Many people like to consult with a physician when they are evaluating the medical report of a referral or for an evaluation of their child once they are home. In addition to sharing the report with your pediatrician, you might want to consult with a specialist with experience in international adoptions. These web pages that have lists of international adoption clinics and physicians.
Directory listing of physicians with a special interest in adoption and foster care medicine from the American Academy of Pediatrics.
The following clinic web sites are listed individually because they have information on them. It is not meant as an endorcement nor as a list of the only physicians that you should use.
Russian Adoption Medical Services was from Dr. Eric Downing, a Canadian MD living in Moscow. Information on medical reports and diagnosis, common medical report problems, translations and terms. This is where you want to start. Although Dr. Downing died awhile ago, they are maintaining the website because of all the important information on it.
Orphan Doctor is Dr. Jane Aronson, a pediatrician specializing in adoption medicine.
Adoption resources: general adoption resources - web sites, books and magazines; international adoption links for every part of the world
Medical resources: medical care abroad, info on common diseases, region-specific issues, general medical issues, her current research, medical photo library
Services: pre-adoption consultation, preparation for international travel, vaccinations for parents, post-adoption evaluation, follow-up care
Adoption Doctors has information on interpreting Russian medicals, developmental evaluation, answers to questions about adoption medicine (used to be "House Calls" on Welcome Garden), questions to ask upon referral, how to take a video for medical evaluation, etc.
International Adoption Clinic of the University of Minnesota. Infections diseases, screening tests, etc. Lots of information for pre- and post-adoptive families.
Topics in adoption and pediatrics: complementary/alternative medicine, diagnosis, development and learning, Eastern Europe, general adoption, growth and nutrition, mental health, parenting and attachment, prenatal alcohol and drugs, sleep, teeth, travel and transition.
Favorite books: adoption, parenting, attachment, sleep, development and learning, general pediatrics
Pediatric tools: growth charts, developmental milestones, Russian medical terms, how to take FAS photos, parenting by temperament, screening for autism in toddlers, children's sleep habits questionnaire, ADHD toolkit, FAS resource list.
Lots of links for adoption and parenting topics.
Ask the adoption docs.
Medical Resources: Following are resources, helpful to new parents as well as those with experience, for growth, development, and health concerns.
Where There Is No Doctor by David Werner is a good book to take on your trip. "Translated into over 90 languages, Where There Is No Doctor is considered the most accessible and widely used community health care manual in the world. This revolutionary health care "bible" has saved millions of lives around the world by providing vital information on diagnosing and treating common medical problems and diseases, and giving special emphasis to prevention. The book also includes sections detailing effective examination techniques, home cures, correct usage of medicines and their precautions, nutrition, caring for children, ailments of older individuals and first aid."
Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers by Laurie C. Miller, published August 2004. "Since 1989, American families have adopted more than 167,000 children from other countries. Many of these children have lived in crowded conditions, sometimes with poor standards of hygiene, inadequate nutrition, and limited numbers of caregivers. Some suffer from endemic infectious diseases. Upon arrival, practitioners often fail to recognize the unique concerns of this group. This text provides an overview of the specialized medical and developmental issues that affect internationally adopted children, offering guidelines to the physicians caring for these children and their families before, during, and after adoption. The reader will learn how to advise families prior to an international adoption, how to perform an effective initial screening assessment of the newly arrived child, and how to recognize and manage developmental and other more long-term problems as they emerge." Dr. Miller is an international adoption specialist at the Floating Hospital for Children in the Tufts-New England Medical Center.
From the Centers for Disease Control and Prevention (CDC):
A common question is whether the child's growth and development are normal, when evaluating a child before adoption as well as while raising them. Most experts say to expect a one month delay for every three months in an orphanage.
Across the Seas is a booklet that provides a structured assessment that parents can perform while in an orphanage with a child. This would be an excellent tool for parents traveling without a medical report. Also available from the same site: 10 Facts About Alcohol Use in Pregnancy .
From the same site as above is Risk & Promise "is written by a team of pediatricians, a clinical psychologist, and an infant mental health specialist based on their extensive research and clinical experience in working with children adopted from overseas. The first two sections of Risk and Promise provide prospective parents with information as it will come to them during the adoption process. Each major section is then divided into key subsections that focus the information on specific characteristics related to the child. The book?s third section consists of worksheets that parents can fill out to help them collect baseline information that will be helpful in both the short and long term. The authors? goal in writing this book is to insure that every adoption is a well-informed adoption that ultimately promotes the health and development of the child and the family." An online test is available which would count toward pre-adoption education requirements.
