Growth failure in international adoptees

Psychosocial growth failure, represented by significant suppression of height, weight, and head circumference at the time of adoption, is highly prevalent in children who are adopted internationally. The effects of institutional deprivation are more profound in children with a higher baseline risk of growth impairment (low birth weight or high risk for prenatal alcohol exposure). Nutritional insufficiency and social deprivation both contribute to the etiology of psychosocial growth failure within institutional care settings. Their relative importance and the consequent clinical presentations relate to the age of the child, with inadequate nutrition contributing more in infancy and early childhood and depression of hypothalamic-pituitary-end organ function, particularly the GH-IGF-1 axis, becoming more important as children age. Both malnutrition and deprivation are associated with suppression of the GH-IGF-1 axis. Children who have experienced institutional care are at an increased risk of medical, developmental, and behavioral problems. Therefore, international adoptees should be carefully evaluated at the time of arrival into their new home country and followed closely as they make the transition to their new home environment. They should be monitored for adequate auxologic and neurocognitive catch-up over time. Children not making appropriate progress should be referred for specialty evaluation. Growth failure at the time of adoption, along with catch-up growth in height and weight, is a risk factor for early and/or more rapid progression through puberty in girls leading to a compromise in final height. There is also reason for concern that children with psychosocial growth failure may be at increased risk of developing metabolic syndrome. Even if growth recovers, persistent abnormalities of the endocrine system or the presence of micronutrient deficiencies during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Infants of low birth weight are particularly vulnerable to the effects of nutritional and social deprivation. This significant impact of psychosocial growth failure on low birth weight infants extends beyond the plight of institutionalized children to the millions of impoverished children worldwide. Psychosocial deprivation within any caregiving environment during early life is as detrimental as malnutrition and must be viewed with as much concern as any severely debilitating childhood disease.