[Different perspectives on caring for a child in an infant care home]

Caring for a child in an infant care home leads professionals to examine their practices. Perrine Hugel, manager of an infant care home, and Maud Léon, an auxiliary child health nurse in the same home, describes the nursing values which they implement on a daily basis to favour the wellbeing of the infant and support parenthood.

[The maternity and childhood care in penal executive system of Russia]

The Russian Federation pays particular attention to maternity and children care. During the last three years, slight decreasing of number of women held in detention together with children of tender age was marked. This tendency is related to policy of humanization of penalty determination and execution of punishment. At that, number of women with pregnancy at the moment of adjudgement of conviction of court increases. Annually, 3% of women residing in institutions of penal executive system are observed because of pregnancy that results with delivery in curative preventive institutions of the penal executive system in 35% and in medical institutions of municipal and state health care systems in 65% of cases. The newborns of women serving a sentence by way of deprivation of freedom enter Home of Child. The Federal penitentiary service of Russia comprise 13 Homes of Child in female correctional institutions where about 700 children are brought up. The article considers issues of development of organization of medical sanitary support of children of tender age in homes of Child of the penal executive system.

Disruptions of working memory and inhibition mediate the association between exposure to institutionalization and symptoms of attention deficit hyperactivity disorder

BACKGROUND

Young children raised in institutions are exposed to extreme psychosocial deprivation that is associated with elevated risk for psychopathology and other adverse developmental outcomes. The prevalence of attention deficit hyperactivity disorder (ADHD) is particularly high in previously institutionalized children, yet the mechanisms underlying this association are poorly understood. We investigated whether deficits in executive functioning (EF) explain the link between institutionalization and ADHD.

METHOD

A sample of 136 children (aged 6-30 months) was recruited from institutions in Bucharest, Romania, and 72 never institutionalized community children matched for age and gender were recruited through general practitioners' offices. At 8 years of age, children's performance on a number of EF components (working memory, response inhibition and planning) was evaluated. Teachers completed the Health and Behavior Questionnaire, which assesses two core features of ADHD, inattention and impulsivity.

RESULTS

Children with history of institutionalization had higher inattention and impulsivity than community controls, and exhibited worse performance on working memory, response inhibition and planning tasks. Lower performances on working memory and response inhibition, but not planning, partially mediated the association between early institutionalization and inattention and impulsivity symptom scales at age 8 years.

CONCLUSIONS

Institutionalization was associated with decreased EF performance and increased ADHD symptoms. Deficits in working memory and response inhibition were specific mechanisms leading to ADHD in previously institutionalized children. These findings suggest that interventions that foster the development of EF might reduce risk for psychiatric problems in children exposed to early deprivation.

Cognitive Functions and Health Related Quality of Life of Institutional Autism Spectrum Disorder Children in Dhaka city

In Bangladesh, nearly 10.5 hundred thousand individuals may have autism. Recent figures released by the CDC (2012) show that autism spectrum disorders (ASDs) now affect 1 in 88 children. Cognitive impairment, limited adaptive skills, and severe social impairment as seen in Autism Spectrum Disorders (ASD) thought to be associated with poorer health related quality of life (HRQoL). The objective of the study was to measure HRQoL and cognitive functioning in a group of autism Spectrum Disorder (ASD) children and to relate HRQoL with their socio demographic characteristics and cognitive functioning from parents' perception. This cross sectional study was conducted amongl49 purposively selected parents who have institutionalized autistic children (2 to 18 years old) from January to June 2013. HRQoL was assessed by Pediatric Quality of Life Inventory 4.0 (Vemil998) and cognitive functioning was assessed with The PedsQL TM Cognitive Functioning Scale. Three fourth of the children were male (n=-115, 77.2%) and the mean (SD) age of the children was 7.8(3.06) years. Symptoms of autism appeared at about their 2rd birthday 2.1 (.70) while the average (SD) age of diagnosis was around three years 2.9 (.98). The children were reported to go to school at an early age of 3(1.75) years. Out of 149 respondents, ten percent parents (n=14) had the history of consanguineous marriage. The sample data provides significant difference between the scores by the ability of verbal communication (p<.05), presence of autistic siblings (p<.05) and mother's occupation (p<.05). There found negative correlation between HRQoL and age of symptom appearance and cognitive functioning with age of diagnosis (r = - 0.18; p=.03). Cognitive functioning was strongly correlated with total PedsQL score and its domains (r = 0.73; p=.00). i.e. Higher cognitive function leads to good health related quality of life. Linear regression was performed to study the relationship between HRQoL and independent variables found significant in univariate analysis. The results of the regression indicated the predictors in the model explained 57 % of the variance (R2=.57, F=23.05, p<.001). It was found that fathers who were doctors and engineers by profession (t=2.34, p= .02), child's ability to communicate with words (t= 2.73, p= .007), age of symptom appearance (t= -2.71, p=.008), and cognitive functioning (t =12.28, p <0.001) significantly predicted HRQol of ASD children. Father's occupational status child's ability to communicate by word, age of symptom appearance, and Cognitive functioning of ASD children were found related to their quality of life.

Systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care

OBJECTIVES

This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries.

METHOD

For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers.

RESULTS

For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care.

CONCLUSIONS

Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design.

Telomere length and early severe social deprivation: linking early adversity and cellular aging

Accelerated telomere length attrition has been associated with psychological stress and early adversity in adults; however, no studies have examined whether telomere length in childhood is associated with early experiences. The Bucharest Early Intervention Project is a unique randomized controlled trial of foster care placement compared with continued care in institutions. As a result of the study design, participants were exposed to a quantified range of time in institutional care, and represented an ideal population in which to examine the association between a specific early adversity, institutional care and telomere length. We examined the association between average relative telomere length, telomere repeat copy number to single gene copy number (T/S) ratio and exposure to institutional care quantified as the percent of time at baseline (mean age 22 months) and at 54 months of age that each child lived in the institution. A significant negative correlation between T/S ratio and percentage of time was observed. Children with greater exposure to institutional care had significantly shorter relative telomere length in middle childhood. Gender modified this main effect. The percentage of time in institutional care at baseline significantly predicted telomere length in females, whereas the percentage of institutional care at 54 months was strongly predictive of telomere length in males. This is the first study to demonstrate an association between telomere length and institutionalization, the first study to find an association between adversity and telomere length in children, and contributes to the growing literature linking telomere length and early adversity.

Gross motor development in children adopted from orphanage settings

AIM

This study sought to examine the effect of environmental enrichment on the motor skills of children adopted from orphanage settings. We investigated balance and bilateral coordination skills in 33 internationally adopted postinstitutionalized children (16 males, 17 females; age range 8 y 5 mo-15 y 10 mo; mean age 10 y 9 mo; SD 2 y 2 mo) and compared them with 34 non-institutionalized children (21 males, 13 females; age range 8 y 3 mo-14 y 10 mo; mean age 11 y 2 mo; SD 2 y 1 mo) being raised in their birth families.

METHOD

The children were individually administered the balance and bilateral coordination subtests of the Bruininks-Oseretsky Test of Motor Proficiency in a research laboratory. Parents completed questionnaires about developmental history, family environment, and orphanage care.

RESULTS

Postinstitutionalized children showed motor system delays compared with the non-institutionalized comparison children (postinstitutionalized balance mean 9.44, SD 5.92, comparison children balance mean 14.12, SD 4.39; postinstitutionalized bilateral coordination mean 11.97, SD 5.43, comparison children mean 19.97, SD 3.97). The length of time that children remained institutionalized before adoption predicted balance delays (b=-1.57, t=-2.33, p=0.027) and the severity of caregiving deprivation the children experienced correlated with bilateral coordination (r=-0.44, p=0.013).

INTERPRETATION

These findings suggest that institutionalized settings do not provide the early life experiences needed for the development of age-level motor skills later in childhood and that simple environmental enrichment following adoption is not enough to remediate skills. Children who have experienced early institutional care may benefit from early identification and targeted intervention.

Sentence comprehension in postinstitutionalized school-age children

PURPOSE

In this study, the authors investigated sentence comprehension and spatial working memory abilities in a sample of internationally adopted, postinstitutionalized (PI) children. The authors compared the performance of these PI children with that of an age-matched group of children living with their birth families. They hypothesized that PI children would perform below clinical threshold on tasks of sentence comprehension and that poor sentence comprehension would be associated with poor performance in working memory.

METHOD

Twenty-three PI children and 36 comparison children were administered sentence comprehension and spatial memory tasks from standardized assessments.

RESULTS

Some oral sentence comprehension skills and the spatial working memory skills were weaker in the school-age PI children than in the age-matched comparison children. A mediational analysis demonstrated that poor spatial working memory performance partially explains the sentence comprehension differences between the 2 groups.

CONCLUSION

These findings provide valuable information to better plan early intervention and special education for PI children.

Prevelance of mental disorders and associated factors in institutionalized 3-5 year old children

OBJECTIVE

In this study, we aimed to determine the prevelance and severity of mental disorders in institutionalized children between the ages of 3-5 years, investigate the factors associated with the mental disorders and compare these findings with the data of a community sample composed of children who were raised by their own families.

