Medical Issues

Many of the resources available for pre-adoptive parents are also used by post-adoptive families, so I decided to combine them all onto one page. On this page you will find

Pre-adoption, General Medicine, Travel
Developmental Evaluation
After the Adoption
Medical Topics in Kazakhstan
Physicians/Hospitals in Kazakhstan

Pre-adoption, General Medicine, Travel

Many people like to consult with a physician when they are evaluating the medical report of a referral or for an evaluation of their child once they are home. In addition to sharing the report with your pediatrician, you might want to consult with a specialist with experience in international adoptions. These web pages that have lists of international adoption clinics and physicians.

International Adoption Medical Clinics from Comeunity has the most complete list by state.
FRUA: Medical Concerns .
University of Minnestota International Adoption Clinic .
Directory listing of physicians with a special interest in adoption and foster care medicine from the American Academy of Pediatrics.

The following clinic web sites are listed individually because they have information on them. It is not meant as an endorcement nor as a list of the only physicians that you should use.

Russian Adoption Medical Services was from Dr. Eric Downing, a Canadian MD living in Moscow. Information on medical reports and diagnosis, common medical report problems, translations and terms. This is where you want to start. Although Dr. Downing died awhile ago, they are maintaining the website because of all the important information on it.
Dr. Jerri Jenista has links to medical articles and a request for medical review.
Orphan Doctor is Dr. Jane Aronson, a pediatrician specializing in adoption medicine.
- Adoption resources: general adoption resources - web sites, books and magazines; international adoption links for every part of the world
- Medical resources: medical care abroad, info on common diseases, region-specific issues, general medical issues, her current research, medical photo library
- Services: pre-adoption consultation, preparation for international travel, vaccinations for parents, post-adoption evaluation, follow-up care
- Stories
Adoption Doctors has information on interpreting Russian medicals, developmental evaluation, answers to questions about adoption medicine (used to be "House Calls" on Welcome Garden), questions to ask upon referral, how to take a video for medical evaluation, etc.
International Adoption Clinic of the University of Minnesota. Infections diseases, screening tests, etc. Lots of information for pre- and post-adoptive families.
Center for Adoption Medicine at the University of Washington, doctors Julie Bledsoe and Julian Davies.
- Topics in adoption and pediatrics: complementary/alternative medicine, diagnosis, development and learning, Eastern Europe, general adoption, growth and nutrition, mental health, parenting and attachment, prenatal alcohol and drugs, sleep, teeth, travel and transition.
- Favorite books: adoption, parenting, attachment, sleep, development and learning, general pediatrics
- Pediatric tools: growth charts, developmental milestones, Russian medical terms, how to take FAS photos, parenting by temperament, screening for autism in toddlers, children's sleep habits questionnaire, ADHD toolkit, FAS resource list.
- Lots of links for adoption and parenting topics.
- Ask the adoption docs.

Medical Resources: Following are resources, helpful to new parents as well as those with experience, for growth, development, and health concerns.

Mayo Clinic has a massive list of articles on parenting.
Akron Children's Hospital offers Tips to Grow By downloads on numerous topics.
Merck Manual of medical information - home edition covers a broad range of information. Children's health issues is Section 23.
Pediatric Internet Resources : large list of links to online resources.
WebMD

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Where There Is No Doctor by David Werner is a good book to take on your trip. "Translated into over 90 languages, Where There Is No Doctor is considered the most accessible and widely used community health care manual in the world. This revolutionary health care "bible" has saved millions of lives around the world by providing vital information on diagnosing and treating common medical problems and diseases, and giving special emphasis to prevention. The book also includes sections detailing effective examination techniques, home cures, correct usage of medicines and their precautions, nutrition, caring for children, ailments of older individuals and first aid."

Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers by Laurie C. Miller, published August 2004. "Since 1989, American families have adopted more than 167,000 children from other countries. Many of these children have lived in crowded conditions, sometimes with poor standards of hygiene, inadequate nutrition, and limited numbers of caregivers. Some suffer from endemic infectious diseases. Upon arrival, practitioners often fail to recognize the unique concerns of this group. This text provides an overview of the specialized medical and developmental issues that affect internationally adopted children, offering guidelines to the physicians caring for these children and their families before, during, and after adoption. The reader will learn how to advise families prior to an international adoption, how to perform an effective initial screening assessment of the newly arrived child, and how to recognize and manage developmental and other more long-term problems as they emerge." Dr. Miller is an international adoption specialist at the Floating Hospital for Children in the Tufts-New England Medical Center.

