Growth & development of Indian children adopted in Sweden

More than 6800 children from India have been adopted in Sweden over the last four decades. At arrival many were undernourished and suffered from infectious diseases. Catch-up growth was common. Unexpectedly, cases of early pubertal development were subsequently reported. In order to investigate the growth and development of adopted children more in detail we studied 114 children adopted from India prospectively during two years. The majority were stunted at arrival and caught up in height and weight after two years. Psychomotor retardation and common infections diminished fairly soon. Those that were stunted did not attain the higher catch-up levels of those not stunted at arrival. Low birthweight also limited the degree of catch-up growth. 107 girls were analysed retrospectively in another study. The median menarcheal age was 11.6 yr (range 7.3-14.6 yr) which is significantly earlier than the mean in Swedish and privileged Indian girls (13.0 and 12.4-12.9 yr, respectively). The pubertal linear growth component was normal in duration and magnitude but likewise started 1.5 yr earlier. The final height/age was 154 cm (-1.4 SDS) and the weight/age 46.9 kg (-1.1 SDS) 8 per cent were 145 cm or shorter. Stunting limited catch-up growth and final height. Those that were most stunted at arrival, and had the fastest catch-up growth, had the earliest menarche. Good maternal and child nutrition is necessary for full expression of a child's growth potential. What is lost in growth early in life can only partially be recovered by catch-up growth. Such growth is associated with risk for early pubertal development which abbreviates the childhood growth period and limits final height. The mechanism underlying the early pubertal development, and the optimal management of nutrition rehabilitation after chronic malnutrition, need to be clarified by further studies.