METHOD

Thirty-four children raised in three institutions in Kocaeli were compared with an age- and sex-matched community sample. Children were assessed according to DSM-IV diagnostic criteria. The Socio-demographic information form, and Early Childhood Inventory-4 (ECI-4) parent scale were used for data collection.

RESULTS

Children that were reared in institutions had evidence of higher rates of mental disorders. In institution-reared children, symptom severity of attention deficit hyperactivity disorder, reactive attachment disorder, oppositional deficient disorder, and pervasive developmental disorder were higher than the community subjects. Age, time spent with father, duration of institutionalization, number of siblings, number of hospital admissions because of physical symptoms and presence of abuse before institutional care were determined to be predictive factors for psychiatric symptoms.

CONCLUSION

These findings revealed that institutionalized children are at risk for mental disorders and protective measures are as important as instutional care for these children. Our results suggest that essential steps should be taken to protect the mental health of children in institutional care.

Research on the Danish Longitudinal Survey of Children (DALSC) at the Danish National Centre for Social Research

INTRODUCTION

This article reviews research results obtained using the Danish Longitudinal Survey of Children born in 1995 (DALSC), which is placed at SFI, the Danish National Centre for Social Research. DALSC aims to gain insight into children's growing-up conditions in contemporary society. DALSC consists of three subsamples: (1) children of Danish mothers; (2) children of ethnic minority mothers; and (3) children in out-of-home care. Four waves of data collections have been carried out since 1996. Being designed with the purpose of obtaining rich and detailed information about children's development and family life, register data was not connected to DALSC before 2006.

RESEARCH TOPICS

By using three categories of children as examples (ethnic minority children, vulnerable children, and children in out-of-home care), the article shows how register data gradually has gained ground in research upon children's health conditions.

CONCLUSION

We expect to see a more extensive use of administrative registers as basis for the analyses in future research.

Early institutionalization: neurobiological consequences and genetic modifiers

Children raised in the profound deprivation associated with institutionalization are at elevated risk for negative outcomes across a host of social and cognitive domains. This risk appears to be mitigated by early foster care or adoption into a family setting. Although pervasive developmental problems have been noted in a substantial proportion of previously institutionalized children, marked variation exists in the nature and severity of these deficits. Increasing evidence suggests that institutional deprivation impacts the developing brain, potentially underlying the wide range of outcomes with which it is associated. In the current review we examine the neural consequences of institutionalization and genetic factors associated with differences in outcome in an effort to characterize the consequences of early deprivation at a neurobiological level. Although the effects of institutional deprivation have been studied for more than 50 years much remains unanswered regarding the pathways through which institutionalization impacts child development. Through a more complete and nuanced assessment of the neural correlates of exposure and recovery as well as a better understanding of the individual factors involved we will be better able to delineate the impact of early adversity in the setting of severe social deprivation.

Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care

OBJECTIVES

To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development.

DESIGN

A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age.

SETTING

Institutionalized and community children in Bucharest, Romania.

PARTICIPANTS

One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children.

INTERVENTION

Institutionalized children were randomly assigned to receive foster care or institutional care as usual.

OUTCOME MEASURES

Auxology and measures of intelligence over time.

RESULTS

Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05).

CONCLUSIONS

Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.

[Characterization of vaccine polioviruses isolated in the closed pediatric collective bodies (children's homes)]

Examination of 281 healthy vaccinees from 6 children's homes could isolate 37 vaccine polioviruses. The detection rate for polioviruses in the children's homes, in which there were children born to HIV-positive mothers, was significantly higher than that in other children's homes. These children's homes showed the longest poliovirus excretion after vaccination. The RFLP analysis showed that 40% of the strains being examined were intertypic recombinant strains. The sequence analysis demonstrated that about 30% of the strains under study had a small number of nucleotide substitutions in the VP3-VP1 genomic region. The study revealed a correlation between the dynamics of poliovirus excretion after oral vaccination and the kinetics of formation of recombinant poliovirus strains.

Does pediatrics need its own bioethics?

Pediatric bioethics raises unique issues because children are constantly growing, developing, and changing. The ethical issues that arise for newborns are different from those that arise for seven-year-olds or 17-year-olds. Furthermore, children do not develop cognitive capacities or moral reasoning skills at the same rate. Thus, it is difficult to generalize about what is appropriate or inappropriate for children in either the clinical or the research setting. This article responds to some of the issues raised by a new volume of essays about pediatric bioethics. It puts these issues into historical context by examining the implications of Saul Krugman's famous studies on the etiology and prevention of hepatitis at New York's Willowbrook State School.

