studies will be helpful in understanding whether these eating behaviors persist over time and whether early intervention is needed.
Reference: Tirella LG, Miller LC. Self-regulation in newly arrived international adoptees. Physical & Occupational Therapy in Pediatrics. 2011; 31 (3): 301-314. http://www.ncbi.nlm.nih.gov/pubmed/21391835