From the Centers for Disease Control and Prevention (CDC):

Health Information for Travelers to Kazakhstan : disease information and recommended vaccinations.
Traveler's Health contains more topics than the few I list below.
Giardiasis
Healthy Swimming
International Adoptions
Travelers' Diarrhea
Travelers' Health: Diseases Related to Travel : massive list.
Travelers' Health: Safe Food and Water
Risks from Food and Water
Tuberculosis
Air Travel
Yellow Book: Health Information for International Travel

MD Travel Health - Kazakhstan contains much of the same information as the CDC>

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Developmental Evaluation

A common question is whether the child's growth and development are normal, when evaluating a child before adoption as well as while raising them. Most experts say to expect a one month delay for every three months in an orphanage.

Across the Seas is a booklet that provides a structured assessment that parents can perform while in an orphanage with a child. This would be an excellent tool for parents traveling without a medical report. Also available from the same site: 10 Facts About Alcohol Use in Pregnancy .

From the same site as above is Risk & Promise "is written by a team of pediatricians, a clinical psychologist, and an infant mental health specialist based on their extensive research and clinical experience in working with children adopted from overseas. The first two sections of Risk and Promise provide prospective parents with information as it will come to them during the adoption process. Each major section is then divided into key subsections that focus the information on specific characteristics related to the child. The book?s third section consists of worksheets that parents can fill out to help them collect baseline information that will be helpful in both the short and long term. The authors? goal in writing this book is to insure that every adoption is a well-informed adoption that ultimately promotes the health and development of the child and the family." An online test is available which would count toward pre-adoption education requirements.

A common term on medical reports is APGAR scores. It is a system for evaluating how well an infant has adapted to extrauterine life within the first minutes of birth. See What is the Apgar score? for an explanation and description of how the test is scored.

Parents always want to know how their child's height and weight compare to normal, so here are sources for growth charts.

Families with Children from China were derived from growth data for Chinese children in the early 1960's.
BabyCenter Growth Percentile Calculator is based upon healthy, full-term, predominantly formula-fed Caucasian children in the US.
CDC has charts revised in 2000 for the US.
Growth charts for Chinese, South East Asian, Thai, and Vietnamese children.
Korean growth charts .
World Health Organization Global Database on Child Growth and Malnutrition. Free registration to view the data.
Karen's Adoption links has charts that Russian pediatricians use for girls and boys.

A common concern in adopting internationally is the possibility of Fetal Alchohol Syndrome (FAS) or Fetal Alcohol Effect (FAE).

Fetal Alcohol Syndrome has links to lots of information, links, pictures, etc.
FAS Alaska has brochures that you can download, information, and links.
The National Organization on Fetal Alcohol Syndrome has a little information on characteristics and how to work with these children, and links to other resources.
Mothers With Attitude also has links to other sites and a Parent's Portfolio (behavior plan).
Alcohol Related Disorders and Children Adopted from Abroad was written by Dr. Jane Aronson, an international adoption medical specialist.
Can fetal alcohol syndrome be detected by doctors? article by an adoption specialist.
FASlink has lots of links and a forum.
Fetal Alcohol Spectrum Disorders is an excellent article covering facial characteristics.
Fetal Alcohol Spectrum Disorder and Behavior from about.com.
Lip-philtrum Guides to aid in diagnosis; avaialbe to order from the University of Washington. It is also available in English/Russian . They also offer a FAS Tutor CD-ROM "to instruct medical professionals, through video, computer animation and photographic examples, on how to screen and diagnose FAS."
Maternal Drinking and Child Development discusses the effect that alcohol has on the developing fetus, and how FAS manifests in a child.
FASD Center for Excellence , from the US Department of Health, has lots of information.
Interactive Problem-based learning from McMaster University allows you to select various features and see them on a sliding scale from normal to FAS in a front and lateral view.
Living with Infants, Toddlers, and Children who have been Prenatally Exposed to Alcohol
CDC FASD from the Centers for Disease Control.

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These are resources for developmental evaluations.

Russian Adoption Medical Services Developmental Milestones ages one month through five years. (this is an archived version of this page)
BabyCenter Milestones has a listing, by month, for 0-3 years.
KidSource has articles on general growth and development.
WorldBank lists ages, stages of development, and what children need from birth through 8 years.
Child Development Institute provides information on physical, mental and emotional growth and development in children and teenagers.
Baby Center has parenting resources, from FAQ to experts to bulletin boards for various ages, and a sections on development for various ages.
Developmental Milestones on the Family Practice Notebook web site. Short list of milestones by age and area of development. This web site also has a list and critique of various screening tests. Talk to your pediatrician about what may be appropriate for you to do. Be aware that developmental screening tests are designed to be given by someone with training and may not be accurate when done by a lay person. Also, many of the early screening tools do not indicate problems later in life.
Age appropriate activities for 2 year olds , 3 year olds , and 4 year olds ; there are links at the bottom of each page for additional sources. I love these suggestions, but this web site tends to change the URLs frequently, so let me know if what I have here doesn't work.
Great Beginnings is a series of articles for parents of infants and young children, from newborn to 3.
Child Development Guide has developmental tasks for physical, intellectual, social, emotional, and moral arenas from birth to nineteen years. Also includes suggested parenting tips for each task.
Live and Learn has developmental activities from birth to age 5, divided into years. This site also has lots of other information that would be helpful to parents, from selecting a daycare to safety in the home.
Assure the Best for your Baby's Physical Development from the American Academy of Pediatrics. Designed for infants 3-15 months, it contains a chart for typical speech, play, and physicial development; and problems to watch for in physical development.

If your pediatrician does not have a copy of the Denver Developmental Screening Tool (DDST), you can order it directly from the company Denver Developmental Materials, Inc. . The entire tool is complicated; I was actually taught how to administer it and interpret the results in nursing school, so it does take some training. There are other developmental screening tools that you can discuss with your pediatrician.

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After the Adoption

A Healthy Beginning Important Information for Parents of Internationally Adopted Children is a brochure put out by the American Academy of Pediatrcs for parents, discusses what to expect during the first medical visit.

Preventing Infectious Diseases During and after International Adoption , in the Annals of Internal Medicine , 2 September 2003, Volume 139, Issue 5 (Part 1), pages 371-378. A review of information and links, covers both your child's health as well as the effect it may have on others. This article is written for physicians; you might want to let your pediatrician know about it.

Primary Care of International Adoptees from the American Academy of Family Physicians.

The American Academy of Pediatrics (AAP) has a good article titled Initial Medical Evaluation of an Adopted Child . Another good article is Families and Adoption: The Pediatrician's Role in Supporting Communication which discusses many issues in raising adopted children.

Management of latent tuberculosis infection in children and adolescents from the New Jersey Medical School. Offers an excellent overview of testing and treatment.

Depending upon your child's situation and background, all of these tests may not be necessary. Dicuss them with your adoption medical specialist and/or pediatrician. This list is a combination of lists that I found at University of Minnesota International Adoption Clinic, Orphan Doctor , Canadian Clinic for Adopted Children , Valley Hospital , and Medical testing recommended for international adoptees on the Families with Children from China (FCC) web site.

Laboratory Tests
- Hepatitis B profile (surface antigen, surface antibody, core antibody)**
- Hepatitis C antibody**
- HIV-1 and HIV-2 (Elisa or PCR)**
- PPD (Mantoux) test for tuberculosis**
- Syphilis serology (RPR, FTA-ABS, VDRL)
- Thyroid function tests (Free T4, T4RIA, TSH)
- Complete Blood Count (CBC), with differential and indices
- Metabolic screen (PKU, Galactokinase, Biotinidase, Hemoglobin electrophoresis, Glucose-6-phosphate dehydrogenase assay, etc.)
- Liver Functions (AST, ALT, GGT) and enzymes (SGOT, SGPT)
- Lead levels
- Rickets screening (calcium, alkaline phosphatase, phosphorus)
- Vaccine titres if you believe that the child has received vaccinations and do not want to repeat them. If the titres come back low, you might want to have the immune system evaluated by looking at immune globulins and white bloood cells before revacinating.
- ** laboratory tests should be repeated six months after arrival
- Urinalysis with microscopic examination
- Stool examination for ova and parasites; these sometimes require repeated tests, especially if symptomatic. It is helpful to know if other children adopted from the orphanage have any of these or other less common ones. (Giardia, Salmonella, Shigella, Yersinia, Campylobacter, Cryptosporidia)
Dental evaluation (for children older than 18 months)
Hearing and Vision screening
Developmental exam (pre-school)
Intelligence screens (school age)
Language evaluations (if speech problems suspected)
To receive a list of recommended post-adoption tests, along with procedural codes and codes for the laboratories, send a blank e-mail to Med Tests and you will receive the document in a reply. Furnished courtesy of EEAC.
The American Academy of Pediatrics, in their Red Book, comment that children over 12-15 months can be tested for immunity by drawing titers, noting that children that have been adopted internationally are now more likely to have been effectively immunized.

