January 18, 2011

Nutrition and the Child from China

ChildNutritionIf you listen to the webinar “Food for Thought” on Adoption Learning Partners, featuring Dr. Dana Johnson, you will see that parents are very concerned how the nutritional status of their children may affect their cognitive abilities [1]. What the parents are really asking is, “Will my child be smart, even if my child had a less than optimum diet while living in the orphanage?” The answer is usually “Yes,” but there are a few things you should know.

Overall, children from China have good nutrient status upon arrival home. In one study Dr. Johnson noted the percentage of children from China who were low or deficient in the following nutrients: iodine or selenium (20%), iron (8%); zinc (50%); and vitamin D (13%). None of the children were deficient in vitamin A, folic acid, or vitamin B 12. Of course, this is only one sampling of children [1]. The dates the children came home were not mentioned but, overall, the care of the children in the orphanages in China has been improving.

For nearly all children living in orphanages, the primary concern is getting enough calories and protein for growth and development. In general, babies in orphanages may receive less than adequate nutrition. In some cases, even if they are given plenty of formula, the children’s bottles are usually propped up, so the children may have limited ability and time to get the milk out of the bottles.

Also, infections can keep a child from absorbing nutrients. In one study, 31% of children from China had an infection of helicobacter pylori in their gastrointestinal tract [2]. This is the bacterium that was discovered in the 1990s that can cause ulcers. It is more typically found among those living in crowded conditions, such as orphanages. In the same study, those children in foster care in China did not have H. pylori in their “gut” [2]. Although H. pylori infection alone does not account for the developmental delays in children adopted internationally, as there are many other factors that contribute to delays, adopted children should be checked for the infection because once the child is home and receiving adequate nutrition and lots of love and stimulation, the infection could continue to cause growth delays. Other infections of the digestive tract, such as Giardia, which is also common in children adopted internationally, can cause malabsorption of nutrients, including iron, which can lead to growth delays [3]. One study also found in certain cases that when the children were treated for Giardia infection, these same children showed improved neurological and psychological functioning [4].

Iron is one of the most important micronutrients; iron deficiency anemia can have a significant impact on how children fare intellectually [3]. In China, iron deficiency anemia is not as prevalent as it is in children adopted from other countries [1]. In fact, Dr. Johnson states that only about 8% of children from China have anemia [1]. In one study not related to adopted children, the researchers state that iron deficiency can have a negative effect on intellectual development and recommended that even US children be given a daily supplement of iron-fortified vitamins [5]. Your adopted child should be tested for anemia upon arrival home and be retested at regular intervals. As your child grows, especially during the first year home, when many children play extreme “catch-up,” the child’s blood volume increases rapidly, and your child may not have enough stored iron for all the new red blood cells that are produced [1]. Another important nutrient is iodine and a lack of it can cause hypothyroidism, which can then cause growth delays.

According to Dr. Johnson, about 20 percent of children from China have a deficiency in iodine or selenium [1]. UNICEF reports that China has successfully implemented iodine fortification in the table salt throughout most of China, so this may be a problem that is decreasing. Also, about 50% percent of children in China are low in zinc and 13% are low in vitamin D [1]. Children can also be low in calcium and magnesium, which can result in the child’s having rickets [1]. Fortunately, rickets is usually treated with diet and seldom is surgery is required [1].

On Thursday, in Part II of “Nutrition and the Child from China,” we will present how nutrition relates to language skills.


1. Johnson, D. “Food for Thought” from the webinar from Adoption Learning Partners and the Spoon Foundation. 2010.

2. Miller, L., Kelly, N, Tannematt, M. & Grand, R. J. (2003) Serologic prevalence of antibodies to Helicobacter pylori in internationally adopted children. Helicobacter. 8(3,) pp. 173-178.

3. Fuglestad A.J., et al. (2008) Iron deficiency in international adoptees from Eastern Europe. The Journal of Pediatrics. 153 (2), pp. 272-7.

4. Miller, L.C. (2005) International adoption: Infectious disease issues. Clinical Infectious Diseases. 40, pp. 286–93.

5. Eden, A. (2005) Iron deficiency and impaired cognition in toddlers an underestimated and undertreated problem Pediatric Drugs. 7 (6), pp. 347-352.

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