Objective: To examine the associations between duration of institutionalization, age at abandonment, and mental and physical health outcomes of young institutionalized children in Romania and to examine patterns of associations between placement history, physical growth variables, and psychiatric symptoms. Method: Institutionalized children (ages 2-6 years) in a Romanian orphanage were studied through caregiver reports. Orphanage staff completed questionnaires on the children's psychiatric symptoms and physical growth measurements and placement histories on the children. Results: Children showed high rates of developmental delays, anxiety/affective symptoms, and physical growth delays. Patterns of associations between history and growth variables (duration of institutionalization, age at abandonment, and physical stature) and psychiatric symptom clusters were examined using three sequential multiple regressions. Longer duration of institutionalization and shorter physical stature were significantly associated with anxiety/affective symptoms ([F.sub.3,47] = 6.49, p < .01). Physical stature was significantly associated with developmental delays ([F.sub.3,47] = 5.603, p < .01) and disruptive behaviors ([F.sub.3,47] = 2.832, p < .05), with smaller stature being associated with greater developmental delays and fewer disruptive behavior problems. Conclusions: Institutionalized children demonstrate high rates of psychiatric symptoms. Duration of institutionalization, physical stature, and age at abandonment differentially relate to psychiatric symptoms. Findings are interpreted in light of implications for intervention and social policy. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(10):1283-1292. Key Words: institutionalization, deprivation, physical growth.