Institutional care is known to adversely affect physical growth in early childhood, but there
have been few opportunities to study the effects of continuous, severe deprivation during
the first two decades of life. At the request of the Romanian government, a
multidisciplinary team evaluated residents of two pediatric neuropsychiatric institutes in
central and north-central Romania. Pediatric neuropsychiatric institutes in Romania
house children felt to be so severely impaired that they require permanent custodial care.
Until recently, once placed in such an institution, a child left only at the time of death or
transfer to a comparable adult institution. Within these pediatric neuropsychiatric
institutes, food is inadequate and formal schooling and rehabilitation unavailable. Most
children spend > 90% of their waking hours within the same room with no age-
appropriate activities. During the evaluation, growth data were obtained on 59 children
and expressed as z-scores (ht and wt z-scores WHO standards, ofc z-scores Tanner 73).
All residents studied had been institutionalized since the first year of life. Mean age at the
of examination was 133+41 months (range 64-216 m). Growth was profoundly affected by