PRIMARY HEALTH CARE PROVIDER
It is essential to identify a primary health care provider for your child before you bring her/him home. Ideally, your child should see the primary health care provider within 48-72 hours of arrival into this country. This individual will take a medical history, do a physical examination, and may order laboratory tests such as samples of blood, urine, and stool. The primary health care provider can also give your child immunizations that are needed for his/her age. It is important to bring any medical or administrative records that you have when you bring your child to the first appointment. If your child is ill when you return to this country, s/he should be seen by a physician within 24-48 hours.
Choosing a primary health care provider is an important decision, but you can get advice from others to lead you in the right direction. Some good sources of recommendations are your own family physician, parents of other children in your neighborhood, friends and relatives in your geographic area, the local medical society, your local hospital, medical specialty directories, and other medical professionals that you know or with whom you come into contact.
Pre-adoption interviews are recommended so that you can start narrowing down your choice. These are often called a "Prenatal Visit" when you schedule them. Some health care providers charge a nominal fee for this visit, and others offer them free of charge. When you schedule the appointment, be sure to mention that you are adopting a child from an international (or domestic) site. This visit is a chance for you and the health care provider to find out more information about each other, so it is expected that you will ask questions about issues of concern to you. Writing down your questions before you arrive will help you to remember what you want to discuss.
Visiting the office/hospital/clinic where the health care provider practices can give you some important information. It should be a convenient site for your lifestyle, with parking or public transportation access that works for you. You can assess the friendliness and professionalism of the reception, nursing, and administrative staff. The waiting area should be clean and comfortable, and parents/children should be treated with respect and concern.
You may have specific questions of personal concern to you that you want to ask. In general, it is important for you to find out how appointments are scheduled, what hours the office is open, how emergencies and after-hours questions/problems are handled, who sees patients when your health care provider is not available, how you can access the health care provider via telephone (as opposed to an actual visit), how payment is handled, and what types of visits are covered by your insurance carrier. You should ask about the health care provider's hospital affiliations or "privileges," since this will be important if your child ever needs admission to a hospital. More specific child care questions may include the health care provider's recommendations about nutrition, immunizations, circumcision, day care, discipline, prevention, baby equipment/supplies, reference books, adoption issues, and use of antibiotics. You should be aware of your health care provider's credentials, appropriate license, board certification, and membership in professional societies (such as the American Academy of Pediatrics). This latter information is often available through the state licensing agency, but you should not feel uncomfortable asking the health care provider about this aspect of his/her professional life.
For children who have been adopted internationally or domestically, it is very important that you keep accurate records of medical information about your child both before and after adoption. This is especially important as your child enters the school-age years, since school entry is often dependent on having had specific immunizations and screening medical tests. In addition, it may be necessary for you to switch health care providers at some point in your child's life.
The relationship that your child and you have with the primary health care provider is an important and special one, and will help you navigate the stages of growth and change during your child's life.
COMPREHENSIVE MEDICAL ASSESSMENT
Children who have been adopted internationally may have exposure to a variety of infectious diseases, and may have medical conditions related to malnutrition or lack of appropriate medical care. In many cases, your child's primary health care provider will be able to evaluate and treat your child without assistance. Some physicians feel more comfortable if a consultant is available to assist with this assessment, however, either to carry it out completely, or to be available for specific aspects of the child's care. If you and your child's primary health care provider wish to access this type of assessment, it should occur within 1 to 2 weeks of your child's arrival in this country. In some cases, the visit with the consultant may occur before the first visit with the primary care provider.
A comprehensive medical assessment will include a medical history, a comprehensive physical examination, and laboratory evaluation/immunization that is often influenced by the geographic site from which your child was adopted. Although your child may look fine, and orphanage documents may indicate that blood tests and immunizations have been done, experience has shown that many times the information you receive may not be completely accurate.
Some of the infectious diseases for which your child will be evaluated include: syphilis, hepatitis (A, B, and C), tuberculosis (TB), human immunodeficiency virus (HIV), and intestinal parasites. This will involve blood and stool samples. Your child will also be evaluated for medical conditions such as: iron deficiency, anemia, lead poisoning, rickets, malnutrition, thyroid disease, and other metabolic diseases. This will involve blood and urine samples. Some children may also require x-rays. If other medial conditions are identified, your child may need special medical tests or referral to a pediatric specialist for that condition. Hearing, vision, and dental screenings will be done, but formal evaluations by an ophthalmologist (eye doctor) and dentist are often recommended. Many children are also referred for a formal hearing evaluation. Immunizations (vaccinations) are usually given as though the child has never received any before being adopted. This is because of uncertainty about the accuracy of your child's medical records or effectiveness of the immunizations used.
All of the information about your child's care will be coordinated and shared with your child's primary health care provider. This consultative medical service helps provide parents and professionals with valuable information and guidance about how to adapt your child's medical care to maximize his/her health and address any problems that have been identified.
Children who have been adopted internationally may have multiple risk factors for developmental delay or problems. Children who have been adopted domestically may share some of these risk factors. In general, a child's development may be impacted by such things as:
- Maternal health and nutritional status during pregnancy, including possible substance abuse (smoking, drugs, alcohol)
- Medical/Genetic conditions which run in the family of either birth parent
- Orphanage stay and/or foster care placement
- Malnutrition, including rickets
- Abuse or neglect
- Prenatal and/or postnatal infection
- Lack of medical care or limited medical care
A formal developmental assessment within 2 to 4 weeks of adoption can provide some important baseline information for parents and primary health care providers. It gives an accurate assessment of the child's current level of function in a variety of skill areas, i.e., gross motor, fine motor, social/adaptive, cognitive, receptive language, and expressive language. It identifies areas of delay which might qualify the child for early intervention services, and helps guide recommendations about appropriate services for the individual child. It helps identify follow-up medical evaluations which are important for that child, including such things as a formal hearing test, special x-rays, or evaluation by an orthopedic sub-specialist because of a bone or muscle problem.
Parents will learn important information about their child's current developmental status to help them understand how to play and interact with their child at a developmentally appropriate level. It helps with the selection of appropriate toys and activities. It helps parents understand what skills to expect to see next, and what skills will not come as quickly. It also provides important information about toys or activities which might not be safe for their child at that time.
Developmental progress can best be assessed by a second formal developmental assessment between 3 and 6 months later, depending on the age and abilities of the child. This allows for calculation of a developmental rate, measurement of the child's "catch-up" in development above what would be expected, and identification of areas where a continued lag in development represents a true disability which needs further evaluation or intervention.
In most cases, parents will be pleased and reassured by the information that they receive about their child's development. It allows them to better understand and enjoy their child, and take an active role in enriching their child's development. In cases where a persistent problem is identified, it educates and empowers parents about how to help their child.
If you wish to schedule a Comprehensive Medical Assessment or Developmental Assessment for your child through the International Adoption Clinic, please call 443-923-9402 or toll-free 1-888-554-2080.
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