Search

Poor diet quality (diet diversity and animal‐source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school‐age children compared to children <5 years of age, especially in low/middle‐income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school‐age children is needed. A 36‐month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school‐age children (5–8 years at baseline) in these households; the present study analysed findings in the cohort of school‐age children seen at all five study visits (n = 341). Diet quality improved more in the full package school‐age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z‐scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi‐sectoral community development intervention was associated with improvements in diet and growth of school‐age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school‐age children can be favourably influenced by community‐level interventions, even indirectly. Key messages: Relatively less is known about the factors that influence diet quality and growth in school‐age children compared to younger children, especially in low‐ and middle‐income countries.Better diet quality and growth were found among school‐age children whose families participated in an impact study multi‐sectoral intervention compared to children in control families or those whose families only received nutrition training.Diet and growth of school‐age children can be favourably influenced by community‐level interventions. [ABSTRACT FROM AUTHOR]

Background: Little is known about bullying experienced by internationally adopted teens residing in Europe. Objectives: Within the framework of an international research effort involving several European countries, the main goal of this study was to explore the experiences of bullying victimization suffered by adopted adolescents, as well as its impact on their psychological adjustment. Methods: The sample consisted of 199 adolescents born in Eastern European countries and adopted in France (n = 50), Italy (n = 59), Norway (n = 25) and Spain (n = 65). Results: More than half of the adopted adolescents had been exposed to some form of peer victimization in the previous 2 months, with verbal harassment and social exclusion being the most common forms of victimization. Differences between receiving countries were not statistically significant, suggesting a common pattern for Eastern European adopted adolescents living in Western Europe. More frequent experiences of peer victimization were associated with more psychological difficulties among the adopted adolescents. Conclusions: Findings highlight that adopted adolescents might have considerable difficulties in social integration with peers; these experiences of peer victimization might play an important role hindering their psychosocial adjustment. The socioemotional development of adopted people is not only linked to their pre‐adoptive experiences; factors in their daily lives (i.e., peer relationships) may also be associated with their psychological adjustment later in life. Interventions are needed to promote the real inclusion of these groups of children in their social and educational contexts. [ABSTRACT FROM AUTHOR]

Intercountry adoptees (ICAs) face life-long challenges within their ecological contexts that warrant exploration. Adoptees' visible adoptions make them susceptible to microaggressions. This study examined the relation between racial and adoption microaggressions (RMAs, AMAs) and youths' belonging-to-family among 98 French intercountry adopted adolescents. Moderators of this relation were also explored (visibility, identity connections to country-of-origin or adoption, and parent-adoptee communication challenges). More RMA experiences were correlated with weaker belonging-to-family; logistic regression analyses revealed that stronger identity connections to country-of-origin exacerbated this correlation. The nature of these microaggressions was similar to those noted in previous studies on ICAs. [ABSTRACT FROM AUTHOR]

Many of the >339,000 international adoptees arriving in the USA during the last 25 years are now teenagers and young adults (YA). Information about their long-term social integration, school performance, and self-esteem is incomplete. Moreover, the relation of these outcomes to facets of family function is incompletely understood. We hypothesised that growth, development, and health at arrival would predict the social and academic success of YA adoptees, and that family flexibility would correlate with more favourable outcomes for family and teen. Arrival records of 88 international adoptees aged 15-25 years were reviewed. Adoptees and their parents completed a series of standardised questionnaires. Results showed that self-esteem was good, although 15% were anxious or unhappy. Family stress varied widely and was higher for families with adopted sons. Adoption satisfaction varied, and correlated to family coping skills, inversely to family stress, but not to age, development, behaviour, growth at arrival, gender, or to parental experience. Generally, family flexibility corresponded to more favourable outcomes.

