Children who live in foster care and institutionalized settings are at risk for malnutrition and inadequate growth. Prenatal exposure to drugs or alcohol, or lack of good nutrition during pregnancy may lead to growth problems. Institutional factors, such as propped bottles, limited access to calorie and nutritionally rich foods, and untreated gastrointestinal problems can also limit growth.

How is growth measured?

When pediatricians think about growth, they consider four areas: height, weight, head circumference and development. Children should increase in a predictable manner, in all four of these areas. Pediatricians use growth charts to compare height, weight and head circumference to standards. There are some standard growth charts available for children particular to different countries, such as China.

Children living in an institution generally will fall off the height and weight growth curve first. As they are unable to keep up with growth in these areas, head circumference starts to fall off the growth curve. Head circumference has been shown in some studies to be linked to the development of cognitive and motor skills, and it is important to consider in internationally adopted children.

Achieving developmental milestones also depends on adequate nutrition. To learn, children need energy to participate, engage and pay attention for appropriate lengths of time. With malnourishment, energy for play and attention to new learning can be difficult.