In recent years, more and more people are extending their families through international adoption. Understanding the medical, social and developmental issues unique to international adoption can help parents prepare for the special challenges and special needs of these children.
"The ramifications for the health of children coming from a Third World setting are profound," notes Julia Bledsoe, M.D., spokesperson for the pediatrics division at the University of Washington and mother of an adopted child. "It becomes very important for parents to become advocates seeking out physicians who can properly screen these children and being proactive in gathering information."
Medical evaluation for international adoptions has become important because of the demographic shift in adoptions in recent years. Currently, a majority of international adoptions are from China, the former Soviet Union and Eastern Europe, where medical care is less developed and where most children come from an orphanage environment.
"There are a lot of unknowns when it comes to adopting internationally, " Dr. Bledsoe explains. "Yet there are some things that parents and physicians can do to ensure that health issues are appropriately addressed."
Dr. Bledsoe recommends that parents make a pre-adoption visit to a health care provider to learn as much as they can about the health of the child. Any type of information, such as medical records, birth history, photos or videotape, can prove helpful for physicians. From this material, a child's basic medical condition can usually be identified, such as recognizing birth defects, abnormal lab results or growth patterns.
Although such evaluations can be helpful, Dr. Bledsoe cautions that they may not be completely accurate.
"These evaluations are often made with little or incomplete information, so there are no guarantees," she says. " It's important to take all information about a child seriously, but to also consider it suspect."
In addition to assessing a child's possible physical problems, parents must also consider issues of attachment and developmental delays. It's estimated that for every three months a child is placed in an orphanage, he or she will be delayed one month in development, Dr. Bledsoe says. Some, though not all, children recover from these delays when placed in a loving home.
After adoption, children should receive a thorough evaluation by a health care provider. Even if a child appears healthy, he or she may have underlying conditions that can only be determined with lab testing.
It's especially important to have children tested for conditions they may be at higher risk for developing. Children from China, for example, commonly have low dietary iodine and may develop hypothyroidism. Many children are affected by intestinal parasites, such as giardia. Also important is screening for hepatitis B, tuberculosis, hepatitis C, HIV, anemia and lead exposure. Immunizations should be checked, because these may have been falsified on records.
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