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Cited by 142Child Welfare and AdoptionChild and Adolescent HealthChild Nutrition and Water Access

Health of children adopted from Guatemala: comparison of orphanage and foster care

Miller, Laurie, Chan, Wilma, Comfort, Kathleen, Tirella, Linda·2005·PEDIATRICS
DOI 10.1542/peds.2004-2359
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Abstract

OBJECTIVE: Since 1986, American parents have adopted >17300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed. METHODS: Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 +/- 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption. RESULTS: Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, -1.00, -1.04, and -1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80-92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure. CONCLUSIONS: Guatemalan adoptees display similar overall patterns of growth and developmental delays as seen in other groups of internationally adopted children, although not as severe. Younger children had better growth and development (cognition, language, and activities of daily living skills) than older children, regardless of location of residence before adoption. Among children who were matched for age, gender, and interval from adoption to evaluation, those who had resided in foster care had better growth and cognitive scores than children who had resided in orphanages before adoption. These findings support the need for timely adoptive placement of young infants and support the placement of children in attentive foster care rather than orphanages when feasible.

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Crossref · 10.1542/peds.2004-2359

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  • Previously published data on motor development in populations of institutionalized and previously institutionalized children found that motor development is affected significantly by institutionalization.

    “Previously published data on motor development in populations of institutionalized and previously institutionalized children found that motor development is affected significantly by institutionalization.”

    From Motor outcomes in children exposed to early psychosocial deprivation (2014) · cites this paper as [18]

  • Among children living in Romanian institutions who did not have overt neurological disabilities, the mean percentile rank was <6% for both gross motor and fine motor skills among children tested at a mean of 2.4-2.6 years of age.

    “Among children living in Romanian institutions who did not have overt neurological disabilities, the mean percentile rank was <6% for both gross motor and fine motor skills among children tested at a mean of 2.4–2.6 years of age.18”

    From Motor outcomes in children exposed to early psychosocial deprivation (2014) · cites this paper as [18]

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Authors
Miller, L., Chan, W., Comfort, K., & Tirella, L.
Affiliations
Tufts Medical Center (US)
ORCID
Miller, Laurie
Venue
PEDIATRICS
Publisher
American Academy of Pediatrics (AAP)
Published
2005-06-01
Volume
115
Issue
6
Pages
e710-e717
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2004-2359
OpenAlex
W2132500580
Cited by
142
References
50
Citations by year
2026: 2 · 2025: 4 · 2023: 1 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 7 · 2018: 2 · 2017: 10 · 2016: 7 · 2015: 6 · 2014: 11 · 2013: 13 · 2012: 11
FWCI
4.62
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
international adoption, orphanage care, foster care, child growth, developmental delay, prenatal alcohol exposure, latent tuberculosis infection, intestinal parasites, anemia, lead exposure, congenital malformations, age at arrival, developmental assessment
MeSH terms
Congenital Abnormalities, Adoption, Anemia, Hypochromic, Body Height, Body Weight, Cephalometry, Child Care, Developmental Disabilities, Child, Institutionalized, Child, Preschool, Female, Foster Home Care, Guatemala, Humans, Infant, Infections, Intestinal Diseases, Parasitic, Male, Medical Records, Retrospective Studies, United States, Vaccination, Comorbidity, Case-Control Studies, Orphanages

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