Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care
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OBJECTIVES: To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development. DESIGN: A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age. SETTING: Institutionalized and community children in Bucharest, Romania. PARTICIPANTS: One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children. INTERVENTION: Institutionalized children were randomly assigned to receive foster care or institutional care as usual. OUTCOME MEASURES: Auxology and measures of intelligence over time. RESULTS: Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05). CONCLUSIONS: Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.
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In a follow-up study extending to 54 months, only those in the FCG showed substantial growth in both height and weight, and all FCG participants were within the normal range of growth trajectories 12 months after randomization.
“In a follow-up study extending to 54 months, only those in the FCG showed substantial growth in both height and weight, and all FCG participants were within the normal range of growth trajectories 12 months after randomization (Johnson et al., 2010).”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Johnson et al., 2010
The Results (Post-Randomization Growth) report substantial gains in height and weight in the foster-care group (FCG), but also a small improvement in weight in the care-as-usual group. At 12 months, all FCG children were in the normal range for height, but only 90% were in the normal range for weight. The paper reports cognitive outcomes at 54 months; its growth analysis extends to 42 months of age, not 54 months. (LLM, conf=0.91)
Experimental — accuracy not yet measuredFoster care intervention was associated with moderate to strong improvements in physical growth (height, weight, BMI).
“Moderate to strong improvements in physical growth; moderate improvements in stress responses”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Johnson et al., 2010
The Post-Randomization Growth results report significant improvements in height and weight z-scores in the foster-care group, while children receiving ongoing institutional care showed no improvement. The Methods list weight-for-height, not BMI, as the third growth measure; the claim’s specific attribution of BMI improvement is therefore unsupported. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFoster care placement before 24 months of age has been associated with better child and adolescent outcomes (e.g., cognition, brain function, attachment, physical growth) compared to placement after 24 months of age.
“Foster care placement before 24 months of age has been associated with better child and adolescent outcomes (e.g., cognition, brain function, attachment, physical growth) compared to placement after 24 months of age (Johnson et al., 2010;Nelson et al., 2007;Smyke et al., 2010;Vanderwert et al., 2016).”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Johnson et al., 2010
The Discussion reports a sensitive period before 24 months for cognitive recovery, attachment behavior, and EEG improvement, while this study finds an earlier threshold—before 12 months—for growth recovery. The paper reports outcomes in young children, not adolescents, so it does not support the claim's adolescent scope. (LLM, conf=0.89)
Experimental — accuracy not yet measuredEarly institutionalization is most strongly linked to delayed physical growth, smaller brains, and lower scores on cognition tests.
“Decades of research have shown that early institutionalization is most strongly linked to delayed physical growth (e.g., height and weight) (Johnson et al., 2010), smaller brains (Nelson et al., 2007;Sheridan et al., 2012), and lower scores on cognition tests (Bos et al., 2009;Smyke et al., 2007;Van IJzendoorn et al., 2020).”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Johnson et al., 2010
Once in a family, previously institutionalized children show steep improvements across domains, including weight, head circumference, and cognitive testing during childhood and adolescence.
“Once in a family, children have demonstrated steep improvements across domains (Johnson, et al., 2010; Van Ijzendoorn, Bakermans-Kranenburg, & Juffer, 2007), including weight and head circumference (Rutter & O’Connor, 2004), as well as showing evidence during childhood and adolescence of improvement on cognitive testing (Beckett, et al., 2006; Fox, Almas, Degnan, Nelson, & Zeanah, 2011; van den D”
From Risk and developmental heterogeneity in previously institutionalized children (2012) · cites this paper as Johnson, et al., 2010
Children with a history of early psychosocial deprivation have smaller volume of the superior-posterior cerebellar lobes, and superior-posterior lobe volume mediates neuropsychological test performance differences between groups of postinstitutionalized versus typically developing children, with larger volumes yielding better outcomes on tests of memory and planning.
“Notably, children with a history of early psychosocial deprivation have smaller volume of the superior-posterior cerebellar lobes, and superior-posterior lobe volume mediates neuropsychological test performance differences between groups of postinstitutionalized versus typically developing children, with larger volumes yielding better outcomes on tests of memory and planning.37”
From Motor outcomes in children exposed to early psychosocial deprivation (2014) · cites this paper as [37]
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- Authors
- Johnson, D. E., Guthrie, D., Smyke, A. T., Koga, S. F., Fox, N. A., Zeanah, C. H., & Nelson, C. A.
- Affiliations
- University of Minnesota (US)
- Tulane University (US)
- Venue
- Archives of Pediatrics & Adolescent Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2010-06-01
- Volume
- 164
- Issue
- 6
- Pages
- 507-16
- ISSN
- 1072-4710 (ISSN-L)
- PMC
- PMC4126580
- OpenAlex
- W2153358224
- Cited by
- 145
- References
- 62
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 10 · 2019: 13 · 2018: 11 · 2017: 14 · 2016: 9 · 2015: 13 · 2014: 13 · 2013: 9 · 2012: 12
- FWCI
- 27.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- foster care, institutional care, orphans, social deprivation, child growth, catch-up growth, height, weight, head circumference, cognitive development, intelligence quotient, verbal IQ, caregiver sensitivity, caregiving quality, low birth weight
- MeSH terms
- Anthropometry, Child, Institutionalized, Child, Preschool, Cognition, Female, Follow-Up Studies, Foster Home Care, Growth Disorders, Humans, Infant, Male, Romania, Social Isolation, Caregivers, Orphanages
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