Frank D A, Klass P E, Earls F, Eisenberg L
Department of Pediatrics, Boston University School of Medicine, Massachusetts, USA.
Pediatrics. 1996 Apr;97(4):569-78.
A large body of medical knowledge exists that can inform the public policy debate as to whether the current needs and future life prospects of poor children could better be served in orphanages than by continuing safety net programs, such as Aid to Families with Dependent Children, Medicaid, and Supplemental Social Security Income, which maintain children in families. This special article explores a century of pediatric and child psychiatry research covering five areas of potential biologic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socioaffective development, and (5) physical and sexual abuse. These data demonstrate that infants and young children are uniquely vulnerable to the medical and psychosocial hazards of institutional care, negative effects that cannot be reduced to a tolerable level even with massive expenditure. Scientific experience consistently shows that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language development. In the long term, institutionalization in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults.
现已有大量医学知识，可用于为公共政策辩论提供参考，即相较于继续实施诸如抚养儿童家庭援助计划、医疗补助计划和补充社会保障收入计划等安全网项目（这些项目让孩子生活在家庭中），孤儿院是否能更好地满足贫困儿童当前的需求并改善其未来的生活前景。这篇专题文章探讨了长达一个世纪的儿科学和儿童精神病学研究，该研究涵盖了孤儿院照料中婴幼儿可能面临的五个生物和社会潜在风险领域：（1）感染性发病率；（2）营养与生长；（3）认知发展；（4）社会情感发展；（5）身体虐待和性虐待。这些数据表明，婴幼儿特别容易受到机构照料带来的医疗和心理社会危害的影响，即便投入巨额资金，这些负面影响也无法降低到可容忍的水平。科学经验始终表明，短期内，安置在孤儿院会使幼儿面临更严重的感染性疾病风险和语言发育迟缓的风险。从长期来看，幼儿期进入孤儿院会增加贫困儿童成长为有精神障碍且经济上无生产力的成年人的可能性。
