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Choosing Adoption - Developmental Impacts of Orphanages Versus Foster Care

By Dawn Davenport, Adoption Expert and Author of The Complete Guide to International Adoption

An overview of developmental impacts of children adopted internationally from oprhanages and institutions. How and why this may differ from children adopted from foster care.

Orphanage is the general term I use to cover institutional care and includes social welfare institutions, group homes, or baby houses. No matter what the name, orphanages are lousy places to raise children. Every child deserves prompt consistent care, lots of verbal and physical stimulation, and love. In short, children need parents, not shift workers. The quality of care varies greatly by country, region, and even within the same orphanage, but evening the best of situations, communal living is not conducive to providing the degree of care infants and children need. This fact alone is why some families choose a country where children are in orphanages in order to provide a home to a child who really needs it.

While most children available for foreign adoption live in orphanages, foster care is available is some countries, most notably Korea and Guatemala. Other countries, such as China, are making some progress in placing children in foster homes rather than institutions. Unfortunately, foster care does not automatically guarantee quality care, but it increases the odds.

Dr. Dana Johnson, from the University of Minnesota International Adoption Clinic, says that the chance that a child adopted from an orphanage will be completely normal (whatever that means) when she first arrives home is essentially zero. Growth and development will both be delayed. For growth delays, the rule of thumb is that a child will lose one month of linear growth for every three months in an institution. In a study comparing Guatemalan children in foster care and orphanage care, the children who had resided in an orphanage before adoption were significantly smaller in height, weight, and head circumference (Miller at al, 2005). Similar growth delays were also found in Chinese and Russian orphans adopted from institutions (Miller and Hendrie, 2000, Albers et al., 1997).

Developmental delays are also common for children who lived I an orphanage before adoption. A large study of children adopted from China showed "gross motor delays in 55% of the children, fine motor delays in 40%, cognitive delays in 32%, language delays in 43%, social emotional delays in 28%, and delays in activities of daily living in 30% (Miller and Hendrie, 2000). Forty-four percent had delays in three or more of these areas. Interviews with international adoption doctors and researchers reveal that developmental delays were common for children who resided in orphanages in other countries as well (Albers et al., 1997).

Most parents accept that their child will arrive home with growth and developmental delays, but their burning question is will their child make up these delays with loving care. Research clearly indicates that love and nutrition do wonders for a child's physical and developmental growth. The gains made in this area post-adoption have been described as miraculous (Ryan and Groza 2004; Bledsoe and Johnston, 2004; Judge, 2004). Motor skills delays are often the first to improve, while language and social skills may lag behind, especially for children who spent more time in an institution. The younger the children, the great the chance that he will make up any growth and developmental delays, but whether your child will completely catch up is impossible to tell. One research, Dr. Victor Groza, categorized the children adopted from Romania several years post-adoption as follows: "the resilient rascal" (20 percent) showed little long -term effects of orphanage life; "the wounded wonders" (60 percent) were making good progress but had some delays; and "the challenged children" (20 percent) continued to struggle. These children came from extreme deprivation and arrived home significantly delayed, but other researchers have seen similar results in other countries. Dr. Dana Johnson said in an interview, "With love, 70-80 percent of the children adopted from orphanages will do quite well; unfortunately, it is impossible to pick out in advance with certainty the ones who won't."

Better orphanages have the following:

  • Consistent care (low turnover among caregivers, caregiver assigned to care for the same children each day)
  • Fewer children per caregiver
  • Adequate nutrition and medical care

It is impossible to generalize about orphanage care for an entire country, but once you have selected an agency you can ask specific questions about the quality of care in the institutions they work with. You can talk with other parents who have adopted from the same region of the country, and it may be possible to find parents who adopted from the same orphanage. Your agency may be able to give you names, and has some groups formed around certain regions. And remember, institutionalization is not an automatic sentence to physical, cognitive, or emotional health problems; many children come home and thrive despite having spent their first years in an orphanage.

  • Albers, L. H., et al. 1997. "Health of Children Adopted from the Former Soviet Union and Easter Europe: Comparison of Preadoptive Medical Records. Journal of the American Medical Association 278: 922-924.
  • Bledsoe, Julia, and Brian D. Johnston. 2004. "Preparing Families for International Adoption." Pediatrics in Review 25: 242-250.
  • Judge, Shannon. 2004. "Adoptive Families: The Effects of Early Relational Deprivation in Children Adopted from Eastern European Orphanages." Journal for Family Nursing 10(3): 338-356.
  • Miller, Laurie C., et al. 2005. "Health of Children Adopted from Guatemala: Comparison of Orphanage and Foster Care." Pediatrics 115: 710-717.
  • Miller, Laurie C., and Nancy W. Hendrie. 2000. "Health of Children Adopted from China." Pediatric Health Care 11(3):117-126.
  • Ryan, Scott D., and Victor Groza. 2004. "Romaanian Adopees: A Cross-National Comparison." International Social Work 47: 53-79.

Dawn Davenport, adoptive parent, researcher, author, attorney, and adoption expert, is the author of The Complete Book of International Adoption. This well researched book is an exceptional guide to anyone interested in adopting internationally. This indepth article on adoption photolistings is copyright protected and reprinted with her permission.
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