Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial

Abstract

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.

Keywords: child maltreatment; child neglect; early adversity; foster care; menarche; sex.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure 1.

Cohort derivation (CONSORT diagram).

Figure 2.

Fitted trajectories and observed means for height, weight, BMI, and head circumference z scores across foster care group and institutionalized group. Error bars are 95% CI for the actual means.

Figure 3.

Fitted trajectories for height and weight z scores from baseline to age 12 years among institutionalized group, foster care group, and ever institutionalized group with 2 or more and less than 2 disruptions in stable caregiving.

Figure 4.

Sum of Tanner genital/breast and pubic hair development for each sex and group at the time of the first and second surveys. Error bars are bootstrapped 95% CIs. *P < .05.

Figure 5.

Reported age of menarche by group.

Figure 6.

Sum of Tanner genital/breast and pubic hair development at the time of the first and second surveys by sex, group, and disruptions in stable caregiving between 30 months and 12 years of age (P < .05.