Physician: Detrimental Effects of Institutions & Orphanages

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What is it about institutions and orphanages that make them so detrimental to a child’s overall health and development?

Adverse effects of institutional care living is not new information; it has been recognized as a problem for many years. The healthiest living condition for a child is obviously with a family who will love and nurture, as well as providing food, shelter and clothing that will ensure this child’s survival.

Unfortunately, this is not reality for many of the world’s children.

By definition, the word orphan means a child who was left without parents to care for him because they are deceased. Today’s international orphans usually have parents but they have abandoned them or their parental rights have been terminated. There are numerous reasons why people abandon their children; reasons seem to be similar worldwide.

Below is a list of the most common reasons why children are placed for adoption worldwide.

  1. Poor economic situation, poverty
  2. Parental illness, mental and or physical
  3. Drug or alcohol abuse by the parents
  4. Mental retardation
  5. Incarceration
  6. Termination of parental rights because of neglect or abuse
  7. Political and economic policies of different countries (one child policy)
  8. Complicated medical conditions that the family can not care for.

Orphanages are part of every societal culture. How good or how bad an orphanage is depends on the particular country's outlook on abandoned children and obviously the financial situation of these countries.

The most devastating effects on orphan children were seen in the orphanages of Romania during the 1980s when abandoned children were basically warehoused in large buildings with little qualified staff to care for them.

Delays in developmental health are common in many of the post-institutionalized children; the degree and severity of problems is directly proportional to the length of time of institutional care living.

Many of these children suffer from physical neglect and poor hygiene, and a lack of a nurturing environment is all too common even in today’s more modern orphanages.

The practice of bottle propping is still practiced even today. This results from the need to feed many children within a short period of time with little nursing staff. This practice continues to place these children at increased risk of developing recurrent ear infections, hearing loss, and severe dental caries. More importantly, these children miss out on experiences encountered from maternal child interactions during feeding. This early human interaction is critical in early emotional development.

The general lack of a lack of a stimulating environment leads to bizarre self-stimulating behavior such as unusual posturing, head banging, and rocking. This also results from a lack of a primary mother figure that would love, nurture and soothe the infant. This is a normal reaction to an abnormal environment. This behavior occurs because of the child’s need to restore the sensory requirements necessary for their brain development.

Sometimes the old buildings where these children are cared for may be laden with environmental toxins such as lead, which can cause developmental delays.

Cognitive development in young children is critically dependent on their experiences during early infancy and childhood. The more hostile the environment the more detrimental the developmental delays. Even in today’s more modern orphanages that are cleaner, full of toys and other stimulating activities, there is still no substitute for a mother child relationship.

It is extremely difficult to care for many children in a group setting no matter what country you are in. Many children who live in orphanages suffer from lack of experiences with the outside world. Many of these children have not left the orphanage grounds; they lack the experience in going to the park, sharing stores or even visiting some other child’s home for a play date. These are simple daily experiences that we all take for granted as part of growing up.

Another devastating effect of institutionalization is the emotional neglect experienced by these children. In order to prevent the spread of infectious disease in young infants, many of the caregivers wear mask that cover the face during feeding, changing and other daily activities of the infants' routine. This well-intentioned activity deprives the infant of having a human contact. Sometimes a bed sheet is also hung on the side of a crib, once again in order to reduce the spread of illness, but limiting the child's field of vision with the environmental surroundings. With this type of medical behavior, many of these infants never even see a human face or other child until they begin to move around on their own.

I feel that the most important detrimental effect of institutional care living is the lack of a one-to-one primary care giver relationship. This is still seen in almost every orphanage around the world. While these harmful effects are known to cause developmental and emotional delays in children, world wide efforts are being made to reduce the care-giver child ratio from 30 to 1 to as little as realistically and financially feasible. Because of shift work by the caregivers, a child may experience many different nannies during the day, afternoon and then the night shift. Shift work from within the caregivers will have detrimental effects on the emotional well being of the child. With this kind of arrangement, the child is faced with different caregiver styles to feeding, bathing and emotion cues. With many different caregivers all providing the same care, the child will experience inconsistent responses to their basic needs, and as a result the child may not learn how to react to a common situation.

Worldwide, poverty remains as the most common reason for abandonment of children. In some countries with extreme poverty, sometimes an institution is the only viable alternative for this child’s survival. At least in an orphanage the child will receive the minimal daily life requirements as food, shelter and clothing. While medical care is somewhat limited it is available. In an orphanage the child should be protected from abuse and neglect and may even be offered formal education.

I can not even begin to imagine at how hard it must be for a parent to abandon their child. Circumstances of desperation and poverty must be pretty significant for them to resort to such extreme measures. Sometimes an institution is the only alternative for some of these unfortunate children.

by George Rogu, M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit or call 631-499-4114.

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