Study Compares Outcomes of Guatemalan Adoptees Cared for in Foster Care and Orphanages
By Mary Allen Staat, MD, MPH
A study from the International Adoption Clinic at the Floating Hospital for Children in Boston is the first to examine the outcomes of children adopted from Guatemala. The authors assessed the health, growth and developmental status of 103 Guatemalan adoptees and compared children cared for in orphanages to those in foster care. Overall, most children did well developmentally (80 to 92% of expected performance) but 14% did have global delays. As expected, children in foster care had both better growth measurements and cognitive skills compared to those from orphanages. These assessments appear to have been done upon arrival to the US so it is unclear whether these delays persisted.
The prevalence of infectious diseases was much lower in this study compared to other studies and what we have seen in our clinic population. Intestinal parasites were found in 8% of children and latent tuberculosis was seen in only 7% of adoptees. The specific methods for testing were not outlined. For example, it is unclear how many children were tested and whether more than one stool specimen was examined. Testing more than one stool is known to increase the yield of identifying intestinal parasites. For tuberculin skin testing, it is also unclear how many children were tested, if younger children were excluded and whether a health care professional read the tuberculin skin test result. With regard to infectious diseases, there were no differences seen in children adopted from foster care versus those from orphanages.
The group also assessed the children for signs of fetal alcohol syndrome noting that the criteria used for assessing facial features has not been standardized in Guatemalan children. None of the children had information available about prenatal exposure to alcohol. Of the 67 children examined the authors categorized 28% of the children to have findings suggestive of prenatal alcohol exposure. In most cases, the physical findings of a smooth philtrum and diminished upper lip fullness supported the diagnosis. There was no significant difference in prenatal alcohol exposure findings in children who resided in orphanages compared to those in foster care.
The authors concluded that children in foster care had better outcomes than children in orphanages and recommended that a concerted effort should be made to promote early placement of children who are identified for international adoption.
There are several limitations to this study. Most notable is that the sample size of the study was very small. Only 25 children from orphanages and 25 from foster care were available for the comparison study. It is also difficult to know how representative these children were of all Guatemalan adoptees. Were these children older? Were they from specific agencies or orphanages? It is important to know how these characteristics compare to all Guatemalan adoptees in order to understand how generalizable the results might be. Another concern is that methods used for several areas of study were not available making it difficult to compare results to other studies and to understand the results. Lastly, given the various heritages of the Guatemalan population and the lack of standardization of facial features for prenatal alcohol exposure the estimate given for prenatal alcohol exposure should be taken with caution. Regardless of the limitations of the study, this is important initial information on the health status of Guatemalan adoptees and will provide a benchmark to those providing care for these children.
Miller L, Chan W, Comfort K, Tirella L. Health of children adopted from Guatemala: comparison of orphanage and foster care. Pediatrics 2005;115:e710-e717.
URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-2359