No comprehensive studies have examined the utility of family drawings within the context of international adoption. We examined the relationship of Kinetic Family Drawings by 54 internationally adopted children in the USA (65% female; M age = 8.57 years, SD = 2.1) to demographics, child competencies (Child Behavior Checklist: CBCL/6-18) and parental adoption satisfaction (Adoption Satisfaction Questionnaire: ASQ). Two raters independently scored drawings for: "emotion" (positive, neutral and negative), "boundaries" (unifying and dividing), "family composition" (inclusion of family members), "interactivity" (active or passive) and "self-emphasis." Drawing features moderately correlated with CBCL subscales ("emotion," "boundaries," "drawing composite": r range = -0.43 to 0.31, all p < 0.05) and parental adoption satisfaction ("boundaries": r = 0.42, p < 0.01). Significant drawing differences were also observed by gender, time since adoption, orphanage care and adoption visibility. These findings support the utility of family drawings as an informative, supplemental tool highlighting concerns related to children's pre- and post-adoption experiences, and their impact on family function.

Emotional well-being of child care providers is important to the welfare of their young charges. Elevated depression and job-related stress may affect caregivers' ability to establish empathic connections with children. This study examined work conditions, job-related stress, and depression in 51 orphanage workers and 69 preschool teachers in Ukraine. Clinically significant levels of depressive symptoms were found in both groups. Hierarchical regression analyses showed that higher levels of perceived job resources and vacation use predicted lower depression. Predictors of perceived job resources included depression, perceived job control, and proportion of children between ages 2 and 3 in the group. A moderating effect of cognitive coping on the relationship between job control and job resources was found. This article informs interventions to promote positive development of children by identifying several factors that appear to reduce caregiver stress and depression.

Background: Children, especially disadvantaged children in poor countries, were expected to be among the "biggest victims" of the Covid pandemic. Economic burdens, decreased nutritious foods, reduced medical care, school closures, and ill‐health or death of family members were predicted to increase child undernutrition and developmental delays, and diminish home child‐rearing quality. Methods: A planned nutrition intervention could not be implemented due to Covid restrictions. However, three surveys (pre‐Covid [December 2019], July 2021, and September 2021) in 280 Nepali households (309 parent‐dyads, 368 children, 6–66 months old) collected demographics, child anthropometry and development (Ages and Stages Questionnaire‐3 [ASQ‐3]), and home child‐rearing quality (caregiver engagement, learning resources, adult supervision [UNICEF's Multiple Indicator Cluster Survey]). Mixed‐effect regression models adjusted for household (wealth, maternal education) and child factors (age, gender) and survey round. Results: Height, mid‐upper‐arm circumference, and head circumference measurements improved over time. The total ASQ‐3 score did not change: Communication scores increased while fine motor and personal‐social scores declined. Girls' growth and development worsened more than boys. Caregiver engagement (especially mothers') generally declined, but learning resource availability increased. More children were left unsupervised at Round 2 than Round 1 or 3. Conclusions: In this sample, some aspects of child growth, development, and home child‐rearing quality improved while others declined. Better understanding of these changes in child well‐being and the family environment during the pandemic could provide insight on how to protect children during future crises. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe reflections of nine American parents on the strengths, challenges, and strategies in parenting young children newly adopted from another country. Eight mothers and one father with an adopted child aged less than 3 years and home for less than 3 months completed standardized assessments measuring the child's social emotional development, sensory processing, and parental stress. Each parent participated in qualitative interview to discuss challenges and strategies helpful in addressing their children's needs. All parents reported challenges addressing their child's needs in the areas of sleep, feeding, attachment and self-regulation, and soothing. Parents reported similar strategies to address their child's behavioral concerns. Parents also reported on family factors and community resources that supported the success of the adoption. Although many families described their adoptive child as having challenges with multiple daily life activities, parents reported being able to create effective strategies to address many of these challenging behaviors. (Contains 4 tables.)

Many newly arrived international adoptees (IA) have difficulties with eating, sleeping, and self-soothing/self-stimulating (SS) behaviors. However, to date the prevalence of these problems and associated risk factors have not been clearly identified. Therefore, we proposed to evaluate 387 IA for the presence of these self-regulation and behavioral difficulties, and examined the relationships between these behaviors and pre-adoptive risk factors including growth measures, orphanage care, age at arrival and presence of medical complications. Data on participants were collected in a retrospective chart review and entered into a standardized data collection sheet by a trained research assistant. This exploratory study included 133 M and 254 F with an average age (M = 16) months at the time of the study. Children in the study represented adoptees from seventeen countries. Forty-nine per cent (49%) of the retrospective sample exhibited SS behaviors, 48% had sleep disturbances, and 34% had eating issues. Many had difficulties in more than one area. Country of origin, pre-adoption residence, and arrival nutritional status all related to the presence of these problems. Hence, self-regulation difficulties are common but both the course and influence of those behaviors on family functioning remains unknown. (Contains 3 tables and 1 figure.)

