UNIVERSITY PARK, Pa. — Children in or adopted from the Pennsylvania foster care system with anemia may have greater odds of certain developmental and behavioral diagnoses according to a newly published study from Penn State researchers. This study, available in PLOS ONE, is the first to examine such a relationship among children in U.S. foster care.   

The researchers, with lead author Amrita Arcot, graduate student in nutritional sciences, and in partnership with the Penn State Evidence-to-Impact Collaboration’s Data Accelerator, analyzed administrative records for over 50,000 youth ages six months to 10 years in or adopted from the Pennsylvania foster care system between 2010-15.

The researchers found that youth suffering from anemia were more likely to be diagnosed with delayed milestones, developmental delays, irritability and adjustment disorders than youth without anemia. The team originally hypothesized that the sample population would have a higher anemia diagnosis rate than other children, but their data revealed that 2.7% of their sample were diagnosed with anemia — a rate that aligns closely with national figures ranging from 2.0% to 3.4% for children in the studied age range.

“Children in foster care, or those who were recently adopted, often undergo frequent medical check-ups,” Arcot said. "Hence, the detection rate of conditions such as anemia might be higher for this group.”

While the rates of anemia diagnosis are not higher in this population, Arcot said that past research indicates the rate of iron deficiency is higher than anemia in children. Iron deficiency precedes anemia and is frequently left undiagnosed until it progresses to overt anemia. As such, the authors said they suspect that children in foster care, or children recently adopted, have a rate of iron deficiency that exceed the rate of anemia, but more research is needed to test this hypothesis.

"This research underscores the nuanced challenges these children face,” said Xueyi Xing, EIC assistant research professor. “Our results indicate that anemia can have a lasting impact, especially during crucial growth periods, like the neonatal and early childhood phases. This can influence developmental outcomes in the long run only detectable through the use of large longitudinal administrative data sets."

In this study, the researchers identified a strong association between anemia and certain developmental and behavioral diagnoses. Children diagnosed with anemia from two to four years of age and five to 10 years of age were nearly three times more likely to be diagnosed with specific delays in development, when compared to children not diagnosed with anemia between six months to two years of age. Specific delays in development broadly encompass diagnoses like difficulty with reading, math, speech and/or coordination development.

"Children with iron deficiency may be at risk of poor cognitive, behavioral and/or developmental outcomes when compared to children without iron deficiency; however, such issues may not be identified until entry into school,” Arcot said. “This underpins the urgency of research focused on the interplay between environment and health."

The study not only highlights the importance of screening practices for these children but also stresses the need for further investigation to examine rates of anemia and other health concerns among children in foster care, according to Arcot.  

“Secondary data analysis is a viable option, especially given the inherent difficulty in recruiting children in the welfare system,” Arcot said. “This study serves as a crucial foundation for future investigations. Moreover, it emphasizes the need for proactive health care interventions, considering the unique challenges and vulnerabilities faced by children in foster care.”

Other authors who contributed to this study include Xiang Gao, professor of nutritional studies, Fudan University; Sarah A. Font, associate professor of sociology and criminology, Penn State; and Laura E. Murray-Kolb, professor and department head of nutrition science, Purdue University.

This work was funded by the John L. Beard Endowment, the College of Health and Human Development Endowment Funds for Professional Development/Dissertation Research and the Clinical and Translational Sciences Institute Translational Summer Fellowship.

The Administrative Data Accelerator supports data partnerships around using administrative records from government and industry sources for research studies. Interested researchers can contact Bethany Shaw at bjw217@psu.edu or submit a project proposal here.

The EIC is a research center for the science of scientific impact — aiming to improve the relevance, value and use of research evidence to increase societal well-being. The EIC leverages expertise in administrative data, program design & evaluation, and researcher-policymaker relationships to optimize public and private investments. The EIC is a unit of Penn State’s Social Science Research Institute and is supported by the College of Health & Human Development.

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