INFANTS AND YOUNG-CHILDREN IN ORPHANAGES - ONE VIEW FROM PEDIATRICS AND CHILD-PSYCHIATRY

A large body of medical knowledge exists that can inform the public po licy debate as to whether the current needs and future life prospects of poor children could better be served in orphanages than by continui ng safety net programs, such as Aid to Families with Dependent Childre n, Medicaid, and Supplemental Social Security Income, which maintain c hildren in families. This special article explores a century of pediat ric and child psychiatry research covering five areas of potential bio logic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive dev elopment, (4) socioaffective development, and (5) physical and sexual abuse. These data demonstrate that infants and young children are uniq uely vulnerable to the medical and psychosocial hazards of institution al care, negative effects that cannot be reduced to a tolerable level even with massive expenditure. Scientific experience consistently show s that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language deve lopment. In the long term, institutionalization in early childhood inc reases the likelihood that impoverished children will grow into psychi atrically impaired and economically unproductive adults.