profession

Comprehensive evaluations of newly adopted children crucial

The AAP offers guidelines to help physicians treat adoptees, who may have a higher risk of medical, behavioral and learning disorders.

By — Posted Jan. 9, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Adopted children often come with a multitude of health needs and little, if any, medical histories to help guide physicians and families in their care. It's a reality that pediatrician Veronnie Faye Jones, MD, PhD, MSPH, has experienced as an adoptive mother.

Three of Dr. Jones' five children are adopted. She knows their medical histories from the time she adopted them as infants, but beyond that is a mystery.

"The thing that I don't have any information on is their family medical histories," Dr. Jones said. "It's worrisome. Things happen and you wonder, 'Does this run in the family?' "

The unique health needs of newly adopted children make it crucial that physicians perform a comprehensive evaluation, including gathering any available medical history and conducting age-appropriate tests, a developmental assessment and complete physical examination, says an American Academy of Pediatrics clinical report in the January Pediatrics.

The article offers guidelines for pediatricians who have little experience treating adopted children, said Dr. Jones, the report's author and a pediatrics professor and associate dean for academic affairs at the University of Louisville School of Medicine.

Missing or inaccurate medical records are common.

"Many times the information is simply not available or it comes in a fragmented manner," she said. "It is important for all the parties involved -- parents, health care workers, lawyers, etc. -- to work together to provide the most comprehensive history as possible."

Children at high risk

More than 100,000 children are adopted in the U.S. each year, including about 22,000 international adoptions, the report said.

Adoptive parents have at least some access to family medical histories when they are relatives, or in open adoptions that involve ongoing communication with one or both biological parents, said Kathy Ledesma. She is national project director for AdoptUSKids, a federally funded organization that helps recruit and raise awareness about the need for foster and adoptive families.

About 80% of adoptions of children born in the U.S. are to relatives or foster parents. "It's that other 20% that I think we really need to be concerned about," she said.

Adopted children may have a variety of health issues, including attention-deficit/hyperactivity disorder, posttraumatic stress disorder and other behavioral or learning issues, Ledesma said.

"The medical conditions that are most challenging are those that you can't see, such as prenatal exposure to alcohol or drugs and the emotional load that they come with," she said.

Children can come from backgrounds of poverty, abuse or neglect. They may have been malnourished, had little or no prenatal care, received inadequate developmental stimulation, or been exposed to toxins in the womb or at a young age, the report said.

In international adoptions, children may have medical problems that the average pediatrician has never encountered, such as rare genetic disorders or exposure to infectious diseases that aren't typically seen in the U.S., said Jane Aronson, MD, a pediatrician and infectious diseases specialist. Mental and developmental health are major concerns, especially among children who have lived in institutions, under extreme poverty or in war-torn countries, she said.

"There are so many ways that children are living that are so degrading and traumatic that most pediatricians would have no clue about," said Dr. Aronson, who has two adopted children and is founder and CEO of the nonprofit Worldwide Orphans Foundation, which seeks to improve the living conditions of orphans around the world.

Gathering medical histories in international adoptions can be difficult, particularly in countries such as China and Ethiopia, where many children are orphans or abandoned anonymously, said Julia M. Bledsoe, MD, clinical professor of pediatrics and director of the University of Washington Center for Adoption Medicine in Seattle.

It's important to know what diseases or conditions an adopted child is at risk for and be vigilant in screening for them, Dr. Bledsoe said. Medical care can vary depending on the country, and children often aren't screened for diseases such as tuberculosis, HIV and hepatitis before coming to the U.S.

Comprehensive health evaluations aid physicians in treating adopted children and help adoptive families to be realistic about what to expect. It's also vital that physicians and families monitor adopted children's development to ensure that they have the counseling and care they need, Dr. Aronson said.

"Reminding physicians of areas to focus on, and screening that may be warranted, will help to identify potential problems and provide optimal care for each child entrusted to our care," Dr. Jones said.

Back to top


ADDITIONAL INFORMATION

Key points for examining adopted children

Guidelines from the American Academy of Pediatrics recommend that physicians perform a thorough medical examination of adopted children and review any available medical records to best assess their needs.

  • Take all vital signs (temperature, pulse, respiratory rate, blood pressure).
  • Evaluate growth points, including length or height, weight, head circumference and body mass index.
  • Conduct a complete physical examination.
  • Examine skin for bruises or scars and signs of infectious diseases, including rashes and infestations. Also look for any congenital skin abnormalities.
  • Check genitalia to identify any abnormality indicating potential prior sexual abuse or cutting. Test for sexually transmitted diseases if abuse is suspected or if patient is sexually active.
  • Conduct a neurologic examination, with emphasis on developmental and neurologic abnormalities.

Source: "Comprehensive Health Evaluation of the Newly Adopted Child," Pediatrics, January (link)

Back to top


External links

"Comprehensive Health Evaluation of the Newly Adopted Child," Pediatrics, January (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn