Ask the Doctor:

A Medical Exam should be part of international adoption.

Post-Adoption Medical Examination

In the USA, generalized routine laboratory screening of healthy children is not standard of care. In children that are internationally adopted, extensive screening tests are performed because of a multitude of reasons. These screening tests are recommended by the Pediatric Red Book of Infectious disease and the Academy of Pediatrics.

It is only through extensive laboratory testing that a physician may:

1) Uncover a medical condition that has not yet presented itself clinically
2) Rule out a diagnosis or condition that was reported on the pre-adoption evaluation
3) Help to confirm the adequacy of treatment of a particular ailment and/or document cure.

Some parents feel that maybe they do not need to test their children because they had some blood work performed by the orphanage, and that the child was already seen by a physician in order to qualify for a visa. While these are all good thing to have done for your child, they are not enough. The Visa medical examination focuses primarily on detecting if there are certain serious contagious diseases that would make the child ineligible for entry in the USA. The procedure usually consists of a very brief physical examination and medical history. A chest x-ray is performed to look for active tuberculosis, and blood test are performed to screen for HIV infection and syphilis. These tests are performed only if the child is older than 15 years or age and in those younger than 15 years, they are only performed if there is a suspicion of medical illness. Chances are that since the child really has no available history and there is little or no testing performed, that the Visa examination consisted of documenting that the child is breathing at the moment of the examination and is not terribly ill with any contagious disease.

As for testing by the orphanage, caution should be used when interpreting the results. While these tests are important in the Pre-Adoption evaluation process in order to help the family in making their decision, the validity of these tests needs to be confirmed and they should only be considered as a screening tool. Confirmation of a medical diagnosis should never be made solely on these test results.

Because there is a wide variation in the geographic regions where children are placed for International adoption, different medical problems can be encountered in different regions. Screening is also important because of the unknown medical background of the child, inadequacy of health care and poor living conditions encountered in the institutional care setting.

A Physician should see an internationally adopted child within 2 weeks of arrival to the United States. A child who is ill upon arrival with either an acute or chronic medical condition should be evaluated for that problem immediately.

After the arrival of the child, this is a very good time for parents and child to get to know one another. The process of attachment and bonding needs to progress. Some parents may feel the need to have large family gathering and parties, go on elaborate vacations to Disney Land, and buy everything at Toy R Us for the child. While their intentions are good, this will only over stimulate the child and stress them out. Just like these painless examples, an immediate visit to a doctors office, and multiple visits to the blood laboratory is another type of excursion that does not need to be made immediately unless the child is acutely ill. Too much love is also no good.

The initial Post-Adoption evaluation will include the following:

1) Thorough review of the child's medical history and concerns discovered on the pre-adoption evaluation
2) Complete physical examination
3) Evaluation of developmental milestones (Denver developmental screen)
4) Immunization status needs to be evaluated and confirmed with vaccine titers. There is no harm to a child receive an extra vaccine, but there may be harm if the child remains susceptible to these childhood illnesses. The doctor will use the same catch-up schedule that would be used if the child was born in the USA and was behind in the vaccines.
5) Laboratory screening for a multitude of medical concerns.

I would like to try to explain what each test generally screens for.

A) CBC: complete blood count It gives us information on the health status of the child's blood cell, pertaining to anemia, which can be caused by a multitude of reasons. Sickle cell disease, Thalasemia, anemia of chronic illness or just iron deficiency anemia.
B) Lead screen: can cause anemia and developmental delay if untreated. Lead can be found in old institution walls, water supply (pipes) and the overall environment as a pollutant.
C) G6PD deficiency: an enzyme deficiency that is common in Asia, Africa, and the Mediterranean region. Screening from these areas needs to be performed prior to prescribing medications that may cause hemolytic (blood cell breakdown) anemia in persons lacking this enzyme.
D) Hemoglobin Electrophoresis : in Asian children to look for Thalasemia Anemia.
E) HIV Elisa: test for the AIDS or HIV virus.
F) VDRL: test for syphilis. Frequently transmitted from the mother to child.
G) Hepatitis B panel: should be performed prior to hepatitis B vaccination. It tests for acute, chronic illness as well as vaccine status.
H) Hepatitis C: for Hepatitis C.
I) Calcium, Phosphorous, Alkaline Phosphatase: screens for Rickets.
J) Urinalysis: check the overall kidney function.
K) Stool sample: for intestinal parasites, Giardia is common in Institutions.
L) Stool cultures : intestinal bacteria.
M) Comprehensive metabolic panel SMA-20: check on overall body function, liver, kidney.
N) TFT: thyroid disease.
O) PPD: tuberculosis status.
P) Immunization Titers: to see if the child mounted an immune response in order to continue with the current vaccine schedule or restart all vaccine from the beginning.
Q) State Newborn Screen: only in children less than 12 months. To check for metabolic disorders routinely tested at birth (PKU, Biotinidase, Sickle cell)
R) Hearing and vision tests

As you can see that there is going to be a lot of blood drawn in order to perform these test. It is a stressful time for both child and parent. I generally recommend that the parents to perform these tests on two visits spread out 1 week apart.

by George Rogu M.D.

Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

© George Rogu, M.D