Peer-reviewed article
Adoption or Placement in Foster Care and Catch-up in Linear Growth and Development: A Meta-Analysis of Individual Participant Data.
Jef L Leroy, Moira Donahue Angel, Edward A Frongillo ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This meta-analysis examined whether children adopted from low-income to high-income settings experience catch-up growth and development. The study included 485 children under 5 years old from 9 adoption studies. Adoption led to substantial catch-up in linear growth, with children recovering 77% of their initial height deficit. However, catch-up in child development was smaller at 46% of the deficit. The findings show that improving environmental conditions enables partial recovery from growth stunting but complete recovery in development is less likely.
Key points
- Adoption reduced the mean length deficit by 3.0 cm (77%) in children with an initial deficit of 3.9 cm
- Catch-up in linear growth occurred in both girls and boys, with girls showing slightly larger gains (3.6 cm vs 2.5 cm)
- Children adopted after 24 months of age also demonstrated catch-up growth, though more modest (2.2 cm)
- Catch-up in child development was substantially smaller (46% of deficit) compared to linear growth
- Sensitivity analyses confirmed the robustness of the findings across different analytical approaches
Limitations
The meta-analysis combines data from only 9 studies and focuses exclusively on adoption to high-income settings, which limits generalizability. The review does not clarify the specific mechanisms of catch-up or the long-term sustainability of developmental gains beyond early childhood.
Abstract
The ability of children to recover from linear growth retardation, often referred to as catch-up growth, has intrigued researchers for many decades. Whether adoption from a low-income to a high-income setting, which provides a comprehensive improvement in the conditions that cause children to not grow well, leads to catch-up growth is unknown. We estimated the association of adoption (or placement in foster care) with catch-up in linear growth and child development before 5 y of age. We conducted a 2-stage meta-analysis using individual participant data for linear growth. We obtained study-specific and subgroup estimates and pooled the estimates using random-effects models. Sensitivity analyses were used to assess the robustness of our findings. A review of child-development outcomes was conducted. We included 485 children under 5 y of age from 9 adoption studies. At baseline, children had a mean age of 15.8 mo and a length deficit of 3.9 cm. Adoption reduced this gap by 77% or 3.0 cm (95% confidence interval [CI]: 1.9, 4.1 cm; mean age: 32.3 mo). Catch-up growth was found in both girls (3.6 cm; 95% CI: 2.9, 4.2 cm) and boys (2.5 cm; 95% CI: 1.9, 3.1 cm) and in children adopted after the age of 24 mo (2.2 cm; 95% CI: 0.6, 3.7 cm). The sensitivity analyses did not change any of the substantive findings. The magnitude of catch-up in child development (mean reduction in deficit of 46%) was smaller than that in linear growth. Catch-up in linear growth in children under 5 is biologically possible when the environment is improved profoundly and comprehensively. Partial reversal of the accumulated height deficit is more likely than recovery in developmental outcomes, which highlights the need to ensure all children grow and develop in environments that prevent deficits from occurring rather than trying to correct them. This review was registered at PROSPERO as CRD42022298715 (https://www.crd.york.ac.uk/PROSPEROFILES/298715_PROTOCOL_20220429.pdf).