Most international adoptees (IA) have rapid catch-up of the delays common at arrival. However, it is not known whether development at arrival predicts later abilities or school readiness. Therefore, we comprehensively evaluated language, fine motor, visual reception (VR), executive function (EF), attention (ATT), and sensory skills (SS) in IA preschoolers. We hypothesized that pre-adoptive risk factors, development at arrival, and the post-adoptive environment (time in day care) would predict developmental and behavioral outcomes and school readiness. 37 IA (12M:25F), currently age 4-5 years and previously seen in our clinic (mean arrival age 12 months), were evaluated with standardized tests of development, language, EF, ATT, and SS, along with demographic information, parent interview, and review of arrival clinic records. Fine motor and VR skills at arrival ranged from average to very below average. At followup, most IA were average or above average in fine motor, VR, and language skills, but many had concerning scores for ATT (42%), EF (11%) and SS (48%). Arrival expressive language "T" scores (Mullen) predicted follow-up scores for expressive language (PLS-4, r = 0.44, p = 0.005). Arrival fine motor scores (Mullen) correlated with follow-up auditory comprehension scores (PLS-4, r = 0.47, p = 0.002) and inversely with inattention scores (Conners', r = -0.48, p = 0.003). Arrival visual reception scores correlated inversely with global measures of attention (Conners' opposition r = -0.45, p = 0.005, ADHD scores r = -0.49, p = 0.002, and to a lesser extent hyperactivity r = -0.35, p = 0.03). Age at arrival was a very strong predictor of many of the outcome measures tested, including language performance, attention regulation, executive function, and sensory processing. Children who spent more time in daycare had significantly more difficulty with emotional control (p = 0.005). Although IA have good catch-up in specific areas of development, difficulties with ATT regulation, EF, and sensory processing may increase the risk of later school problems.

More than 230,000 children have been adopted from other countries by American parents since 1989, including more than 72,000 from Eastern Europe. Many arrive with growth and development delays, and medical problems. Yet, little is known about the long-term outcomes for these children. Therefore, we assessed long-term developmental, neurobehavioral, and educational performance outcomes in a group of adopted 8- to 12-year-old children from Eastern Europe. A parent questionnaire was mailed to families of school-age Eastern European adopted children who had been in the United States for two years or more. Of the 81 children (33M: 48F) described in the returned surveys, 84 percent were 3 years old or older at adoption. Sixty-one percent of the children received special education services, and 32 percent received occupational therapy. Fifty-two percent had language disorders, 38 percent had attentional problems, and 36 percent had learning disabilities. Thirty-five percent had multiple neurodevelopmental diagnosis. Thirty-two percent of the children had post-traumatic stress disorder; these children were older at adoption than those without this problem (p = 0.04). Anxiety and depression each occurred in 19 percent of children; 66 percent of those with depression also had anxiety (p = 0.0001). Most children attended school willingly (70 percent), had a best friend (63 percent), and got along their parents (75 percent). Although nearly two-thirds of the internationally adopted children received special education services and 35 percent had multiple neurodevelopmental disorders, most children displayed remarkable social, peer, and family integration skills. (Contains 5 figures.)

Early-childhood development (ECD) is an important determinant of a child's cognitive ability, learning, productivity, and lifetime earnings. Animal-sourced food (ASF), which is a rich source of high-quality protein and micronutrients, has been linked with ECD outcomes. This study investigates the relationship between the number, frequency, and cumulative consumption of ASF at 6, 9, 12, and 18 months of age and ECD outcomes at 24 months of age, controlling for physical growth. The study uses data collected from 701 mother–child pairs from an observational birth cohort study carried out in Banke, Nepal. ECD outcomes were assessed through a standardized ages and stages questionnaire (ASQ-3) tool. Separate multivariable ordinary least squares regression models were used to test for associations. Significant positive association was seen between total ASQ-3 score at 24 months of age and any ASF consumption at 18 months (β = 8.98, p-value < 0.01), controlling for growth outcomes. The study findings highlight the positive contribution and the accumulating benefit of consistent ASF consumption on ECD outcomes. This study recommends support and promotion of ASF intake among young children in Nepal through policy and programming actions relevant to female education; nutrition knowledge; quality ASF production; improved market access; cold storage; and poverty reduction. [ABSTRACT FROM AUTHOR]

