TY - JOUR
T1 - Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care
AU - Johnson, Dana E.
AU - Guthrie, Donald
AU - Smyke, Anna T.
AU - Koga, Sebastian F.
AU - Fox, Nathan A.
AU - Zeanah, Charles H.
AU - Nelson, Charles A.
PY - 2010/6
Y1 - 2010/6
N2 - 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 care-giving 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. Trial Registration: clinicaltrials.gov Identifier: NCT00747396
AB - 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 care-giving 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. Trial Registration: clinicaltrials.gov Identifier: NCT00747396
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U2 - 10.1001/archpediatrics.2010.56
DO - 10.1001/archpediatrics.2010.56
M3 - Article
C2 - 20368481
AN - SCOPUS:77953303333
SN - 1072-4710
VL - 164
SP - 507
EP - 516
JO - Archives of Pediatrics and Adolescent Medicine
JF - Archives of Pediatrics and Adolescent Medicine
IS - 6
ER -