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Maia Szalavitz Headshot

How Orphanages Kill Babies-- and Why No Child Under 5 Should Be in One

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For most people, the word orphanage conjures cold Dickensian images of cruelty to children -- and yet whenever I write that children under five should never be kept in institutional care, I hear from people who vigorously defend such facilities.

With public attention focused on the horrifying case of Artyom Savelyev who was sent home alone to Russia after being briefly adopted from an orphanage, more people need to know why orphanages for infants are indefensible and can safely and economically be shuttered.

Indeed, that has already quietly happened in the U.S. and Western Europe over the last few decades. Baby orphanages here have gone extinct because experts now understand the profound dangers they pose for infants. But to help more kids and future adoptive families, these facilities for infants need to be abolished in the rest of the world as well.

Unfortunately, the myth of the good orphanage for little ones lives on in the popular imagination and in Eastern Europe and China. Even the New York Times recently promoted it, with an article that claimed that research shows orphanages are fine for kids. Sadly, the article failed to note that the research was conducted on children over six-- and so doesn't apply to orphanages for babies.

More recently, in an editorial on the Savelyev case, the Times said that Russia's orphanages were merely "overcrowded, with too few staff members and resources." Instead, it should have called for replacing baby orphanages entirely with foster care.

Here's why. As we discuss in our book, Born for Love: Why Empathy Is Essential -- and Endangered, about 1/3 of babies placed in the barest orphanages can actually die as a result (one very early study found this death rate).

Half of the rest -- at least double the rate seen in the general population -- will suffer from mental illness. Each month spent in an orphanage in early life reduces IQ and increases risk of behavioral and psychological problems--and this has been proved by the highest level of scientific proof we have, a randomized controlled trial.

But how could simply being in an orphanage kill a baby? Basically, they die from lack of love. When an infant falls below the threshold of physical affection needed to stimulate the production of growth hormone and the immune system, his body starts shutting down.

Research suggests a physiological pathway that produces this effect, which was first understood as "runt syndrome" in mammals. In litters of puppies and kittens -- even in rats and mice -- oftentimes one or two animals are significantly smaller than the rest.

The weakness exhibited by these animals signals the mother that they have little chance of survival. To make sure her genes live on, she would be better off using her limited resources to make sure that the rest of litter stays healthy.

The signaling works like this: in some species, each baby has a "preferred" nipple. The weak ones don't suck strongly enough to stimulate that nipple sufficiently. Consequently, the mother does not lick or nurture the baby that uses that nipple very much. In other species, the weak animals simply don't get access to the nipple and the mother then ignores them.

Unfortunately for the runts, a certain level of maternal licking and nuzzling is necessary to turn on the production of growth hormone in the brain. Without growth hormone, food isn't metabolized properly and growth and development do not progress. Barring intervention, the runt will "fail to thrive" and essentially, wither and die.

In humans, the immune system seems to be profoundly affected, making these children especially vulnerable to all types of disease -- probably because not being nurtured is extremely stressful and high levels of stress hormones can turn off the immune system. (That's why corticosteroids-- essentially stress hormones -- are often used to treat auto-immune diseases where too much immune response is the problem).

In fact, "failure to thrive" in human infants has been shown to result from lack of individualized, nurturing, physically affectionate parental care, whether in an orphanage or due to extreme parental neglect. Babies' brains expect that they will experience nearly constant physical touch, rocking and cuddling: without it, they just don't grow. And without receiving kind empathetic care, they are less likely to behave that way towards others as they get older.

Orphanages simply cannot provide the levels of intensive individual care that infants need to generate enough growth hormone and empathy. Incidentally, this is why babies raised in orphanages are almost always physically smaller and have smaller heads and brains than those raised with even not-so-great parents.

Moreover, that's just part of the physiology that we understand. When a baby is not the center of someone's world, he or she misses out on many other types of stimulation and experience as well. No one has yet documented how this affects other brain and body systems but we know that the stress system affects virtually every cell in the body. The emotional and behavioral problems that often frustrate adoptive parents and the children themselves are mostly preventable. Though these children can be remarkably resilient if they later receive intense affection, there is no doubt that the experience of orphanage life is painful and damaging.

So why do baby orphanages still exist? It's not cost -- foster care is actually at least six times cheaper than keeping a baby in an institution, according to research [pdf].

The problem is cultural beliefs that orphanages aren't harmful and funding streams that preferentially provide money to institutions, not individual families. The only way to fight this is to raise awareness of the issue and prod governments and funding agencies to provide humane, family-based care to all children. Baby orphanages are harmful and there is no legitimate justification for their continued existence.