A common term on medical reports is APGAR scores. It is a system for evaluating how well an infant has adapted to extrauterine life within the first minutes of birth. See What is the Apgar score? for an explanation and description of how the test is scored.
Parents always want to know how their child's height and weight compare to normal, so here are sources for growth charts.
Lip-philtrum Guides to aid in diagnosis; avaialbe to order from the University of Washington. It is also available in English/Russian . They also offer a FAS Tutor CD-ROM "to instruct medical professionals, through video, computer animation and photographic examples, on how to screen and diagnose FAS."
Baby Center has parenting resources, from FAQ to experts to bulletin boards for various ages, and a sections on development for various ages.
Developmental Milestones on the Family Practice Notebook web site. Short list of milestones by age and area of development. This web site also has a list and critique of various screening tests. Talk to your pediatrician about what may be appropriate for you to do. Be aware that developmental screening tests are designed to be given by someone with training and may not be accurate when done by a lay person. Also, many of the early screening tools do not indicate problems later in life.
Age appropriate activities for 2 year olds , 3 year olds , and 4 year olds ; there are links at the bottom of each page for additional sources. I love these suggestions, but this web site tends to change the URLs frequently, so let me know if what I have here doesn't work.
Great Beginnings is a series of articles for parents of infants and young children, from newborn to 3.
Child Development Guide has developmental tasks for physical, intellectual, social, emotional, and moral arenas from birth to nineteen years. Also includes suggested parenting tips for each task.
Live and Learn has developmental activities from birth to age 5, divided into years. This site also has lots of other information that would be helpful to parents, from selecting a daycare to safety in the home.
If your pediatrician does not have a copy of the Denver Developmental Screening Tool (DDST), you can order it directly from the company Denver Developmental Materials, Inc. . The entire tool is complicated; I was actually taught how to administer it and interpret the results in nursing school, so it does take some training. There are other developmental screening tools that you can discuss with your pediatrician.
A Healthy Beginning Important Information for Parents of Internationally Adopted Children is a brochure put out by the American Academy of Pediatrcs for parents, discusses what to expect during the first medical visit.
Vaccine titres if you believe that the child has received vaccinations and do not want to repeat them. If the titres come back low, you might want to have the immune system evaluated by looking at immune globulins and white bloood cells before revacinating.
** laboratory tests should be repeated six months after arrival
Urinalysis with microscopic examination
Stool examination for ova and parasites; these sometimes require repeated tests, especially if symptomatic. It is helpful to know if other children adopted from the orphanage have any of these or other less common ones. (Giardia, Salmonella, Shigella, Yersinia, Campylobacter, Cryptosporidia)
Dental evaluation (for children older than 18 months)
Hearing and Vision screening
Developmental exam (pre-school)
Intelligence screens (school age)
Language evaluations (if speech problems suspected)
To receive a list of recommended post-adoption tests, along with procedural codes and codes for the laboratories, send a blank e-mail to Med Tests and you will receive the document in a reply. Furnished courtesy of EEAC.
The American Academy of Pediatrics, in their Red Book, comment that children over 12-15 months can be tested for immunity by drawing titers, noting that children that have been adopted internationally are now more likely to have been effectively immunized.
Parents Network for the Post Institutionalized Child is "a support network devoted to understanding the medical, developmental, emotional and educational needs of children adopted from hospitals, orphanages and institutions throughout the world." Information is available in their newsletter, and they have a large links section.
Additional links can be found on the Resources page.
Health Topic : links to many health concerns, including Alcohol . I used this data to create the following table. This lists the amount of alcohol consumed by an adult (over 15) per year. It is interesting to note that in looking at the historical data, the numbers for Kazakhstan have slowly been decreasing since independence from the USSR.
An international study on gender and alcohol known as GENACIS (Gender, Alcohol, and Culture: An International Study) is currently under way. WHO provided funding in Kazakhstan. Results are not available yet.
The following quote is from an Adoption Medical News [formerly at http://www.adoptionmedicalnews.org/] survey of adoption medical specialists, published in the January/February 2002 issue. The ranking scale was 1-10, with 10 being the best. "This country was ranked 7-8 by the experts and the consensus was 7.5. Because the comments from the doctors were 'children in excellent condition' or 'generally in good condition,' one might think the consensus should be 8. A more restrained endorsement was this one: 'children in excellent condition - babies that is; older children have all the issues of children from US foster care.'" To give you a frame of reference, here are the rankings of a few other countries: China 7-8, Colombia 8-9, Ethiopia 6-7, Guatemala 6-9, Korea 8-10, Russia 4-6, and Vietnam 6-7. Reprinted with permission.