IV. Growth failure in institutionalized children
Open accessAbstract
Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone–insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any caregiving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.
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Knowledge is limited about how early institutionalization affects pubertal development, with studies reporting delays, accelerations, and no effects on various pubertal markers in boys and girls.
“Less is known about how early institutionalization influences pubertal development with reports of delays,16 accelerations,10,14,17,18 and null15,19 effects on various markers of pubertal development in boys and girls.”
Severe growth failure is a characteristic feature of institutional care in early childhood.
“Profound growth failure is a hallmark of institutional care in early childhood.10–12”
Many studies have shown short-term catch-up growth when children are moved to more nurturing environments.
“Many studies have documented catch-up growth over the short term in children placed in more nurturing environments,10–12”
Past studies reporting earlier puberty in girls were conducted in intercountry adoptees placed in Western Europe and the United States.
“Past studies reporting earlier puberty in girls were conducted in intercountry adoptees placed in Western Europe and the US.10,17,18”
Many studies have reported a higher rate of early pubertal development in children adopted out of adverse environments, especially girls.
“In contrast, in children adopted out of adverse environments such as institutional or foster care, many, though not all studies,15,19 have documented a higher rate of early pubertal development particularly in girls.10,17”
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Self-citationSlopen, N., Tang, A., Nelson, C. A., Zeanah, C. H., McDade, T. W., McLaughlin, K. A., & Fox, N. A. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000696 · Cited by 18 · see citing works
The epigenetic impacts of pubertal acceleration following early caregiver disruptions
Jopling, E., Drury, S. S., Fox, N. A., Zeanah, C. H., & Nelson, C. A. (2025) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2504216122 · Cited by 2
- Authors
- Johnson, D. E., & Gunnar, M. R.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Johnson, Dana E
- ORCID
- Gunnar, Megan R
- Venue
- Monographs of the Society for Research in Child Development
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-12
- Volume
- 76
- Issue
- 4
- Pages
- 92-126
- ISSN
- 0037-976X (ISSN-L)
- 1540-5834
- PMC
- PMC4214390
- OpenAlex
- W1813546283
- Cited by
- 110
- References
- 196
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 13 · 2019: 6 · 2018: 10 · 2017: 11 · 2016: 10 · 2015: 7 · 2014: 9 · 2013: 8 · 2012: 2
- FWCI
- 16.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Monographs of the Society for Research in Child Development (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. National Institute of Mental Health (080905, 078105, 079513)
- Topics
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- institutionalized children, growth hormone/insulin-like growth factor axis, catch-up growth, low birth weight, prenatal alcohol exposure, social deprivation, caregiver sensitivity, puberty timing, adult height, cognitive recovery, hypothalamic-pituitary-adrenal axis, micronutrient deficiency, metabolic syndrome, early childhood deprivation
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