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Medical
Resources :: General Medical Issues :: Medical Evaluation of the Internationally
Adopted Child (page 2 of 3)
| Medical Evaluation on Arrival |
| • Newly adopted child should be seen
within a week of arrival |
| • Make allowances for a possible initial sick visit
with a follow-up consultation later |
| • Physical Exam with attention to diagnoses known
from prior medical abstracts from the country of origin-heart murmur,
dysplasia of the hips |
| Pediatric Annals April 2000 Aronson |
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| Developmental Assessment |
| • Look at the child’s development
and see them in 6-8 wks to re-evaluate the development, growth, and
adaptation to the new home |
| • Early Intervention referrals should be considered
for children 12-15 months with delays in expressive language, children
with oral motor dysfunction, and sensory sensitivities, and obvious
gross motor and fine motor delays that are more than expected for
an institutionalized child |
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| Sensory Integration Dysfunction |
| A. Jean Ayres, Ph.d., OTR 40 years ago |
| • Children are living in an environment that is
devoid of normal stimulation |
| • Children may not be wired to handle the sensory
input of their “new world” |
| • Response to light, sound, taste, touch can potentially
be unusual and distracting |
| • Occupational Therapy focuses on retraining children
to handle sensory input comfortably |
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| Sensory Integration Dysfunction (SID) |
| • Interoceptive |
| • Tactile |
| • Vestibular |
| • Proprioceptive |
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| Sleep Disturbances |
| • Jet lag-give it a week at least for
the baby and maybe two weeks for you |
| • Sleep issues of children in general are complex;
make a family plan and re-evaluate the plan in a few months |
| • Cultural biases--co-sleeping and the family bed |
| • Night terrors--Are they more common in orphans? |
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| Feeding Behavior |
| • Bottle propping |
| • Speed feeding |
| • Rickets and malnutrition |
| • Lack of heterogeneity of food stuff |
| • Oral motor dysfunction |
| • Sensory Integration Dysfunction |
| • Speech and language delays |
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| Age |
| • Dates of birth may not be accurately
assigned due to abandonment |
| • Bone age and dental x-rays are inexact, but certainly
can be of some use in children who are adopted at school age |
| • Developmental assessments over time are much
more accurate |
| • Reassigning date of birth may be necessary for
proper school placement |
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| Laboratory Evaluations |
| • CBC with diff, plts, rdw |
| • Hemoglobin electrophoresis-Asia, Latin America |
| • G-6-P D Asia, Latin America (male) |
| • Rickets screen-alk phosphatase, ca, phos |
| • Liver enzymes (AST, ALT) |
| • Thyroid function tests |
| • Newborn screen for infants < 6 mos. (includes
thyroid, PKU, and HIV tests) |
| • Hepatitis B, C serology-initial and 6 mos |
| • Syphilis serology-RPR, FTA-AB |
| • HIV 1, 2 initial and 6 mos later |
| • Lead (venous) |
| • Stools O & P X3 |
| • Giardia antigen, Cryptosporidium DFA |
| • Stool C & S X1 |
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| Medical Investigations |
| • PPD (Mantoux test) on arrival and
6 months later |
| • Hearing evaluation--Audiology |
| • Vision screening--Pediatric Ophthalmologist |
| • Dental Care--Pediatric Dentist should see children
by 18 months |
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| Prevalence of Infectious Diseases Among
Internationally Adopted Children |
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|
Saiman, Aronson, Zhou et al.
Columbia University, Winthrop-University Hospital, International Pediatric
Health Services, Division of Tuberculosis Elimination, Centers for
Disease Control and Prevention |
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Pediatrics September 2001 Vol. 108, no.
3, 608-612 |
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Winthrop-University Hospital International
Adoption Medical Consultation Services, 1997-1998 |
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• 504 children |
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• Mean age: 1.6 years (range 11 days
to 11.7 years) |
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• 71% female |
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• 29% male |
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• 16 countries: China (48%), Russia
(31%), Southeast Asia (8%), Eastern Europe (8%), and Latin America
(5%) |
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Latent TB Infection by Country |
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• Tuberculosis exposure-404
children tested with Mantoux and read by physician |
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• 75/404 (18.6%) greater than or equal
to 10 mm with negative chest films (LTBI) |
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• China 21/201 (10.4%) LTBI |
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• Russia 40/133 (30%) LTBI |
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• Other 14/70 (20%) LTBI |
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Hepatitis B Carriage |
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• 14/499 (2.8%) were positive
for Hep B surface antigen |
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• 8/240 (3.3%) from China Hep BsAg
+ |
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• 4/154 (2.6%) from Russia Hep BsAg
+ |
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Hepatitis B Vaccine |
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• 175/499 (35%) Hepatitis
B surface antibody positive |
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• 96/499 (19%) received Hep B vaccine |
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• 42 of 96 received 3 doses and 29/42
(69%) seroconverted |
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• 21 received 2 doses and 14/21 (67%)
seroconverted |
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• 32 received 1 dose and 8/32 (25%)
seroconverted |
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| What Can Go Wrong with Immunizations in Orphanages? |
| • No cold chain |
| • Expiration of products |
| • Poorly produced products in some countries |
| • Malnutrition and poor immunogenicity |
| • Country specific schedules |
| • Given too young |
| • Intervals too close |
| • Poor documentation |
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