Our Stories :: In the News :: "Adoption Medicine
Brings New Parents Answers and Advice", from the New York Times
(Health & Fitness)
September 4, 2001
By David Tuller
Ann and Stanley Reese were thrilled last summer when they adopted two
toddlers from Romania, Ileana and Tratan, and brought them home to Rye,
N.Y. But two days later, Ms. Reese noticed that Ileana was limping badly
and took her to the emergency room.
The doctors determined that Ileana had broken her ankle in two places.
Then they delivered the really bad news: she had an advanced case of osteoporosis,
a bone-thinning condition that primarily affects older people. Unnerved,
Ms. Reese called Dr. Jane Aronson, a New York City pediatrician who is
an expert on the health problems of children adopted from abroad.
"Jane laughed and said, 'It's not osteoporosis. It's rickets, but
they've never seen a case of rickets in Rye,'" said Ms. Reese, who
found out about Dr. Aronson through an adoption Web site.
Rickets, a treatable bone ailment caused by malnutrition and a lack of
vitamin D, is usually seen in developing countries.
A decade ago, only two or three doctors in the United States had extensive
experience inn the medical problems of children born abroad and adopted
into North American families. Today, more than a dozen physicians in the
United States and Canada are considered specialists in the emerging field,
known as adoption medicine.
These doctors offer parents pre-adoption counseling and evaluation based
on a child's medical records, as well as post-adoption consultations.
Often, the doctors provide the child's primary care. The field attained
greater visibility last year when a leading journal, Pediatric Annals,
devoted an entire issue to adoption medicine.
Dr. Aronson became intrigued with the field during her pediatric training
nine years ago when she sometimes received phone calls from worried adoptive
"They would say, 'My kid has parasites, my kid has a positive TB
test, and my pediatrician doesn't know what to do,' said Dr. Aronson,
whose clinic is called International Pediatric Health Services. "It
became clear to me that this was a big population that had nowhere to
go for information."
That population has only increased since then. In the late 1980's, Americans
adopted fewer than 10,000 children annually from abroad, many from Korea.
Last year, the figure topped 18,000 with large numbers from China, Russia
and other former Soviet bloc nations, India and Guatemala.
The emotional and behavioral problems of some of these children, particularly
those arriving from Russian and Romanian orphanages early in the 90's,
received wide-spread attention because of some high-profile cases of alleged
child abuse. In 1997, an adoptive mother in Colorado, Renee Polreis, was
convicted of killing her Russian-born son, who had serious behavioral
But much of what specialists in adoption medicine look for is more mundane.
They focus on infections and ailments like hepatitis B and C, tuberculosis,
intestinal parasites, scabies and lice. They look for signs of fetal alcohol
syndrome, which can cause cognitive and emotional problems, and malnutrition,
which can impair growth and motor skills. The run tests on the children
to determine whether their record of vaccinations, if one is even available,
"A surprising number of internationally adopted children do not receive
proper evaluation and follow-up," Dr. Laurie Miller, a pediatrician
at the New England Medical Center in Boston, wrote in an editorial last
year in The New England Journal of Medicine.
Her editorial continued: "Some physicians make the mistake of accepting
the results of screening tests performed in the child's country of birth,
even though the laboratories there may be unreliable or the child may
have become infected after the testing was performed."
In parts of the United States where immigrants are uncommon, Dr. Miller
added, physicians may be unaware of the need for screening tests.
The editorial accompanied a case study of a 9-year-old boy in North Dakota
who was found to have tuberculosis two years after he arrived from the
Marshall Islands. The child's disease was diagnosed only after one of
his guardians contracted it. They study reported that 20 percent of 276
people who had come into contact with the boy showed evidence of tuberculosis
In another case, New Jersey health officials discovered three years ago
that several children adopted from China had elevated levels of lead in
their blood, which can cause brain damage. A study of 452 Chinese adoptees
that was published last year in the Journal Pediatrics found hat 14 percent
had elevated lead levels.
In the same study, 35 percent of the Children suffered from anemia, 9
percent from intestinal parasites and 10 percent from abnormal thyroid
function. Many of the adoptees also lagged behind American-born children
in height, weight and head circumference.
