Ask the Doctor:

Blind Referral

I have a "blind referral" but I would feel more comfortable if a medical professional reviews my child's data and video while I am traveling overseas. How can I prepare the medical package and how do I get the data back home in a timely fashion?

The pre-adoption medical evaluation is educational service for pre-adoptive parents and is not mandatory prior to adoption. It is an intelligent service to take advantage of because a professional can review medical data and explain medical information and jargon to parents that they would otherwise not understand. The Internet is a wonderful place to gather information about a particular medical topic, after many hour of surfing one can obtain sufficient knowledge about a medical topic. While the information is there, it should be understood that the Internet is not a controlled environment, hence a lot of medical misinformation and personal opinions do exist. This misinformation can cloud the judgment of a parent in making a decision on whether to accept a particular referral.

A formal evaluation demystifies all of this for parents. It also must also be clearly understood that the evaluation is not intended to be a system in which a doctor picks out a particular child or excludes another one for adoption. That decision is left totally up to the desecration of the family. A physician can forensically examine medical records, pictures and videotape, and systematically try to explain medical concerns and maybe alleviate others. After the family becomes educated in some aspects of International Adoption Medicine that pertains to their referral, they then become empowered in making an intelligent decision on whether to accept or decline a particular referral.

Most families receive a limited medical synopsis of the child's past health history, maybe videotape and/or some pictures. With this, agencies expect them to make a quick lifelong decision that would not only affect themselves, but also the child and other members of their immediate families. If the data is available for review in the U.S.A, then a physician or someone from www.adoptiondoctors.com can review the data and educate the family accordingly, and also act like a medical liaison for the family. They can guide parents on what more information to request from the agency and/or other laboratory testing. In a case such as this one an evaluation is very easy and readily available from anywhere in the U.S.A. Unfortunately not all cases are like this.
Some agencies only provide blind referrals and the parents have nothing to go on..

A blind referral is when the parent must travel overseas and only then will they receive information about the child. Some people travel knowing that they have been assigned a sex and maybe age. They are provided nothing about medical background or any social information. Obviously this can produce undue stress upon a prospective adoptive parent. With services like www.adoptiondoctors.com and many other International adoption clinic around the U.S.A., this stress can be reduced if the parents prepare properly. With proper guidance “they can act in the role of the doctor and collect medical data, take appropriate pictures, performing a Denver developmental examination, and produce a home grown video tape. This data can then be submitted to an International Adoption Physician for evaluation. With the advent of technology, it is now possible to send large amount of data via the Internet to a Physician State side almost immediately. Once received, the doctor performs an official evaluation of the medical data that Dr. Mom has collected. If you are traveling to a remote area of the world that does not even have a telephone line, this procedure is still valuable because upon return, you can have a doctor evaluate the data and bring closure to your decision that you probably have already made.
Collecting the Medical Data
Pieces of medical information can be collected from almost anyone who took care of the child, a medical director, specialist, facilitator, independent physician, or a nurse. This format is generally used as a standard medical intake that is taught in medical school 101. Pieces of information that are relevant are to a adoption evaluation are listed below. The technical aspect of computers and uploading will be entertained in next month's article.

Parents adopting from a country where a two-visit process is required or for a blind referral can use this generalized medical intake form. The data can be collected from anyone who cares for the child. You as the parent need to be educated in knowing what to ask.

1. Birth History
1. Name of child
2. Date of Birth
3. Place of Birth
4. Home Birth or Hospital Birth
5. Pregnancy history (number of pregnancies, births, health issues during pregnancy)
6. Apgar scores
7. Type of delivery (vaginal or cesarean section)
8. Health at time of delivery.
9. Birth weight, height, head circumference
10. Date of admission to infant hospital:
11. Date of admission to orphanage:
2. Family History:
* Mother (age, profession,)
* Father (age, profession,.)
* Siblings (at home, in orphanages,)
3. Social History
4. Alcohol, drugs, smoking history for parents
5. Growth Parameters
* Weight,
* height,
* head circumference at 3 months,
* 6 months,
* 9 months,
* one year,
6. Physical Exam of Child
7. Health issues while in the orphanage
(Bronchitis, asthma, anemia, vomiting, diarrhea, allergies, heart murmur, urinary tract infection, skin rashes, chronic medical issues)
8. Hospitalizations
9. Medical interventions
10. Medications &Transfusions
11. Diagnoses given to the child
12. Ultrasound evaluations of organ systems (commonly done in Russia)
13. Blood tests (results and dates of tests)
HIV, Hepatitis B, syphilis
14. Developmental milestones by age (what age did the child do each of the following):
* Reach for objects
* Sitting independently
* Creep & Crawled
* Pulled to stand
* Stand alone
* Walking
* Understands simple commands
* Vocalizes vowel sounds, consonants, single words, puts two words together, etc.
15. Immunization status (names and dates)

A video recording of a child can be a useful tool for evaluating the developmental milestones of a child and to determine if there are any facial characteristics that may be associated with any syndromes or genetic defects.It can also give us some insight into the socialization of the child.

Unfortunately a video recordingcan not be considered a replacement for a general physical examination, but for some parents that is all we have to go on.
Guidelines for Preparing an Adoption Video
Video Setting

* The setting should be familiar to the child
* The environment should be as free from distractions.
* Well-lit area.
* Avoid having other children in the video

Filming the child is very important. More footage does not make it better. This is a perfect example where less is more. A short 4-5 minute clip is ideal and easier to upload via the Internet. It is best to get small clips everyday of the child (1-3 minutes long) and one will visualize how the child's demeanor and disposition change with each passing day.

1. Close-up shot of the face, including different angles and various facial expressions
2. The remaining video should about a three-foot distance.
3. The video should show the child both dressed and partially undressed
4. Spontaneous movement of the arms, legs and trunk should be documented.
5. Age appropriate skills should be evoked with the help of assistants. (ex: gross motor, fine motor, adaptive skills such as dressing, undressing and eating and playing)
6. Engage the child in verbal interactions as well as play.
7. Developmental progress can be evaluated with age appropriate activities.

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.