Children who are living in foster care and institutionalized settings are at risk for malnutrition and inadequate growth. Growth related issues may stem from prenatal exposure to drugs or alcohol, or lack of good nutrition by from the biological mother during prenatal months. Institutional factors, such as propped bottles, limited access to calorie and nutritionally rich foods, and untreated gastrointestinal problems can also limit growth.
When pediatricians think about growth, they consider four topics: 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 charts available for children particular to different cultures, such as China. A child 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 domains, head circumference starts to fall off the growth curve. Head circumference has been shown in some research studies to be linked to cognitive and motor skills development, and it is an important consideration with international adoption.
Achieving developmental milestones also represents nutrition — children need energy to participate and engage for appropriate lengths of time with good attention to learn. With malnourishment, energy for play and attention to new learning can be difficult.