See related article by Gray.
Acting in the best interest of the child is the fundamental principle that is supposed to guide local, national, and international policy, programming, research, and care for children. Most people would agree, yet there is a raging debate among scientists about how, what, where, and when to measure and interpret “best interests.” The stakes are high as there are millions of children lacking one or both parents (orphans) and millions more whose parents are alive but due to poverty or other circumstances such as substance abuse can’t, or at least don’t, provide them with an optimal care environment—or sometimes even one that meets their basic needs. Consequently, millions of children, especially in low- and middle-income countries, turn to the streets in an effort to take care of themselves.
On one side is a large body of evidence, mostly historical and from Eastern Europe and North America, about the negative physical and mental health outcomes of children in institutions.1 In essence, the evidence clearly demonstrates that socially and emotionally deprived environments are bad for children and that institutions caring for infants, particularly in Eastern Europe and North America, have embodied neglectful environments. As a result of this evidence, there are global demands for universal deinstitutionalization.
Yet the paper by Gray and colleagues published in Global Health: Science and Practice challenges stakeholders to perhaps rethink these sweeping conclusions.2 Their data, from a multicenter cohort of school-aged children in 5 low-income countries, indicate that …