Study Location: Murmansk Region, Russia
Type of Paper: Original Article; Medical Chart Review
Purpose: To describe the health of young children living in Russian orphanages
- Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores were calculated using the World Health Organization standards.
- Medical chart review
Participants: 193 children living in three baby homes in the Murmansk region of Russia who were between 2 and 72 months of age (average age was 22. 8 months; 90% were younger than 40 months). Children had entered the baby homes at various ages, from birth to 72 months (average was 11 months). This study included all the children in the baby homes except for those with special needs.
Methods: Review of the medical charts at the orphanage. Physical growth measurements were available for birth, entry into the baby home, and current. Orphanage staff were trained in obtaining growth measures.
- Physical growth: The following number of children were below -2 z scores for growth (-2 z scores is equivalent to approximately the 5th percentile):
- Underweight: 17%
- Microcephalic (small head size): 19%
- Entry into orphanage: Physical growth worsened between birth and entry into the baby homes.
- Underweight: 34%
- Short stature: 25%
- Microcephalic (small head size): 34%
- Current: Height decreased significantly from entry into the orphanage to the current measurements, whereas head size improved.
- Underweight: 38%
- Short stature: 29%
- Microcephalic (small head size): 28%
- In children born full-term, growth delays increased during early infancy (<18 months of age) while in institutional care. By 18 months, 40% were underweight and had short stature. As children got older, the prevalence of growth delays decreased (especially for weight and head size).
- In children with growth delays (≤ -2 z scores) at entry into the orphanage, many growth delays improved. Specifically, children with more impaired growth at entry had more rapid growth, especially for head circumference. More than 40% improved in height and weight, and 62% improved in head circumference. However, in others, growth delays worsened, 27% in weight, 15% in height, and 14% in head circumference.
- Other nutrition-related history and diagnoses: Small for gestational age (22%), premature delivery (17%), rickets (21%), and anemia (6%).
Conclusions & Clinical Implications: Many children had growth delays both before and during institutionalization. Some children who were growth impaired prior to entry into the orphanage experienced catch-up growth, particularly in head circumference, while in the orphanage. These findings suggest that the baby homes may be an improvement in environments for some children coming from hospitalization or dysfunctional family environments. However, growth recovery is likely not complete as most children remained below average for growth. In addition to delayed growth, low birth weight, premature birth, rickets, and anemia were reported.
Limitations of the Nutritional Results: The authors do not discuss the accuracy of the children’s medical history regarding birth history and nutritional diagnoses such as rickets and anemia.
Reference: Miller LC, Chan W, Litvinova A, Rubin A, Tirella L, Cermak S. Medical diagnoses and growth of children residing in Russian orphanages. Acta Pædiatrica. 2007; 96 (12): 1765-1769. http://www.ncbi.nlm.nih.gov/pubmed/17971188