Much of what adoption specialists do, said Dr. Jerri Ann Jenista, a pioneer
in the field, is evaluate as thoroughly as possible - before the adoption
is final - the medical conditions of children that a family is thinking
of adopting. Dr. Jenista, a pediatrician at St. Joseph Mercy Hospital
in Ann Arbor, Mich., as well as the adoptive mother of five children from
India, said she had performed thousands of such pre-adoption consultations
in the past few years. Wide variations in the amount and accuracy of the
records can complicate the task. "From Korea, we get extensive information,
including how many doses of cough syrup they've been given," said
Dr. Jenista. "From Guatemala, we typically get a one-line statement
saying the baby was seen, is healthy and has all major body parts."
Some countries send videos of the children, which can offer a great deal
of information about developmental issues, she said.
In making her evaluations, Dr. Jenista said, she outlines what she perceives
to be the child's main health risks and explains what resources the parents
may find useful. But even when she believes a child has major disabilities,
she said, she presents the situation frankly to the parents but stops
short of advising them about whether to proceed.
Recently, Dr. Jenista said, she evaluated the pre-adoption records of
a Russian 3-year-old, who was the 10th child born to chronic alcoholics
and was the size of a 1-year-old.
She explained to the boy's prospective parents that he was likely to improve
but would probably continue to have major developmental difficulties and
require support for the rest of his life.
"So I tell them, if that's what you envisioned as a parent, then
adopt him," she said. "But if you envisioned that he would just
need some early intervention in school, speech therapy, and better nutrition
and would then be indistinguishable from al the other second graders,
and you'd all live happily ever after, that isn't going to happen."
But some problems are hard to predict. Nancy and John Crotty, a couple
from Rye, were excited when they adopted 5-month-old Anna from Hungary
four years ago. But because her pre-adoption medical records gave her
a relatively clean bill of health, they were completely unprepared when
she repeatedly suffered from asthma attacks ad other respiratory ailments,
most likely from poor orphanage conditions.
"We were in and out of hospitals," Ms. Crotty said. "I
took for granted that the medical record given to me was true, and I had
no idea then that there were special doctors that took care of these children."
When the couple adopted another Hungarian child this year, they consulted
with Dr. Aronson before and after bringing the boy home.
For some new parents, the children's medical problems can feel overwhelming.
Thais Tepper of Washington, Pa., adopted an 18-month-old boy from Romania
in 1991 and quickly realized that he had severe problems. He did not start
talking until he was 3 and ½, had severe trouble tolerating touch,
sound and other stimuli, and he engaged in repetitive behaviors like flapping
his hand in front of his face for long periods.
Ms. Tepper finally found a specialist who said her son, Drue, had reaction
attachment disorder, a condition in which children have difficulty bonding
with others because of early deprivation. Drue started receiving six sessions
of therapy a week for physical, speech, psychological and other problems.
Though he still has some learning disabilities, he now attends a regular
In response to her difficulties, Ms. Tepper helped to start the Parent
Network for the Post-Institutional Child, an organization offering parents
the chance to compare notes and information on medical and developmental
"We developed the network because the only real support you had were
other people," she said. "It was horrible because you would
think you were doing something wrong if you didn't know other parents."
Despite the obstacles, the specialists and parents say that most of the
children's medical problems are treatable and even those with more serious
developmental difficulties generally recover.
Dr. Jennifer Ladage, director of the Foreign Adoption Clinic and Educational
Services in St. Louis, estimated that only 3 to 5 percent of foreign adoptees
continued to have major long-term behavioral and emotional problems. For
children adopted after 2, however, some studies indicate that as many
as a third may have lasting problems.
Dr. Ladage became interested in the field in 1996 when she adopted a boy
from China. Alex, her son, had an unrepaired cleft lip and palate, and
at 14 months was not walking or even sitting up by himself. But within
six months he had developed motor skills appropriate for his age, she
said. He also recovered well from surgery to his lip and palate.
"In most cases these children catch up, and some of them show such
rapid growth and developmental milestones that it's pretty amazing,"
she said. Now, Dr. Ladage added, she cannot imagine her life without Alex
- and she is waiting eagerly for approval to return to China and adopt
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