Absence of opportunistic parasitic infestations in children living with HIV/AIDS in children's homes in Jamaica: pilot investigations

BACKGROUND

Many children living with HIV/AIDS in developing countries are infected with intestinal parasites. These infections add unnecessary morbidity to children already suffering the clinical insult of living with HIV/AIDS.

OBJECTIVE

To determine the prevalence and potential risk factors for intestinal parasitic infections in HIV-infected children living in two institutions in Jamaica.

METHODS

A total of 82 faecal specimens were collected from 41 HIV-infected children (age range 2-14 years) who resided in two Children's Homes. A structured 42-item questionnaire was administered to caregivers to obtain clinical and demographic data on each child. Faecal specimens from each patient were examined using standard microbiological techniques and Cryptosporidium antigen detection was conducted using a commercially available enzyme immunoassay (EIA).

RESULTS

No opportunistic intestinal parasites were identified in this study. Non-opportunistic parasites diagnosed included Giardia lamblia (12.2%) and Ascaris lumbricoides (2.4%) while the commensals Endolimax nana and Entamoeba hartmanni were found in 4.9% and 2.4% of children, respectively.

CONCLUSION

Children living with HIV/AIDS in institutions in Jamaica that are closely supervised do not appear to be at substantial risk for intestinal parasites. This may be due to the strict clinical monitoring of the children and personal and environmental hygiene practices.

Language acquisition with limited input: Romanian institution and foster care

PURPOSE

To provide the first detailed information about native language abilities of children who are or had been institutionalized.

METHOD

The language of ten 30-month-old children raised in Romanian orphanages was compared with that of 30 chronological-age-matched peers: 10 children who had moved recently from orphanages to foster care, 10 children in foster families for at least 1 year, and 10 children raised in their biological families. Ten language measures were obtained from communication during play and from parent/caregiver report.

RESULTS

Children who were institutionalized and children in foster care for a brief time showed substantial language delays, with some of these children not yet producing intelligible words. Children in foster care for at least 1 year approximated the expressive output and receptive language of children who had never been institutionalized; however, they showed lower expressive grammatical abilities. Within the group of children who were institutionalized, the presence of a preferred caregiver and a measure of development, greater height, were associated with greater language output. Although children in orphanages produced fewer complex forms than children in biological families, there were no systematic qualitative differences in language structure across groups.

CONCLUSION

Foster care facilitated language growth after substantial language delays associated with institutionalization.

Who will care for me? The debate of orphanages versus foster care

The issue of how best to address current problems in the foster care system while at the same time considering past problems with the orphanage concept is a cause of national debate. Among the questions being examined are, is a return to orphanage care feasible and if so, would the re-creation of orphanages benefit the children who would be placed in them. The advanced practice nurse is perfectly situated to participate in this discussion and to advance a theory of harmony by addressing social, economic, and political factors within a patient's environment. Nurse practitioners can also fill an important gap in care for these children who often suffer the consequences of well-intentioned but flawed child care systems.

The role of social pedagogy in the training of residential child care workers

A requirement for most people working in residential child care in Denmark, Germany and the Netherlands is a qualification in social pedagogy. Social pedagogy is not narrowly concerned with a child's schooling but relates to the whole child - body, mind and spirit. This article describes the first social pedagogy course to be introduced and professionally recognized in the UK: the BA in Curative Education Programme. This 4-year programme blurs the line between 'classroom learning' and 'learning in practice'. A unique feature of the programme is that most students 'live the course' in residential care communities for children or adults with intellectual and developmental disabilities. The life-sharing aspect of the programme ensures that the principles of dignity, value and mutual respect can be meaningfully translated into practice. The social pedagogic model presents a timely challenge to current care philosophy and practice.

Internationally adopted children: a new challenge for pediatricians

Children adopted from abroad by Italian families have increased during the last years. Since 2001 to 2004 they have been more than 10,000, mainly from Eastern Europe, and all indications suggest that they will continue to increase. Most of the internationally adopted children reside in orphanage before adoption where they may experience malnutrition, exposure to infectious diseases, environmental deprivation, neglect. Moreover, their pre-adoptive records are scarcely reliable and their immunization status is not always adequate. The most common long-term problems of internationally adopted children concern developmental and scholastic delay especially if they come from a long and severely deprived institutional setting, precocious puberty and, during adolescence, depressive disorders as well as antisocial behaviours. Inter-country adopted children are at increased risk for health and social problems and have to be recognized as a group of subjects requiring special medical attentions. Specialized centres for internationally adopted children where they could receive medical evaluations upon arrival and a prolonged health follow-up should be set up.