These kids are a high-risk group by any standard. An orphanage is a terrible place to raise an infant or young child. All institutionalized children fall behind in large and fine motor development, speech acquisition and attainment of necessary social skills. Many never find a specific individual with whom to complete a cycle of attachment. Physical growth is impaired.
Children lose one month of linear growth for every three months in the orphanage.
Weight gain and head growth are also depressed. Finally, congregate living conditions foster the spread of multiple infectious agents. I have seen very few children for whom sufficient information on prenatal factors, birth weight, and postnatal growth and development was available to say that the child was normal. A more common situation is identifying children who clearly are very abnormal. These are children who have the typical facial and growth characteristics of fetal alcohol syndrome, children with clear neurologic abnormalities and children with autistic-like behavior.