Infections, immunization status and medical history are several of the key issues that physicians must consider when evaluating internationally adopted children, according to Dr. Jane Aronson, Director, International Pediatric Health Services, PLLC in New York City. In this interview, Aronson, who has treated more than 1,300 children adopted from abroad by U.S. parents, tells physicians how to interpret medical records and what health issues to look for in these children.
In your experience, how reliable are the medical records
from other countries?
|In your experience, how
reliable are the medical records from other countries?
Aronson: I don't think of reliability as the issue. Every country creates a medical abstract which is standard for that country; this record reflects cultural and philosophical differences. Physicians from different cultures may have unique medical training and think about health in ways that we might not understand. Adoption medicine specialists learn the characteristics of these records from each country and this helps us explain the information to prospective parents. The information in the records is scanty and reflects social dysfunction. Children are abandoned in hospitals and there is little opportunity to collect prenatal information. The majority of women who abandon children in maternity hospitals do not have prenatal care. The orphanage staff physicians receive incomplete records from these hospitals. Orphanage records may often be quite detailed with regard to feeding, growth, and illnesses, but there is little time or money to translate this information when the pre-adoption medical record is created. Staff in orphanages are not trained physicians and there is little guidance from medical personnel. Measurements of weight, height, and head circumference which are really our signposts of health in a growing child, may be inaccurately recorded because of poor skill and inadequate equipment. It is essential to not judge why the records are poor, but rather to determine which data is useful for parents. Pediatricians who specialize in the review of these rudimentary documents usually provide a list of questions for the parents to present to their agencies to attempt to fill in some of the voids. Current measurements, better photographs, and sometimes if we are lucky, video is requested to enhance the understanding of the child's developmental status.
Let's look at China as a specific example. In China, infant girls are abandoned due to the "One child family policy" and the preference for male heirs who must care for their elderly parents. Thousands of abandoned children are truly "foundlings" and there is no medical history available when they are placed in an orphanage. Prematurity, intrauterine growth retardation, hypoxia and poor Apgar scores, congenital infection, and the type of delivery are conditions that we will not know about.
|What are some of the
key infections that pediatricians should look for in children adopted from
Aronson: There are a number of infections that are commonly found in children adopted from abroad. Let me highlight a few.
|What role does hepatitis
B play in international adoption?
Aronson: 3.3% of children from China and 2.6% of children from FSU are hepatitis B carriers from a study of my practice. Most of these cases are reflective of maternal-infant transmission. Children from China cannot benefit from vaccine at birth because they are abandoned and in other countries the vaccine is not readily available. Most children are tested in the first few months of life which may not reflect the lengthy incubation period of Hepatitis B infection (6 weeks-6 months). The quality assurance commonly found in labs in the U.S. may not be available in countries abroad which may also explain inaccurate testing.
|Do you see a lot of Hepatitis
Aronson: Out of 1, 300 children who I have
tested for Hepatitis C, I have two infected children and they are both
asymptomatic; they have negative PCR RNA tests and are considered "immunotolerant".
I think that we need to continue testing children for Hepatitis C infection
because epidemiology changes over time. The story is evolving.
|Is HIV something that
adoption clinicians should be concerned about?
Aronson: This is an unfolding story. Each country has its own story which we must follow closely. There are always reports of increasing prevalence of HIV in different countries. There have been a few children who have been found to be HIV-infected after they were adopted by American families. This may reflect inadequate laboratory technique in the country of origin. As adoption specialists we advise families about how to interpret HIV tests.
|What types of immunizations
should children adopted from abroad receive upon arrival in the United States?
Aronson: Most of us are basically redoing the
entire immunization schedule for children adopted from abroad, except
for children from Korea and some in foster care from Guatemala. This approach
is based on what we have experienced when we study the immunization records
from abroad. Intervals are not appropriate, expiration dates are not honored,
and vaccines may even be dated before the child was born. We also know
that vaccines are not kept refrigerated and that children who are malnourished
may not respond to vaccines. For older children, checking antibody titers
may allow for the creation of an individualized schedule to meet the unique
needs of the child.
|How should families prepare
themselves for travel when they are adopting a child from abroad?
Aronson: All families need to be prepared for
travel and this involves a three-prong approach:
I have created a section on this web site called International
Medical Clinics which includes a list of most accredited clinics in
cities where families commonly travel for adoption. Individual web sites
for these clinic systems are also available on the internet. I am also
available to my families for calls from abroad for trouble- shooting.
Vaccines which are baseline for travel abroad for adoption include: Hepatitis
B, A, updated tetanus/diphtheria (once every ten years), measles, mumps,
rubella for those born in 1957 or after, chicken pox vaccine for those
with no documented history, influenza vaccine during the winter season,
and cholera and typhoid as dictated by CDC recommendations. If you have
the primary polio series you probably do not need a booster, but if you
cannot get your records, one dose of inactivated polio vaccine is recommended.
Note that checking antibody titers for measles, mumps, rubella, and chicken
pox is an alternative if you would like to avoid shots! Malarial prophylaxis
recommendations should be the province of an infectious diseases specialist.
|This page last updated November 26, 2007 8:59 PM EST|