The best time to select a physician is well before your child comes home. In fact, many families consult with pediatricians who have specialized knowledge about internationally adopted children when they receive referrals. Although the information provided with the referral is sometimes limited, a physician familiar with this may be able to review the available medical records (which are sometimes as basic as simple bloodwork and measurements) and explain any concerns to you. Regardless of whether you choose to do this, it is absolutely imperative to have a knowledgeable pediatrician for your child upon his arrival home.
While agencies generally categorize children as "special needs" or "healthy," many adoption professionals say that all children who come from a country with limited medical care and who have been in group care (i.e., an orphanage) have some level of special needs. While these are most often correctable and not serious, the doctor must be aware of the unique circumstances, health concerns and developmental delays that your child could face. Without such understanding and experience, a doctor can overlook important situations.
Dr Thomson, who owns Edina Pediatrics in Minnesota, provides care to children adopted from several different countries. She states, "While foreign-born children who are adopted into the US are certainly no different in the long term than children born in the US, it is vital to factor into their individual treatment plans the unique social and medical conditions, as well as the psychological impact of institutionalization and loss that these kids may have experienced."
The bottom line is to prepare for medical and emotional situations your child may face by choosing a pediatrician who can recognize and treat them -- or refer you to a medical provider who can.
Children adopted from other countries often -- but not always -- come from group care settings. This makes them more susceptible to a range of illnesses and parasites that spread in close conditions. Says Dr Thomson, "Immediately upon a child's arrival home, aggressive testing and treatment of conditions (such as giardia, scabies, TB, etc.) that often run rampant in close physical quarters and a warm climate will alleviate pain and discomfort that a child may be experiencing."
Depending on where your child was born, some conditions are more likely to be present than others. Most physicians familiar with internationally adopted children order a battery of blood tests and stool samples to check for parasites, communicable diseases and other conditions. If she's from a country where tuberculosis is prevalent, your child may also have several TB tests at various times. Sometimes, the child's vaccine record is available; however, you may wish to re-vaccinate or run blood titers to determine whether your child still has immunity. Not all vaccines are the same, and maintaining records properly in settings with many children can be difficult.
Continually evaluate and watch for other issues as your child adjusts to life with your family. Children in group care settings, no matter how kind and attentive the caretakers are, don't enjoy the level of care that children living with biological parents typically do. As such, children in institutionalized care sometimes experience physical, emotional and attachment-related delays. Most, if not all of these, can be overcome or greatly improved, but a good pediatrician who can recognize such problems is crucial.
Previously institutionalized children are also at risk for sensory integration issues (or sensory processing disorder, also known as SPD). Occupational therapy can help (the sooner, the better). Speech therapy can address delays due to limited interaction and the introduction of a new language, and physical therapy can help with physical delays.
To prepare and educate yourself, search for books and information on medical needs specific to children born in the country from which you are adopting. You are your child's best advocate. Experts such as Dr Aronson, the "Orphan Doctor" (orphandoctor.com), offer invaluable advice. Read, read, read, and be prepared to ask questions of your child's pediatrician. If you have a genuine concern, do not overlook it simply because you are unsure or your child's pediatrician isn't familiar with it. Keep reading and asking questions.
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