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Global Nutrition (Poster Theater Flash Session 7)

(PTFS07-02-25) Adoption or Placement in Foster Care and Catch-Up in Linear Growth and Development: A Meta-Analysis of Individual Participant Data

Sunday, June 1, 2025
4:04 PM – 4:08 PM ET
Location: South Hall B (The Hub) - Poster Theater / Poster Board Number PT-2

    Presenting Author(s)

  • JL

    Jef L L. Leroy, PhD

    Senior Research Fellow
    International Food Policy Research Institute
    Washington, DC, District of Columbia, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Edward A. Frongillo, Jr., Ph.D (he/him/his)

    Professor
    University of South Carolina
    Columbia, South Carolina, United States

  • MA

    Moira Angel

    International Food Policy Research Institute, United States

Objectives: 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-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 years of age.

Methods: We conducted a two-stage meta-analysis using individual participant data for linear growth (PROSPERO registration: CRD42022298715). 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.

Results: We included 485 children under 5 years 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% 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 in linear growth.

Conclusions: Catch-up in linear growth in children under five is biologically possible when the environment is improved profoundly and comprehensively. Partial reversal of the accumulated height deficit was 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.

Funding Sources: The study received financial support from CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by IFPRI.