Better nurture, better health

Loving care is key for helping socially deprived children catch up on their growth, a new study in Romanian children shows.

Social deprivation can stunt children's growth, but kids can catch up if they're moved to a more nurturing environment, Dr. Dana E. Johnson of the University of Minnesota in Minneapolis and his colleagues explain in their report.

The Bucharest Early Intervention Program, in which 136 healthy children living in orphanages were randomly assigned to foster families or to remain institutionalized, and compared over time to 72 healthy kids who'd never lived in an institution, allowed Johnson and his team to study this poorly understood phenomenon. (Because foster care was "exceedingly rare" in Romania when the study was launched, and all children would likely have stayed in orphanages otherwise, the researchers and the Romanian government decided that sending some children to orphanages was ethically sound.)

In the current report, Johnson and his team investigated whether the quality of care children received played a role in their growth and mental development. The children ranged in age from 5 to 32 months at the study's outset, and were followed up when they were 30, 42, and 54 months old.

The researchers rated caregiving quality at the beginning of the study and again at each follow-up appointment. Sensitivity, physical affection, warmth, respect and acceptance on caregivers' part were positives; detachment was a negative.

At the beginning of the study, institutionalized children's caregiver quality scores averaged around 2 on a scale from 1 to 4, "which is not a very good situation at all," Johnson told Reuters Health. While care quality in foster families tended to be better, he added, this wasn't always the case.

At the beginning of the study, the institutionalized children were significantly smaller than the never-institutionalized children; they were shorter, weighed less, and had smaller heads. The 63 children placed in foster care showed rapid growth in height and weight, and all were in the normal range for their height and weight within a year.

But growth didn't improve for the 62 children who remained institutionalized. (The researchers did not report specific heights, but standardized ranges of growth.)

Children who went into foster care before they were a year old showed the greatest increase in growth. And the better quality care a child received, the more his or her growth increased.

The findings show, Johnson said, that just giving children food isn't enough. "I think we've seen a lot of focus on 'Let's make sure kids get enough to eat,'" he added. "Getting enough to eat is a lot more than putting a box of food on a parent's table and saying 'here it is.'"

A lot of the early interactions between parent and child centers on food, Johnson pointed out, and parents and other caregivers need to make this interaction as nurturing as possible.

The findings also show, he added, that tracking a child's growth after foster care placement is a simple, inexpensive way to monitor the quality of the care they're getting. "If you don't see them growing and thriving, then there's something wrong with that foster care," he said.

What do you think qualifies as a nurturing environment?
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