Among the requirements for optimal physical development during childhood are appropriate nutrition, protection from infectious diseases, adequate medical monitoring and interaction with a competent, dedicated caregiver dedicated to providing the safest and most nurturing environment possible. Children experiencing neglect and/or abuse either within families or within orphanages are deprived of many if not all of these needs due either to indifference, parent exhaustion from the challenges of surviving day-to-day, caregiving deficiencies within institutional settings or inadequate health and financial support.  Unfortunately, the burden of these harmful conditions may be superimposed on preexisting problems such as maternal illness and poor prenatal care that alone can compromise child well-being. Consequently, children entering family care from adverse care settings exhibit a wide range of medical problems, which can affect virtually every organ system (Table 1).

    Table 1

    • Hepatitis A, B and C

    • HIV

    • Syphilis

    • Intestinal parasites

    • Vitamin D, zinc, iron and iodine deficiencies

    • Lead, alcohol and illicit drug exposures

    • Inadequate immunizations

    • Poor oral health

    • Fractures

    • Hearing and vision impairments

    • Language delays

    • Undiagnosed and undertreated disabilities

    Physical growth, one of the most important and easily measured indicators of child health, is frequently impaired by family or institutional abuse/neglect. Length, weight, and head circumference are all diminished through complex and incompletely understood interactions between undernutrition, inflammation and lack of nurture. Nutrition, most often compromised by an inadequate diet can also be caused by failure to ingest the food that is offered due to deficient feeding techniques, e.g. bottle propping for infants, or severe apathy in under-nurtured children. Recurrent infections and consequent elevation of agents that promote inflammation aggravate nutritional deficiencies by impairing absorption and increasing energy expenditure as well as by suppressing bone growth.  Finally, lack of nurture, a stressful experience in early life, activates stress hormones, which, in combination with undernutrition and circulating inflammatory mediators disrupts the actions of growth hormone.  Failure to interrupt these interactions not only affects body and brain but may also increase the risk for future cardiovascular disease.

    The good news is that many of these problems can be corrected by placing a child into permanent family care.

    -Dana E. Johnson, Neonatologist

    Founder, International Adoption Clinic, University of Minnesota

    MD, University of Minnesota Medical School, Minneapolis, MN

    PhD, Anatomy, University of Minnesota, Minneapolis, MN

    Professor, Department of Pediatrics

    Residency in Pediatrics, University of Minnesota Medical School, Minneapolis, MN

    Fellowship in Neonatology, University of Minnesota Medical School, Minneapolis, MN