Malnutrition

By Jean Nelson-Erichsen and Heino R. Erichsen

Most children arriving in the United States from institutional care have mild caloric deprivation or mild to serious psychosocial dwarfism. Given love, nourishment, and medical care, they rapidly develop into normal little kids. Although the relationship of severe malnutrition in infancy and childhood to brain damage is a well established fact, seriously affected children are not typically selected for adoptions. Studies of severe malnutrition in infancy and childhood do show that children may experience persistent and permanent cognitive, behavioral, and social defects - the severity of the effects are impacted by the age of onset of malnutrition, the length of time of caloric deprivation, and other existing health conditions, such as premature birth and fetal alcohol syndrome (FAS). However, the damage of even severe malnutrition may be ameliorated by the age of rehabilitation (the younger the better), better social environments, and adequate educational support. Long-term studies of malnourished children show generally good outcomes, especially if the child is adopted before the age of three years. Prospective adoptive parents with concerns about the effects of malnutrition should visit with parents who have adopted foreign children who were once in this condition.

Many adopted children have phenomenal appetites and will eat whatever is presented to them. Some children will not know when to stop eating. They may gain weight initially, although their weight will level off as catch-up growth ensues and they begin growing taller. Serve them well balanced meals and snacks. A daily multi-vitamin tablet is also helpful. If the child shows no acceleration in growth, an underlying illness such as tuberculosis may be suspected.

U.S. pediatricians use the National Center for Health Statistics growth chart, which is also used by the World Health Organization. This chart indicates population standards divided into the fifth, tenth, twenty-fifth, fiftieth, seventy-fifth, ninetieth, and ninety-fifth percentiles. Ninety percent of the population should be covered by these charts. By plotting the child's growth, the doctor knows what percentile is normal for this child and can also see if the child's growth has slowed. In normal growth, the child's measurements follow along one of the percentile lines on the chart. If growth slows, the measurements cross percentile lines. The doctor can see if the child has recovered by plotting his or her return to normal. This system depends on taking repeated measurements in order to establish the normal patterns of growth.

Malnourished or neglected children, of course, do not have a normal growth pattern. Adoptive parents are usually very disappointed at their first appointment with a pediatrician because their child does not measure up to ideal U.S. standards. Upon placement in a nurturing adoptive home, however, the children's sizes change dramatically, due to the advent of “catch-up” growth. Catch-up growth may continue for years after placement. Your child's recovery from malnutrition is complete when height and weight are in proportion to each other, and the child is growing at a steady pace in a typical growth diagram.

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Jean Nelson-Erichsen and Heino R. Erichsen