Dr. Jane Aronson, December 4, 2007
Those families who receive referrals of children who come into care without a known birth date need to be mindful of cultural and clinical factors related to age assignment. Even though doctors may be called upon to make the guess in the child’s country, there often is insufficient information to determine the age accurately. The reality is that the final determination of age will not be able to be made until the child has arrived and been in the U.S. for a couple of years. With more awareness of the difficulties with age assignment, I believe better age assignment will occur.
Russia, Guatemala and most other countries where children are born in hospitals and are placed in orphanages or foster care directly from the hospital.
Over the last few years, as adoptions have sharply increased, age assignment for abandoned and/or disadvantaged children referred for adoption has become a very important issue for families adopting from Ethiopia. The following is a list of factors making this issue of age assignment among children from Ethiopia very challenging.
How do I help families handle the complexities of age assignment for older children?
Based on what we know about the eruption of the primary dentition, children start having teeth at about 6 months of age (kids can be 15 months and have no teeth in some cases and this is normal) and complete the eruption of 20 teeth by 30 months (some kids don’t have all 20 teeth until they are 36 months of age). Knowing these facts can be somewhat helpful in assessing the ages of infants and toddlers.
If the child is less than 7 years of age, the primary teeth may not have been replaced as yet. If you have adopted a child who is assessed as perhaps 3 years old and there are permanent teeth, then you likely can make a good guess that the child is at least 5 years of age or more. Children do not usually lose primary teeth until they are 5 years of age. This guesstimate of age should be reinforced of course by social and intellectual abilities.
As an adoption medicine specialist, I ask parents to wait for two years before doing anything and to use this time to collect data. Visits to the pediatrician will be useful because developmental screening is part of each visit. Children will grow and develop and do the amazing catch-up that we frequently see over time. Children will have play dates and it will become apparent over time how close in age the child is to peers. For children who take classes and attend school, teachers will observe the child and can report on the behavior and class participation which will be helpful with cognitive assessments. The teachers will also know the social maturity of the child. Teachers see how the child performs socially and can report on that behavior. This wait-and-see approach maps adaptation and is a better way to assess a child’s age. Older children may also be able to share how old they are, once they have learned English and attach to their family.
Once this two year adaptation period is complete and we have gathered valuable data from teachers and parents/family/friends, I suggest a set of dental x-rays and a bone age, which is a set of x-rays of the right hand and wrist or in some cases knee x-rays. Children do not mature at the same rate. Just as there is wide variation among the normal population in age of losing teeth, the bone age of a healthy child may be a year or two advanced or delayed. The eruption of teeth and the replacement of the primary dentition with permanent teeth is quite variable. Age estimated through developmental and school assessments may be supported by bone age and dental x-rays to arrive at a final assessment. If the x-rays and dental films are not revealing, which is common, I don’t use them to determine actual age.
Internationally adopted girls may menstruate early and have precocious puberty which is not well-understood. Some families have used menstruation to help estimate age, but this may be a misleading way to determine age. If however it is determined that the child does not have precocious puberty, menstruation could be helpful.
Those families who receive referrals of children who come into care without a known birth date need to be mindful of these cultural and clinical factors related to age assignment. Even though doctors may be called upon to make the guess in the child’s country, there often is insufficient information to determine the age accurately. The reality is that the final determination of age will not be able to be made until the child has arrived and been in the U.S. for a couple of years. With more awareness of the difficulties with age assignment, I believe better age assignment will occur.
Changing the date of birth in family court in the U.S. can be arranged after the age has been determined with letters of support from the family, teacher, pediatrician, and supporting documentation (dental x-rays, bone age x-ray report can be offered if they support the other psycho-social and developmental pieces of evidence).
|This page last updated December 6, 2007 4:58 PM EST|