The economic and health crises related to the COVID-19 pandemic raised considerable concern about child and family diet, especially among small-holder farming households in low- and middle-income countries (LMIC). In rural Nepal, 309 families (including 368 children aged 6–66 months) were enrolled pre-COVID-19 in a prospective study of a nutrition education intervention and family milk consumption. The intervention could not be implemented due to COVID-19; however, child and family diet was assessed in three household surveys (one before and two during the pandemic). Over time, after adjusting for child and household factors, child and family diet quality declined (reduced diet diversity, consumption of milk and animal-source-foods (ASF)). However, in dairy-animal-owning (vs. non-dairy-animal-owning) households, both children and family were more likely to consume milk (aOR respectively 2.88× (p < 0.05), 5.81× (p < 0.001)). Similarly, in households producing >3.5 L/d milk (vs. ≤3.5 L/d), children and family members were more likely to consume milk (respectively 7.45× and 11.88× (both p < 0.001)). Thus, the overall decline in child and family diet quality, especially related to milk consumption, was buffered independently by household ownership of ≥1 dairy animals (cow or buffalo) and by milk production >3.5 L/day. A better understanding of these protective factors might facilitate the development of interventions to promote resilience in future crises. [ABSTRACT FROM AUTHOR]

Abstract. More than 230,000 children have been adopted from other countries by American parents since 1989, including more than 72,000 from Eastern Europe. Many arrive with growth and developmental delays, [...]

Maternal depression has been associated with adverse child growth and development; less is known about its relation to children's diet. In a cross‐sectional study embedded at endline of a longitudinal community development intervention, mothers of 629 children (age 23–66 months) in rural Nepal responded to household and children's diet questionnaires and were screened for depression. Child anthropometry and development (Ages and Stages Questionnaire) were assessed. Regression models examined children's diet, growth and development, adjusting for household, child and maternal characteristics. The prevalence of maternal depression was 21%. Maternal depression was associated with 11% lower likelihood that the child consumed one additional food group [Poisson regression, adjusted relative risk (aRR) 0.89, 95% confidence intervals (95% CI 0.81, 0.99), p = 0.024] and 13% lower likelihood that the child consumed one additional animal source food (ASF) [aRR 0.87, (95% CI 0.76, 1.01), p = 0.061] compared with children of nondepressed mothers. However, maternal depression was not associated with either child anthropometry or development: these outcomes were strongly associated with better home child‐rearing quality. Stunting also related to child age and intervention group; child development related to mother's education and household wealth. This study suggests a correlation between maternal depression and child dietary diversity. This association could be due to unmeasured confounders, and therefore, further research is warranted. Understanding the relationship of depression to child outcomes—and the role of other potentially compensatory household factors—could help address some of the earliest, modifiable influences in a child's life and contribute to innovative approaches to improve child well‐being. [ABSTRACT FROM AUTHOR]

