Newly adopted children need specialized health exams

(Reuters Health) - Children who are adopted, whether domestically or internationally, have unique healthcare needs that should be assessed as soon as possible, according to new guidance from the American Academy of Pediatrics.

Pediatricians and other healthcare workers should play a significant role in the adoption process, the guideline authors emphasize.

“Adopted children often don’t have full medical histories or have experienced trauma in life, which leads to a more complex medical exam when it comes to physical, mental or behavioral concerns,” said lead author Dr. Veronnie Faye Jones of the University of Louisville in Kentucky.

“We’ve learned more in recent years about what prior trauma can do, especially for brain development,” she told Reuters Health in a phone interview. “We should remind families that we’re here to help them along the journey.”

In the new guidance, Jones and co-author Dr. Elaine Schulte of the Children’s Hospital at Montefiore in New York City outlined trends in domestic and international adoption. They also review components of the health evaluation, the preadoption visit, the initial medical history review, the initial physical exam and chronic health concerns.

Approximately 120,000 children are adopted in the U.S. each year, they note. Most domestic adoptions occur through the foster care system, with about 50,000 adoptions per year, typically at around age six. About half are adopted by foster parents, and another third are adopted by relatives.

International adoptions have been decreasing in recent years, they point out, primarily due to changes in several countries’ policies, concerns about illegal or unethical practices by adoption services, and issues with unregulated custody transfers of adopted children. Just 5,372 immigrant visas were issued to children adopted abroad in 2016, down from 7,037 in 2015 and a 77 percent drop from the high of 23,000 adoptions in 2004. The greatest number of adopted children came from China, the Democratic Republic of the Congo and Ukraine in 2016.

Although international adoption numbers have dropped, medically-complex cases have grown, said Dr. Susan Friedman, director of the International Adoption Health Program at the Children’s Hospital of Philadelphia. She sometimes sees undiagnosed medical issues when working with families during the pre-adoption process.

“Proceeding without having the records reviewed by a specialist in international adoption is dangerous, especially because this can be done electronically,” she said in a phone interview. “Fragmented medical care can manifest itself in many ways that can be misinterpreted or mislabeled.”

A comprehensive medical evaluation can confirm or clarify medical diagnoses, including oral health problems, developmental concerns and behavioral issues. Several visits may be necessary to review lab findings and make referrals to other specialists who can help.

Many children may have faced adverse childhood experiences such as poverty, inadequate prenatal care, malnutrition, exposure to drugs or alcohol and child abuse that should be addressed.

Importantly, all children will need sensitive care, the guidance says. Healthcare providers and parents should proceed slowly, be aware of the child’s cues and provide reassurance throughout the exam process. This is also a good time to address adjustment issues and transitions that may lead to temper tantrums, aggression, sleep problems or eating problems, and develop strategies to promote strong, healthy attachments that address the child’s need for extra security around food, sleep and family.

“Even children adopted out of domestic foster care and residing in the adoptive home for a period of months or years may never have had a comprehensive health evaluation, although the adoptive family is likely to have a great deal of insight into the child’s health issues,” said Dr. Moira Szilagyi of the University of California, Los Angeles.

“A commitment to adopting a child is life-altering for both the child and the family,” she told Reuters Health by email. “Health specialists in adoption, foster and kinship care can assist adoptive parents with understanding the scope of their child’s past experiences, how they might impact current and future health issues, and how they might best help their child achieve their fullest potential moving forward.”

SOURCE: Pediatrics, online April 29, 2019.