Medical Resources :: Common Diseases :: Developmental Issues :: Growth in Children Adopted from Abroad

Malnutrition

• Poor prenatal care and prematurity
• Low Birth Weight (average BW 2500 grams in Russia considered LBW in U.S.)
• Undernutrition in orphanage
• Micronutrient deficiencies (iron[anemia], calcium and vitamin D [rickets], zinc[skin], iodine [hypothyroidism])
• Environmental toxins (lead, pollutants)

Feeding in Orphanages

• No formula, intermittent formula
• Formula mixed improperly (diluted)
• Milk products (Kefir) mixed with pureed foods in early infancy
• Bottle propping leads to underfeeding, choking, and aspiration
• Swift/forced feeds and no solids well into toddler years leads to oral aversion

Feeding and Emotions

• When a child is fed, emotional connections are made
• Eye contact between baby and caretaker promotes attachment
• Holding and support promotes attachment
• Security is established during feeding
• Love is provided during feeding

Malnutrition, Depression, and Immunosuppression

• Undernutrition can lead to immunosuppression (PCP in abandoned babies in nurseries in the 1940s)
• Malnutrition can lead to apathy, depression and immunosuppression
• Immunosuppression in orphanages puts children at increased risk for respiratory and gastrointestinal infections

Psychosocial Short Stature

• Growth failure secondary to emotional deprivation-can be transient or sustained depending on onset and chronicity
• Some children have actual growth hormone deficiency which normalizes when the child is in a new environment
• Infants and children may have failure to thrive (nutritional deficiency) as well

Failure to Thrive

• Length or weight, or both, < 5th%
• Length or weight rate not paralleling one of the percentile lines on a standard growth chart
• Weight less than 90% of the expected weight for measured length
• Actual weight loss regardless of length
• Use country specific charts if possible

Psychosocial Short Stature

• Some children who are failing to thrive are underweight for height and have growth deficiency
• Some children may not be underweight for height

Failure to Thrive in Udmurtia Republic

• Data on 151 children available
• nl wt/ ht <5th% 29/151 19%
• nl ht/wt <5th% 5/151 3%
• ht <5th%/wt <5th% 36/151 24%
• nl ht/nl wt 81/151 54%
• Failure to Thrive 46%

Recovery from Growth Failure

• Recovery with adequate calories and removal from the orphanage and placement in a loving environment (foster care or adoption) may be miraculous W
• ithout knowing the family history, (parents' heights) it is impossible to predict what a child's final potential for growth will be

Growth Failure in Orphanages

• Widdowson (1951)-two German orphanages run by two women of different personalities-see figure in Gardner, L.I. "Deprivation dwarfism". (1972)
• Loving care and attention are important to normal growth Spitz (1945, 1946)- "Hospitalism" and growth failure

Psychologic Manifestations of Psychosocial short stature

• Apathy, depression, passivity, attachment disorder, pain agnosia, bizarre eating habits, sleep disorders, lack of discrimination in relationships, self-destructive behavior can be part of sustained deprivation and psychosocial short stature

Psychological Manifestations of Failure to Thrive

• Gaze avoidance, decreased facial muscle activity, expressionless face, wide-eyed stare, visual fixations on hands, fingers, and small objects
• Decreased motor activity, clenched fists, obsessive hand, thumb, finger sucking, decreased vocalization and socialization
• Posturing away from the caretaker

Sleep Disorders and Growth Failure

• EEG abnormalities (Stage IV) and growth failure -Taylor & Brook (1986)
• Growth hormone deficiency and sleep disorders such as roaming and restlessness-Wolff & Money (1973)
• Normalized EEGs and sleep habits when the child is removed from the deprived environment

Growth in Orphanages

• Siret, Romania November 1997 Aronson
• 16 children examined and measured
• Age range 3 1/2 to 17 years
• Mean age 12 years
• nl wt and nl ht 8/16=50%
• nl wt and ht <5th% 1/16=6%
• ht <5th% and wt <5th% 7/16=44%

Head Circumference

• Head circumference in infancy correlates with brain growth
• Brain growth is rapid in utero and in the first two years of life
• Microcephaly is defined as head circumference <5th%
• Head size is generally universal (Nellhaus 1968)

Head Circumference Studies

• Siret, Romania November 1997 Aronson
• N=16, range 3 1/2 to 17 yrs, mean=12 yrs.
• 7 (44%) Head circumference <5th%, microcephalic

Head Circumference Studies

• Udmurtia Republic-Glasov, Izhevsk, Votkinsk Summer 1998 Stickney & Aronson
• Age range 2.5 months-54 months
• Mean age 20 months
• Head circumference <5th% 41% N=145

Catch-up Brain Growth in Children Adopted from Russia

• Retrospective chart review from Nov 1996 to Dec 1998 Aronson & Johnson
• 34 children evaluated-mean age at time of arrival was 13.2 months
• Mean age at follow-up was 26 months
• 67.6 % of the children increased their head size

Head Circumference Data

• 93 children evaluated from EE/FSU
• 33 (36%) were microcephalic on arrival
• 9 (27%) had catch-up growth in 6 months
• 0-1 month follow-up 3
• 1-3 months follow-up 4
• 3-6 months follow-up 2

Microcephaly

• Microcephaly is associated with prematurity, intrauterine infection, chronic intrauterine hypoxia, smoking, alcohol, drugs, poor
• prenatal care, craniosynostosis (rare)

Head circumference in premature infants

• It is essential to use special growth charts designed for children born prematurely
• It is very difficult to know how premature a child may have been in Russia
• Unknown gestational age is common
• Difficult to differentiate a baby who is premature from a baby who is "small for dates"

Growth and Mental Development.Galler & Ross 1996

• Type and Severity of malnutrition
• Timing of Malnutrition
• Duration of Malnutrition
• Intrinsic Factors-Some children may appear to have everything going against them and yet they survive and even escape the devastating effects of malnutrition

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