- Group sizes tend to be large (typically 9-16 children per ward, although in extreme cases the number may approach 70). The number of children per caregiver is large (approximately 8:1 to 31:1, although a few institutions have fewer children per caregiver).
- Most institutions have homogeneous groups with respect to ages and disability status. Children are periodically "graduated" from one age group to another perhaps as many as two or three times in the first two or three years of life.
- Caregivers for any single child tend to change constantly because there may be a high staff turnover; caregivers may work long shifts (e.g., 24 hours) and be off three days; caregivers may not be consistently assigned to the same group; and caregivers may get up to two months vacation. The result is that a child may see anywhere from 50 to 100 different caregivers in the first 19 months of life.
- Other adults tend to come and go in children's lives, including medical and behavioral specialists, prospective adoptive parents, and volunteers who may visit for only a week or a few months.
- Caregivers likely receive little training, and the training they do receive is more focused on health issues than on social interaction. They spend the vast majority of their hours feeding, changing, bathing, cleaning children and the room, and preparing food rather than interacting with the children. Caregivers are invariably female, so children rarely see men.
- When caregivers perform their caregiving duties, it is likely to be in a business-like manner with little warmth, sensitivity, or responsiveness to individual children's emotional needs or exploratory initiatives.
- These are the reasons why institutional care should be labeled as 'structural neglect' which is an institutional form of child maltreatment. Our studies on institutional settings in the Netherlands, Greece, India, and Ukrain document the large developmental delays of children growing up in orphanages.
Bakermans-Kranenburg, Dobrova-Krol, VanIJzendoorn 2011 GxE 5HTT moderates the impact of institutionalized care on disorg attachment, pdf file
Dobrova-Krol, VanIJzendoorn, Bakermans-Kranenburg, Juffer 2010 Physical and Cognitive Development of Children in Ukraine, pdf file
Dobrova et al. 2008 Physical growth delays and stress dysregulation, pdf file
Dobrova-Krol, Bakermans-Kranenburg, VanIJzendoorn, Juffer 2010 The importance of quality of care, pdf file