Tuesday, December 27, 2011

Estimating Age of International Adoptees

MedPage reports on an article in the journal Pediatrics:
International adoptees often arrive in the U.S. with an incomplete birth certificate and medical history, thus questions arise as to the child's accurate date of birth. As a result, pediatricians are often called upon to render an age determination based on standard measures, such as dental eruption and radiographic bone age.

When making an age determination, a difference of a few weeks or months will not matter as much in children under the age of 1. But for an older adoptee, age determination could influence placement in school, wrote Veronnie Jones, MD, PhD, and colleagues on the AAP Committee on Early Childhood, Adoption, and Dependent Care.
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Delaying any changes on the birth certificate more than a year after adoption allows for "catch-up growth" and extended observation of the child's physical and emotional development, they wrote in a clinical report in Pediatrics.
I've known parents who had their adopted child's age changed, some based on medical evidence that the given birth date is likely inaccurate and some based on an assessment that the child was developmentally delayed and needed to be thought of as younger to allow for catch-up.

That second reason strikes me as problematic, for once the child catches up, they are still physically older than their records indicate.  That would be an advantage in everything from Little League to behavior expectations in school.  And that added year may be a serious disadvantage, too, as this article (where an international adoptee is charged with statutory rape, and there's a question as to his actual age, which would make a difference in whether he is in fact guilty) illustrates.

I'm not generally in favor of changing anything in the child's history before adoption, it just creates a false history, and we already do plenty of that with fake birth certificates.  I see the role of adoptive parents as preserving that history, not altering it. But what if there's reason to believe that history prior to adoption has already been falsified?  Does that make a difference?

There's some uncertainty as to my children's actual birthdates.  Maya's birthdate was estimated in China, and the evidence that suggests Zoe's birthdate may have been fabricated. Still, it's likely that if their birthdates are off, they are only off by days, not months or years, so I think we're luckier than many. . . .


Sarah said...

My mom changed my brother's to be 9 months younger than what we were given - he was supposed to be turning 4 and he just seemed so, so young. After the change he was 6 months younger than my sister, who he was definitely physically, emotionally, and developmentally younger than. They very much had a younger-brother-older-sister relationship as soon as they met (she came to China with us) even though he called her "mei mei."

We used dental evidence to change his birth month when we went through the readoption process (he didn't have his 3 year molars or something). And we only did it, I think, because he was found at a very late age (between 1 and 2) and we figured the orphanage's guess couldn't have been any better than ours.

I see what the article is saying and it's good advice. He could have been stunted by malnourishment when he was younger or something. But I'm sure it would have been a lot more complicated to change the birthdate a year later, instead of doing it during the postadoption paperwork.

And this all could have been better if our insurance had actually covered a visit to the international adoption clinic!!!!!!!! Sheesh.

I have no idea how he'll feel about this when he's old enough to understand it (just like the million other choices parents make with transracial adoptees...), but it's not like we did it on a whim. He doesn't have to feel self conscious about being shorter than his sister now, and they're at the same grade level so that's not an issue, and we also saved him from a Christmas birthday. ;)

Anonymous said...

Wasn't there an article recently about an adoptee's reunion and the birthdate was several months off?
I imagine this happens all the time.

As an alternative to changing a child's given birthday, I would have my child repeat or delay kinder.

Karen said...

I have two a-brothers from Korea. The oldest one was aging out of the IA system, so everyone is fairly certain they made him younger than he really is, in the orphanage. The younger one was 2 when they adopted him, so his age seems more accurate.
Honestly, I don't have a problem with lowering the age if they are delayed that much, and the true birth date/year is unknown.
The older children are when IA occurs, the higher the chances that the child might never really "catch up".
My brother who is older than the other one is still, IMO, "slow" even though he is somewhere between 30 and 35 years old. I attribute that to the fact that he was abandoned when he was probably 3or 4 years old, and left in a park. He remembers a woman and a man vaguely, (possibly his mother and the father of the mother's second child). And he remembers going to the park. And the orphanage attendants documented that he was very attentive to the babies, so most likely he had a younger sibling conceived by a different father, hence, having to abandon him at such an older age. He has never quite gotten over all the trauma of his childhood before being adopted at age 5-8. The orphanage said he was 5, but he was tall and looked older at the time. My dad and step-mom however, stayed with the younger age they were told, because of his emotional delays. I probably would have too, if he were my child. It was obviously BEST for the child at the time.

Karen said...

