Researchers studying child development in Ukraine have found that quality of care in an orphanage or family setting has a greater impact on children’s physical growth and cognitive development than does the impact of having HIV.

HIV infection, institutional care, and family adversities are related to slow physical growth and lower cognitive performance. This study sought to determine which factors had a greater impact on children.

Dr. Natasha A. Dobrova-Krol and colleagues at the Centre for Child and Family Studies at Leiden University in the Netherlands observed 64 children. Of those chosen to participate in the study, 35 were raised by a family and 29 were raised in one of four children’s homes in Ukraine.

Nearly half of the children were HIV positive.

How and where the children were raised were the greatest determinants of physical growth and cognitive performance as the children aged.

“Our findings are in line with a body of research on the negative impact of institutional care on the development of children conducted throughout the world,” said Dr. Dobrova-Krol.

“We may expect that the findings of our study can be generalized to other countries, especially if we deal with similar institutional care arrangements and families suffering from multiple adverse circumstances, like in the Ukrainian study.”

Among the measures employed and tracked by researchers were physical growth, cognitive development, and cortisol production. Cortisol, known as the “stress hormone,” is produced in greater numbers by the body in highly stressful environments.

The study found that children raised by families fared better on those three measures than did children raised in institutions. This held true regardless of whether or not the family was experiencing distressed economic conditions.

HIV-positive children raised by disadvantaged families showed more advanced development than HIV-positive children raised in institutions. They also showed greater development than uninfected children raised in institutions with positive physical environments.

Higher cognitive scores in HIV-positive children were found if the children were raised in a better quality atmosphere, whether by a family or an institution.

The results from this study indicate that the child-caregiver relationship in the development of HIV-positive children is of utmost importance, and that a better quality early rearing environment, whether in families or institutions, was associated with higher levels of cognitive performance.

A greater understanding of the role of child-caregiver relationships in an HIV-positive child’s early rearing environment may contribute to practical interventions as the number of HIV-positive children swells worldwide, Dr. Dobrova-Krol noted.

“For those children who nevertheless end up in an institution, the rearing environment must be optimized,” she said. “If adequate physical and medical care is provided, it can be achieved by ensuring stability and improving the quality of caregiving. Because adverse experiences during the first year of life may have long-term or even permanent detrimental impact on children, interventions should be introduced at the earliest possible stages of life.”

For more information, please see the study in Child Development.