PEDIATRICS Vol. 97 No. 4 April 1996, pp. 569-578
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Infants and Young Children in Orphanages: One View From Pediatrics and Child Psychiatry

Deborah A. Frank MD1, Perri E. Klass MD2, Felton Earls MD3, and Leon Eisenberg MD4

1 Department of Pediatrics, Boston University School of Medicine; Department of Public Health, Boston University School of Public Health, Cambridge, Massachusetts
2 Department of Pediatrics, Boston University School of Medicine, Cambridge, Massachusetts
3 Harvard University Schools of Medicine and Public Health, Cambridge, Massachusetts
4 Departments of Social Medicine and Psychiatry, Harvard Medical School, Cambridge, Massachusetts

A large body of medical knowledge exists that can inform the public policy debate as to whether the current needs and future life prospects of poor children could better be served in orphanages than by continuing safety net programs, such as Aid to Families with Dependent Children, Medicaid, and Supplemental Social Security Income, which maintain children in families. This special article explores a century of pediatric and child psychiatry research covering five areas of potential biologic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socioaffective development, and (5) physical and sexual abuse. These data demonstrate that infants and young children are uniquely vulnerable to the medical and phychosocial hazards of institutional care, negative effects that cannot be reduced to a tolerable level even with massive expenditure. Scientific experience consistently shows that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language development. In the long term, institutionalization in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults.

Submitted on January 2, 1996
Accepted on January 24, 1996




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