This topic does, though, bring up an interesting aside.
It's why I also do not agree with people posting pictures of children and saying, "This child's file is going to be returned soon. Consider adopting him/her if you're still waiting to adopt". Nor do I agree with people advocating for SN or older children to avoid the longer waits, and giving testimonial at the same time that they did it, and they had a happy ending.
That is what happened to my dad and step-mother and their adoption agency. They wanted a younger child. The agency director showed them the picture of the older child, and said his file was going to be withdrawn by the orphanage soon. My dad and step-mother adopted him, IMO, based on their own belief that they could "save" him from being raised in an orphanage for the rest of his childhood. This has caused a lot of grief for him and my dad/step-mom. NO ONE should ever adopt because a child is aging out of the system, or because they want to save a child. And some people are just not cut out to raise SN children or children with emotional problems.
Their second child whom they adopted at barely 2 years old was not delayed. And he has always been their "golden boy". My dad and step-mother would have been a LOT better off if they would have adopted two younger children, than continually putting the younger one on a pedestal, which also added to the mix of the older child's emotional and self esteem issues. No matter how much they would have liked to have saved a child, in this case (and probably many others like it) the agency did a huge disservice by working on the emotional guilt of my dad and step-mother with the concept of "if you dont adopt him, he will live out his childhood in an orphanage".
I really cringe when I see people post about SN children or older children needing to be "rescued", and then giving testimonial about their own adoption experience of SN or older children, as a success story, especially because I believe a lot of people make see those posts or pictures and then those types of decisions based on their emotion (or feelings of karmic guilt) and not based on rational thinking of whether or not they have the capacity to deal with the difficulties of SN or older child adoption.

veggiemom said...

My older daughter was adopted from Ethiopia. At the time of her adoption, she was 5 1/2 on paper but was adamant she was 7. As I got to know her, I became more and more convinced she was correct. The problem was she didn't know her birthday. I changed her age at readoption, making her a little over 7 at the time of her initial adoption by me. We later found her first family and found her true date of birth, which made her 6 months older than the new birthday I'd given her, making her almost 8 at adoption.

This has been huge for her. Even though she was very small at adoption, she caught up quickly. Emotionally, she was more mature than her classmates and started to develop physically much sooner (she'd initially been placed in school based on her paper birthday.) It was very hard on her to be 2 years older than her school peers. We were lucky that the school has worked with us and my daughter was able to move up a grade this year (now she's just one year behind...not so problematic since that is quite common).

Being older isn't always easy on or better for kids. My daughter was teased and questioned quite a bit about her situation. When one child learned of her age and grade, she said to my daughter, "what are you? stupid?"

It's a difficult decision to change a child's age but is sometimes for the best. All factors about physical and social development need to be considered. It's important to remember that under aging can be just as problematic as over aging.

Sharon said...

When a birthday has been medically estimated, and then it becomes evident that the estimate is wildly incorrect, then I see nothing wrong with adjusting the child's legal birthday if it appears to be in her best interest. It's not always a case of willfully falsified records. If a child isn't born in a hospital and has no original birth certificate, which is the case for millions all over the developing world, estimating is the only option at adoption. My own grandmother, born at home in a rural part of the US, was never sure if she was born in 1908 or 1910 because she had no original birth certificate. Later, when she needed to obtain an official document as an adult, her mother signed a statement that it was 1910, but nobody was really certain.

Karen said...

It's curious that there was that much of a gap of 2 full years with your great grandmother not knowing when your grandmother was born. I find that fascinating.

Anonymous said...

Karen, your advice is good but too often falls on deaf ears. One adoption forum I belong to is always advocating adoption of hard to place children with their rainbow stories. if anyone posts caution, or their own less than rosey experiences, that poster is labeled as "being negative". There is also a strong religious preference that advocates for these children and so it is layered with the savior complex.

Liz said...

I'm glad the subject of international special needs adoption was brought up. It's a bit of a double bind: while the "savior" language is obviously extremely problematic, when it comes to some adoptions -- particularly SN adoptions out of Eastern Europe, where the policy is to institutionalize unadopted SN kids at ages 4 or 5 -- it's unfortunately also accurate. Adopting special needs also seems to be a different kettle of ethical fish: these are not healthy infants (for which the demand is much greater than the supply) but children with moderate to severe health conditions (for which the supply is much greater than the demand).

Diane Sawyer actually did a piece on Reece's Rainbow and international Down Syndrome adoption the other night. Take a look. Malinda, I would LOVE to hear your opinions on this!


Liz said...

Oh, two more important details about what I just posted:

- The waiting list domestically to adopt a child with Down syndrome is 2 years long

- Reece's Rainbow focuses a great deal of their ministry on programs in Eastern Europe which encourage parents to keep their children with Down syndrome

Meredith said...

Greetings all,

I'm newish to this forum (We are in the process of adopting a "SN" son from China.), and wanted to begin with a thank you as I've learned so much from the posts and comments. I also wanted to add my agreement that prospective parents of a SN child need to be fully informed on the child's immediate/ transitional and long-term needs and brutally honest with themselves as to whether they actually parent this child. I agree that a "savior" mentality can be counter-productive if it whitewashes the reality of whether they can parent the child day to day to weeks to years; and further if the child perceives that he was worthless, i.e. in need of saving. We took part in a DSS-type adoption training which was invaluable in helping us determine what types of needs we felt prepared to parent as well as learning about the available resources and support systems.

Also, I was surprised to see the waiting list numbers for Downs Syndrome children. We recently had experience with an agency attempting to place a downs syndrome newborn. After a two-week national outreach, they identified only one qualified family.