Objectives
To determine the effects of foster care vs institutional care, as
well as disruptions in the caregiving environment on physical development
through early adolescence.
Study design
This was a randomized controlled trial of 114 institutionalized,
though otherwise healthy, children from 6 orphanages and 51 never
institutionalized control children living in birth families (family care
group) in Bucharest, Romania. Children were followed from baseline (21
months, range 5–31) through age 12 years for caregiving disruptions
and growth trajectories and through age 14 years for pubertal
development.
Results
Children randomized to the foster care group showed greater rates of
growth in height, weight, and body mass index (BMI) through age 12 years
than institutionalized group. Tanner development was delayed in
institutionalized group boys compared with foster care group and family care
group boys at 12 but not 14 years. There were no differences in Tanner
development and age of menarche among foster care group, institutionalized
group, and family care group girls at ages 12 and 14 years. More disruptions
in caregiving between 30 months and 12 years moderated decreases in growth
rates of height in foster care group and weight in foster care group and
institutionalized group across age. institutionalized group boys with
≥2 disruptions showed lower Tanner scores at age 12 vs
institutionalized group and foster care group boys with <2
disruptions. foster care group girls with ≥2 disruptions had higher
Tanner scores at age 14 vs foster care group girls with <2
disruptions. Age of menarche was not affected by caregiving disruptions.
Conclusions
For children who experienced early institutionalization, stable
placement within family care is essential to ensuring the best outcomes for
physical developmental.
Trial registration
clinicaltrials.gov: NCT00747396.