American families who wish to adopt Romanian orphans should be aware that these children suffer from many physical, psychological and emotional disorders because of their prolonged stay in orphanages. Researchers who visited these orphanages after the fall of the Ceausescu regime found children living in appalling conditions with little human contact. A study of 65 Romanian children adopted by American families found that only 15% were physically and developmentally normal. Evidence of past or present hepatitis B infection was present in over half. One-third had intestinal parasites, most commonly Giardia. None were HIV-positive. In many, height, weight and head size had been compromised as a result of malnutrition. These children were most likely adopted because they were the most healthy children observed. Indeed, none had been found in the asylums for 'incurables'., Objective.--To determine the medical condition of Romanian adoptees and the effects of the Romanian orphanage system on their health. Design.--Case series. Setting.--The international adoption clinics at the University of Minnesota, Minneapolis, and the New England Medical Center, Tufts University, Boston, Mass. Participants.--Sixty-five Romanian adoptees who were brought to the United States during a 12-month period beginning in October 1990. Main Outcome Measures.--Incidence of hepatitis B, intestinal parasites, tuberculosis, syphilis, human immunodeficiency virus type 1, growth failure, and developmental delay. Results.--Although the adopted children were presumably chosen from the most vital and attractive adoptees, only 15% were judged to be physically healthy and developmentally normal. Fifty-three percent had serological evidence of past or present hepatitis B infection, and 20% of screened children tested positive for hepatitis B surface antigen. In children aged 7 months or older, the overall prevalence of chronic hepatitis B was 23%. Intestinal parasites were found in 33% of subjects, and 45% of infected children had two or more pathogens identified. All the children tested for human immunodeficiency virus type 1 were negative. Two patterns of growth failure were observed that resembled the two subtypes of psychosocial short stature that occur in association with prolonged psychological harassment or emotional deprivation. Infants&apos; length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children&apos;s height was reduced. Only 10% of children older than 12 months were developmentally normal. Conclusion.--Romanian adoptees are an extraordinarily high-risk pediatric group as a consequence of decades of government-sanctioned child neglect and abuse. (JAMA. 1992;268:3446-3451)

Aim: In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. Methods: Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. Results: Three hundred and fifty IACs [mean age: 3.4 years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety‐nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P <.001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P =.02), while SN children were more often microcephalic or underweight (respectively P =.03 and.02). Conclusion: The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow‐up. [ABSTRACT FROM AUTHOR]

Abstract Background Children with physical disabilities may have an increased risk for obesity and obesity might be a risk factor for inflammatory arthritis. The aims of this study were: to determine the prevalence of obesity in children and adolescents with juvenile idiopathic arthritis (JIA), and to examine the association between obesity and disease activity in this population. Findings A cross-sectional analysis of all patients with JIA attending a pediatric rheumatology clinic, between October 2009 and September 2010, was performed. A linear regression model was used to explore the association between obesity and disease activity in patients with JIA. A total of 154 subjects were included in the analysis; median age was 10.6 years, 61% were female, and 88% were white. Obesity was found in 18%, 12% were overweight, and 3% were underweight. There was no association between obesity and JADAS-27 (Juvenile Arthritis Disease Activity Score 27), physician's assessment of disease activity, parent's assessment of child's well-being, erythrocyte sedimentation rate, number of active joints, or C-reactive protein (p-value range 0.10 to 0.95). Conclusions Although 18% of patients with JIA were obese, we did not find an association between obesity and disease activity. As obesity confers an additional health risk in children with arthritis, addressing this co-morbidity should be a health priority in patients with JIA. Future studies are necessary to further explore potential associations between obesity, development of JIA, and disease activity.

The "second 1000 days" is a period of rapid brain growth which consolidates developmental foundations and establishes school readiness. Understanding the relation between household characteristics, child diet, and child development remains incomplete, especially in resource-poor settings where >250 million children risk not achieving their full developmental potential. Child developmental performance was assessed (Ages & Stages Questionnaire [ASQ]) at ages 2 and 5 years in a cohort of Nepali children (n = 207) whose families participated in a nutrition/livestock management+community development intervention trial. Relationships between child developmental performance and mother's education, family wealth, child diet (animal source food [ASF] consumption, dietary diversity score [DDS]), school attendance, and intervention group were examined by adjusted linear regressions. These relationships varied at the 2 ages. At age 2 years, ASQ scores related positively to "Full Package Intervention" and negatively to "Partial Package Intervention" membership. At age 5 years, intervention group did not relate to ASQ scores. Mother's education did not relate to developmental findings for 2-year-olds. Mother's education, wealth, and school attendance positively predicted ASQ scores for these same children as 5-year-olds. Animal source food consumption was related to child development more strongly at age 5 than at 2 years. DDS had a less pronounced relationship to development than ASF consumption at both ages. Over this time span bracketing the second 1000 days, household characteristics and child diet related differentially to developmental performance depending on child age. Better understanding of the timing and mechanisms of these relationships is needed to effectively design interventions targeting improved child development in resource-poor settings. [ABSTRACT FROM AUTHOR]