Adopted Children Bring Growing List of Problems With Them

A report from the American Academy of Pediatrics annual meeting,  in the Internal Medicine Digital News, discussing both medical and psychosocial issues (I found the latter a great reminder of important points, so I've highlighted it in red -- scroll down if you want to skip the medical stuff):

It’s hard to grow up in an orphanage – quite literally. Small stature figures prominently on a growing list of problems that children adopted from abroad are bringing to the United States, according to two adoption specialists.

“More children are being placed in-country,” said Dr. Elaine Schulte, medical director of the International Adoption Program at the Cleveland Clinic Children’s Hospital, one of two speakers who outlined current trends in international adoption at annual meeting of the American Academy of Pediatrics. “Fewer healthy children are available for international adoption, and families are pushed to accept sicker children.”

The number of foreign adoptions to the United States has dropped roughly in half from 2004 to 2009, when it reached 12,753, according to figures from the U.S. Department of State cited by Dr. Schulte. Those children available are more likely to come with serious medical problems. Among the most common are cleft lip and palate, congenital heart disease, Down syndrome, orthopedic problems, amniotic band deformities, and infectious disease such as hepatitis B and C, and HIV.

Only 20% of internationally adopted children have no special medical or developmental issues; in 60%, these problems are mild to moderate and in the rest, severe, Dr. Schulte said.

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Families who want to adopt get very little information about the children’s backgrounds and health, and are getting even less time than in the past to decide whether to take these children home.

The adoption process itself can lead to health issues. The adopting families may encounter infectious diseases in the general population of the child’s country, and they may be infected by the child they are adopting. “I always remind them that they have to take care of themselves,” said Dr. Schulte, herself the mother of two children adopted from China. “What are you going to do if you get sick, and you have to take care of the child?”

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The second speaker, Dr. Sarah H. Springer, medical director of the International Adoption Health Services of Western Pennsylvania, recommended a wide range of lab tests, including a CBC, lead level, stool test for ova and parasite (O&P) (3), rapid plasma regain (RPR) or VDRL (Venereal Disease Research Laboratory) tests for syphilis, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HbsAb), hepatitis B core antibody (HbcAb), hepatitis C virus (HCV), HIV-1 and HIV-2, a tuberculin skin test (PPD) or an interferon gamma release assay (IGRA) test if the child is older than 5 years of age. These should be rechecked after 6 months, because some diseases take that long to seroconvert.

Whatever immunization records the child brings are unlikely to meet the AAP and CDC standards. “You can’t take anything you get from another country at face value,” said Dr. Springer, also of Kids Plus Pediatrics at the University of Pittsburgh Medical Center. One increasingly common exception is immunizations supervised by the U.S. State Department. Even if records do meet standards, you should check titers.

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Among the common psychosocial issues likely to crop up in this visit are the following:



• Malnourished youngsters may hide food in their pockets, their beds, or even their cheeks. They also may eat ravenously. Dr. Schulte’s advice: Let them have as much food as they want so that they will lose their fear of scarcity.


• Some children are affectionate with everyone because they are so starved for attention. They must learn to distinguish between strangers and family.


• Some are stubborn or angry, testing to see whether their new families really want to keep them. Parents must simply insist that they will always be there for these children.


• Other children may cling to one parent, crying uncontrollably if left for even a minute. Dr. Schulte advised helping these children by playing with them on the floor until they let go, then getting up to leave, promising to return and fulfilling the promise each time. Caregivers can start with separations of a couple of minutes, then gradually increase the interval.

• Adopted children may not sleep well. Because they often fear abandonment, Dr. Schulte advised against using “cry-it-out” technique to teach them good sleep patterns.

• Many children rock themselves or display other self-stimulating behavior which they embraced because they didn’t get any other stimulation.


• Internationally adopted kids have elevated rates of schizophrenia, bipolar disease, fetal alcohol syndrome, attention-deficit/hyperactivity disorder, and a host of other mental illnesses.

So after that first visit, see the children often. Many will grow swiftly, catching up to their normal height, overcoming emotional challenges, and recovering from illnesses. Others will need years of special education and other support.

If you're about the travel, or have recently returned from an adoption trip, I'd highly recommend sharing the whole article with your child's pediatrician. It includes specific information for billing and insurance purposes.

I know personally that the recommendation to retest kids six months after the first testing  is important -- Zoe tested negative for TB exposure the first time and positive for TB exposure the second time.  We were so fortunate that our EXCELLENT pediatrician knew to retest, so we could promptly treat Zoe and avoid future problems.