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

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.

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 [external link] 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 [external link] has links to medical articles and a request for medical review.
  • Orphan Doctor [external link] 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 [external link] 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 [external link] of the University of Minnesota. Infections diseases, screening tests, etc. Lots of information for pre- and post-adoptive families.
  • Center for Adoption Medicine [external link] 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.

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Where There Is No Doctor link in new window 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 link in new window 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):

MD Travel Health - Kazakhstan [external link]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 [external link] 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 [external link].

From the same site as above is Risk & Promise [external link] "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?[external link] 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.

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

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These are resources for developmental evaluations.

  • Russian Adoption Medical Services Developmental Milestones [external link] ages one month through five years. (this is an archived version of this page)
  • BabyCenter Milestones [external link] has a listing, by month, for 0-3 years.
  • KidSource [external link] has articles on general growth and development.
  • WorldBank [external link] lists ages, stages of development, and what children need from birth through 8 years.
  • Child Development Institute [external link] provides information on physical, mental and emotional growth and development in children and teenagers.
  • Baby Center [external link] has parenting resources, from FAQ to experts to bulletin boards for various ages, and a sections on development for various ages.
  • Developmental Milestones [external link] 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 [external link], 3 year olds [external link], and 4 year olds [external link]; 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 [external link] is a series of articles for parents of infants and young children, from newborn to 3.
  • Child Development Guide [external link] 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 [external link]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 [PDF link] 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. [external link]. 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 [PDF link] 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 [external link], in the Annals of Internal Medicine [external link], 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 [external link] 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 [external link]. Another good article is Families and Adoption: The Pediatrician's Role in Supporting Communication [external link] which discusses many issues in raising adopted children.

Management of latent tuberculosis infection in children and adolescents [PDF link] 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 [external link] International Adoption Clinic, Orphan Doctor [external link], Canadian Clinic for Adopted Children [external link], Valley Hospital [external link], and Medical testing recommended for international adoptees [external link] 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 [e-mail link] 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

Adoption and the Stages of Development [external link] 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:

From the World Health Organization (WHO):

An international study on gender and alcohol known as GENACIS [external link] (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 [external link], 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.

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