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Plasticity of Growth in Height, Weight, and Head Circumference: Meta-analytic Evidence of Massive Catch-up After International Adoption

Van IJzendoorn, Marinus H. PhD; Bakermans-Kranenburg, Marian J. PhD; Juffer, Femmie PhD

Journal of Developmental & Behavioral Pediatrics: August 2007 - Volume 28 - Issue 4 - p 334-343
doi: 10.1097/DBP.0b013e31811320aa
Review Article

Are serious growth delays caused by malnutrition and neglect permanent or reversible? The effects of institutionalization and international adoption on children's physical growth are estimated with meta-analysis. Studies with sufficient data to compute differences between adoptees and the reference population (33 papers with 122 study outcomes) were collected through Web of Science, ERIC (Education Resource Information Center), PsycINFO (Psychological Literature), and Medline (U.S. National Library of Medicine) (1956–2006). The influence of pre- and postadoption care on height, weight, and head circumference was tested. Effect sizes (d) and confidence intervals (CIs) around the point estimate for the growth lag indices were computed. The more time spent in institutional care, the more the children lagged behind in physical growth (d = 1.71, 95% CI: 0.82–2.60, n = 893). At adoptive placement, the children showed large delays in height, weight, and head circumference (d = −2.39 to −2.60; n = 1331–3753). Although after adoption, they showed almost complete catch-up of height (d = −0.57, 95% CI: −0.87 to −0.27, n = 3437 adoptees) and weight (d = −0.72, 95% CI: −1.04 to −0,39, n = 3259 adoptees), catch-up of head circumference seemed slower and remained incomplete (d = −1.56, 95% CI: −2.27 to −0.85, n = 527). Later age at arrival was related to less complete catch-up of height and weight. International adoption leads to substantial catch-up of height and weight but not of head circumference, demonstrating differential plasticity of children's physical growth.

From the Centre for Child and Family Studies, Leiden University, Leiden, The Netherlands.

The Adoption Meta-Analysis Project (ADOPTION MAP) is supported by grants from Stichting VSBfonds, Stichting Fonds 1818, Fonds Psychische Gezondheid, and Stichting Kinderpostzegels Nederland to F.J. and M.H.v.IJ. in cooperation with the Adoptie Driehoek Onderzoeks Centrum (ADOC; Dr. van IJzendoorn is supported by the NWO/SPINOZA Prize of the Netherlands Organization for Scientific Research. Dr. Bakermans-Kranenburg is supported by the VIDI grant of this organization. Dr. Juffer is supported by Wereldkinderen.

Address for reprints: Marinus van IJzendoorn, Ph.D., Centre for Child and Family Studies, Leiden University, P.O. Box 9555, NL-2300 RB Leiden, The Netherlands; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.