Medical Screening Recommendation Your Child’s Health After Adoption
R. Scott Krupkin, M.D.
It has been a long road, but now you are home with a new child. Health concerns are paramount to parents. Medical and mental health data about your child is probably limited. If you do not have a primary care physician yet, read the section on "Finding a Doctor After Adoption". This next section is to inform you about medical issues and follow-up specific to children adopted from foreign countries.
The first step is to set-up an appointment with a pediatrician or family doctor as soon as possible after returning home. Adoption medicine is a growing subspecialty. There are several international adoption medicine centers now established in various locations in the United States. To locate the nearest center to you, I recommend checking the International Adoption Medical Clinic Directory for Pediatric & Children’s Health (www.comeunity.com). Another good reference regarding the health of foreign adopted children is "The Complete Guide to Foreign Adoption" by Barbara B. Bascom, M.D. and Carole A. McKelvey, M.A. This book can be purchased through your local bookstore.
Background: Up until now, your knowledge about your new child’s health has been limited to medical summaries that are often incomplete and misleading. You may have seen photographs or a video of the child. This information may have been reviewed by a physician. Since this information is likely to be very limited in scope, a comprehensive medical evaluation at home should be obtained within 72 hours of your return to the United States. During this visit, your doctor should review with parents any medical information, including available medical records, known family and birth history, known allergies, immunization history, and known medical and mental health problems. This is followed by a complete physical examination of all body systems head to toe. Part of this examination should include developmental and grown parameters. Doctors often us screening tools such as the Denver Developmental Screen to help gauge how your child has matured compared with their chronological age. The use of a growth chart to map height, weight and head circumference for your child in comparison with expected norms. I caution parents and health care providers to take this initial information with some skepticism. It is well documented that foreign and institutionalized children often fall below anticipated growth curves, and usually exhibit some degree of developmental delay due to living in an orphanage. What is important is to obtain baseline data about your child and monitor how they respond to their new lives.
Children with known medical problems may require evaluation by an appropriate specialist. Your primary care physician should be a facilitator for these appointments, if necessary. Do not be afraid to discuss your ideas and concerns with your child’s doctor. If your find communicating with the physician difficult, then say so. Most doctors want to be responsive to their patients and parents.
Diagnostic Testing: Your pediatrician may recommend some tests to better understand your child’s health status. Obtaining blood for testing is common. There is no specific guideline on what tests to perform, but adoption medicine specialists suggest the following blood tests: Metabolic screen to measure electrolytes and renal function. Complete blood count to rule-out anemia and other hematological abnormalities. Rickets screen to determine Vitamin D deficiencies. Liver function tests, including screening for Hepatitis B & C. Testing for other infectious diseases such as HIV and syphilis. Thyroid function testing to rule-out another cause of growth deficiency. Toxicology screening for lead exposure. Urinalysis. Stool testing for culture, ova (eggs) and parasites (giardia and pin worms are common causes of persistent diarrhea and irritability among children living in foreign countries). There are literally hundreds of blood tests that can be performed to diagnoses various disease states. Those listed above are suggestions of where to start. Another commonly ordered blood test is for levels of Glucose-6-phosphate dehydrogenase which is an enzyme. The use of a PPD skin test is recommended to rule-out tuberculosis, but remember that persons exposed to Tb (but do not have the disease) and children who received a BCG vaccine may test positive. This is one reason a chest xray may be performed to rule-out respiratory tuberculosis. Children with bone or other deformities may go on to have further musculoskeletal xrays and chromosomal testing. Hearing and vision should also be evaluated.
Vaccinations: The use of vaccinations to prevent disease remains a controversial topic for all parents. The scientific literature indicates that childhood vaccination has reduced morbidity and mortality from may infectious diseases, but not without risks. Small numbers of children have negative allergic reactions to some vaccines. Usually these reactions are mild causing a rash or swelling. But severe anaphylactic reactions may result in acute respiratory distress, cardiac and neurological complications, and even death. Current recommendations are that foreign children should start a full series of standard vaccinations, even if they have received some vaccines while living abroad.
Worrisome "Red Flags": All new parents wonder when to call the doctor. Foreign adopted children are no different from biological children when it comes to coughs, colds, bumps and scrapes. Tender loving care and commonsense usually leads to a "cure". But that does not change the protective nature of parents. My rule is: ‘when in doubt, call the doctor’. Here are some guidelines on when to call: Fever greater than 100 degrees F. Wheezing and difficulty breathing. Forceful or repeated vomiting. Persistent diarrhea. Blood in stool or urine. Frequent, inconsolable, or high-pitched crying (e.g. irritability). Persistent lethargy. Unwillingness to eat or drink. Yellow or orange skin or eyes. Sudden rash, blisters or irritated skin. White patches in the mouth. Any unusual discharge from the eyes, nails, navel or genitals.
While you have traveled a long way down the path of adoption, the journey is still in its early stages. Take advantages of the resources provided by your doctor and community. Do not forget that your adoption agency should continue to provide back-up to help address any problems after coming home. Most good agencies have a "helpline" to assist you with emergencies or simply to have someone to talk to about your questions and concerns.
