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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' length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children'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.

Economic growth and poverty reduction are not always sufficient to improve child health and nutritional status.Heifer Internationalpromotes livestock introduction and related training for community development and poverty alleviation. These programmes do not directly address child health or nutrition. To determine effects of its activities on these important outcomes,Heiferconducted a 4-year longitudinal investigation in rural Nepal. The intervention was associated with significantly improved child anthropometry (related to the duration of intervention exposure) and child health.Heiferactivities represent a viable ‘nutrition sensitive’ intervention, but these impacts take time to manifest and be sustained. [ABSTRACT FROM PUBLISHER]

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;Mage = 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) andself-emphasis.Drawing features moderately correlated with CBCL subscales (emotion,boundaries, drawing composite: rrange = −.43 to 0.31, allp < .05) and parental adoption satisfaction (boundaries:r = .42,p< .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. [ABSTRACT FROM AUTHOR]