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 Pediatricians and other healthcare workers should play a significant
role in the adoption process, the guideline authors emphasize.
"Adopted children often don't have full medical histories or have
experienced trauma in life, which leads to a more complex medical
exam when it comes to physical, mental or behavioral concerns," said
lead author Dr. Veronnie Faye Jones of the University of Louisville
in Kentucky.
"We've learned more in recent years about what prior trauma can do,
especially for brain development," she told Reuters Health in a
phone interview. "We should remind families that we're here to help
them along the journey."
In the new guidance, Jones and co-author Dr. Elaine Schulte of the
Children's Hospital at Montefiore in New York City outlined trends
in domestic and international adoption. They also review components
of the health evaluation, the preadoption visit, the initial medical
history review, the initial physical exam and chronic health
concerns.
Approximately 120,000 children are adopted in the U.S. each year,
they note. Most domestic adoptions occur through the foster care
system, with about 50,000 adoptions per year, typically at around
age six. About half are adopted by foster parents, and another third
are adopted by relatives.
International adoptions have been decreasing in recent years, they
point out, primarily due to changes in several countries' policies,
concerns about illegal or unethical practices by adoption services,
and issues with unregulated custody transfers of adopted children.
Just 5,372 immigrant visas were issued to children adopted abroad in
2016, down from 7,037 in 2015 and a 77 percent drop from the high of
23,000 adoptions in 2004. The greatest number of adopted children
came from China, the Democratic Republic of the Congo and Ukraine in
2016.
Although international adoption numbers have dropped,
medically-complex cases have grown, said Dr. Susan Friedman,
director of the International Adoption Health Program at the
Children's Hospital of Philadelphia. She sometimes sees undiagnosed
medical issues when working with families during the pre-adoption
process.
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"Proceeding without having the records reviewed by a specialist in
international adoption is dangerous, especially because this can be
done electronically," she said in a phone interview. "Fragmented
medical care can manifest itself in many ways that can be
misinterpreted or mislabeled."
A comprehensive medical evaluation can confirm or clarify medical
diagnoses, including oral health problems, developmental concerns
and behavioral issues. Several visits may be necessary to review lab
findings and make referrals to other specialists who can help.
Many children may have faced adverse childhood experiences such as
poverty, inadequate prenatal care, malnutrition, exposure to drugs
or alcohol and child abuse that should be addressed.
Importantly, all children will need sensitive care, the guidance
says. Healthcare providers and parents should proceed slowly, be
aware of the child's cues and provide reassurance throughout the
exam process. This is also a good time to address adjustment issues
and transitions that may lead to temper tantrums, aggression, sleep
problems or eating problems, and develop strategies to promote
strong, healthy attachments that address the child's need for extra
security around food, sleep and family.
"Even children adopted out of domestic foster care and residing in
the adoptive home for a period of months or years may never have had
a comprehensive health evaluation, although the adoptive family is
likely to have a great deal of insight into the child's health
issues," said Dr. Moira Szilagyi of the University of California,
Los Angeles.
"A commitment to adopting a child is life-altering for both the
child and the family," she told Reuters Health by email. "Health
specialists in adoption, foster and kinship care can assist adoptive
parents with understanding the scope of their child's past
experiences, how they might impact current and future health issues,
and how they might best help their child achieve their fullest
potential moving forward."
SOURCE: https://bit.ly/2vBJzA0 Pediatrics, online April 29, 2019.
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