Post adoption support for special needs

Raising the Post-Institutionalized Child by Ronald Federici, a developmental neuropsychologist with an excellent reputation.
Children of the Heart : Attachment and Bonding in Adoption. This link goes to an archived version, as the website is no longer online.
Nancy Thomas Parenting : "is a not-for-profit service organization offering information and resources on attachment disorder."
Association for Treatment and Training in the Attachment of Children (ATTACh) "is an international coalition of parents, professionals and others working to increase awareness about attachment and its critical importance to human development."
Center for Cognitive-Developmental Assessment and Remdiation has lots of information, particularly for parents of school-aged children.
Parents Network for the Post Institutionalized Child is "a support network devoted to understanding the medical, developmental, emotional and educational needs of children adopted from hospitals, orphanages and institutions throughout the world." Information is available in their newsletter, and they have a large links section.
Additional links can be found on the Resources page.

Adoption and the Stages of Development looks at attachment and adoption and how they affect the children at various ages.

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Medical Topics in Kazakhstan

From the United Nations (UN). Kazakhstan is considered to be in Asia:

Statistical Databases : these are interesting because they list all countries for various subjects (such as life expectancy, population, etc.) making it easier to put it in perspective.
Women, Youth and HIV/AIDS in Kazakhstan Paper presented in November 2000.
UN Children's Fund (UNICEF) Statistics
State of the World's Children 2003 and State of the World's Children 2006 from UNICEF.

From the World Health Organization (WHO):

Global InfoBase Online , includes surveys on alcohol and tobacco use.
Global Health Atlas allows you to compare multiple countries.
Kazakhstan Overview : statistics and links to additional information
Country Information from the WHO Europe Office.
WHO Europe Office Highlights on Health in Kazakhstan 2005
Kazakhstan: TB . You can also access additional information through the Global TB Database
Kazakhstan: HIV/AIDS 2005
Epidemiological Fact Sheets on HIV/AIDS and sexually transmitted infections: Kazakhstan written December 2006.
Alcohol statistics for Kazakhstan from the WHO Europe health for all database.
Kazakhstan country profile, Global Status Report on Alcohol 2004
Alcohol in the European Region - consumption, harm and policies , article written in 2001.
Health Topic : links to many health concerns, including Alcohol . I used this data to create the following table. This lists the amount of alcohol consumed by an adult (over 15) per year. It is interesting to note that in looking at the historical data, the numbers for Kazakhstan have slowly been decreasing since independence from the USSR.

Country Total Beer Wine Spirits

Kazakhstan (2000) 2.31 0.37 0.31 1.61

Russia (1999) 10.70 1.67 1.07 8.05

US (2000) 9.08 5.11 1.67 2.29

An international study on gender and alcohol known as GENACIS (Gender, Alcohol, and Culture: An International Study) is currently under way. WHO provided funding in Kazakhstan. Results are not available yet.

The following quote is from an Adoption Medical News [formerly at http://www.adoptionmedicalnews.org/] survey of adoption medical specialists, published in the January/February 2002 issue. The ranking scale was 1-10, with 10 being the best. "This country was ranked 7-8 by the experts and the consensus was 7.5. Because the comments from the doctors were 'children in excellent condition' or 'generally in good condition,' one might think the consensus should be 8. A more restrained endorsement was this one: 'children in excellent condition - babies that is; older children have all the issues of children from US foster care.'" To give you a frame of reference, here are the rankings of a few other countries: China 7-8, Colombia 8-9, Ethiopia 6-7, Guatemala 6-9, Korea 8-10, Russia 4-6, and Vietnam 6-7. Reprinted with permission.

Quality of hospital care for children in Kazakhstan, Moldova and Russia , printed in Lancet in March 2006.

USAID Documents: one focus of this organization is in the health field, you can look for reports on various topics.

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Physicians/Hospitals in Kazakhstan

This list is not meant to be comprehensive, it is just to serve as a resource for those traveling to Kazakhstan. If you know of any information that I can add here, please e-mail me and let me know.

Almaty: International SOS Clinic, 11 Luganskovo Street, Tel: 7 7272 581 911
Almaty: The Diagnostic Center (Diagnosticheskiy Tsentr), 57 Auezova (corner or Auezov and Djambula), Tel: 42.29.79 (for English speaking desk and foreign doctors), 42.44.54 (Russian only)
Almaty: Interteach, 83 Aiteke bi (between Zheltoksan and Naurizbai batir, look for Chikenland), Tel: 58.81.00 (English and Russian)
Almaty: Myra Shoinbeckova IOM - Almaty, ul Abdullinykh 56, (7 7272) 582240, (7 7272) 584907
Atyrau: International SOS Clinic, River Palace Hotel, 55 Aiteke bi Street, Tel: 7 7122 586 911
Karaganda: Dr. Natasha Streltsova, Department # 6, Regional Children Hospital, 8 Yerjanova Street. Telephone (7212) 43 21 29; Ar. Buhar-Zhuray 74, Apt 18 (ADOPTION CASES ONLY), (7 7212) 434137

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Page last updated on 30 September 2009.