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general
health questions
International Pediatrics
Health Services, (212)
727-0627
Canadian
Government Health Requirements for Entry Into Canada (Canadian visa
site)
Note: There are few internation
adoption clinics in Canada ( a pathetic statement about health care
priorities here)
Canadian
Doctors who specialize in International Adopted Children include:
Dr. Angelo Simone offers
medical consultation services to individuals involved in domestic and
international adoption, and provides pre- and post adoptive consultations
at his clinic. Dr. Simone, board certified pediatrician and endocrinologist,
is the Chief of Pediatrics for the Trillium Health Center in Mississauga.
The Canadian Clinic for Adopted Children counsels prospective adoptive
parents, reviews video and medical reports. Dr. Simone screens the adopted
children after arrival and provides ongoing follow-up and referral.
The Clinic also has an extensive health care network of specialists
in many areas. 2338 Hurontario Street, Suite 200, Mississauga, Ontario.
tel: 905-848-8303. fax: (905) 848-5727 email address: asimone@attcanada.net
Website URL: http://CdnClinicAdoptedChildren.homestead.com/CdnMedClinic.html
The following information is from Robin Hillborn of Adoption
Helper
- Cecilia Baxter, M.D., Edmonton, Alta., 780-477-4605, fax 477-4072.
Consulted by many Alberta families.
- Jean-Francois Chicoine, M.D. International Health Clinic, Ste. Justine
Hospital, Montréal, Qué. Accepts children with adoption-, travel-
and immigration-related sicknesses. Because of a change in hospital
policy in September 1998, this clinic no longer takes walk-in cases,
only referrals from pediatricians. Until the policy change, the clinic
had been seeing directly about 700 of the 900 children adopted each
year to Québec. You can still get an appointment with Dr. Chicoine
at the Quebec Travel Medicine Centre (see next). [From Gilles Breton,
webmestre@quebecadoption.net]
- Jean-Francois Chicoine, M.D., Pre-adoption Clinic, Quebec Travel
Medicine Centre, St. Luc Hospital, 1001 St. Denis St., Montréal, Qué.
H3T 1K2, 514-281-3295. Pre-adoption consultation before accepting
a child proposal. Not covered by health insurance; $75 a visit.
- Family Medicine Clinic, Berger Medical Centre, 1000 chemin Ste-Foy,
Suite 116, Québec, Qué., 418-688-1385, fax 688-3249. Specializing
in health care for children adopted abroad.
- Mark Handley-Derry, M.D., 658 Danforth Ave., Suite 210, Toronto
M4J 5B9 416-461-3937, mark.handley.derry@utoronto.ca. Pre- and post-adoption
assessment. Waiting list, so book ahead if possible.
- Sharon Marcovitch,M.D., 491 Lawrence Ave. West, Suite 405, Toronto
M5M 1C7, 416-780-0909, fax 780-9490, drsharon@interlog.com. She is
author of Romanian Adoptee and Family Follow-up Study. Pre- and post-adoption
assessment.
- Angelo Simone, M.D., Cdn Clinic for Adopted Children, 2338 Hurontario
Street, #200, Mississauga, Ont. L5B 1N1. 905-848-8303, fax 848-5727,
asimone@attcanada.net http://CdnClinicAdoptedChildren.homestead.com/CdnMedClinic.html
Pre- and post-adoptive medical consultations for domestic and international
adoption. Counsels parents, reviews video and medical reports. Reviews
videos sent from abroad and emails or faxes back the evaluation to
the parents abroad. Medical screening of children after arrival; developmental
evaluations. Referrals to specialists. Most services covered by OHIP.
Dr. Simone is Chief of Pediatrics at Trillium Health Centre.
- Gaelle Vekemans, M.D., International Post-adoption Clinic, Centre
Hospitalier Ambulatoire Régionale de Laval, 1515 boul. Chomedey, Laval,
Qué. H7V 3Y7, 450- 978-8301, fax 978-8339. Working with Dr. Jean-Francois
Chicoine. Post-adoption assessment. [From Gilles Breton, webmestre@quebecadoption.net]
For updated information from Robin Hillborn's Adoption
Helper site about medical professionals and international adoption
follow this link
post-international adoption tests American Academy of Pediatrics recommendations for post-international
adoption tests
note: many parents have vaccinations
reported to have been done in China repeated upon adoption. To avoid unnecessary
replication, tiiters performed by your pediatrician will ascertain whether
the vaccination has either been performed or "taken." If
doctors are not familiar with international adoption, parents will have
to be the health advocate for their children.
Dr. Jane Aronson, a NYC specialist
in international adoption medicine writes about the general health of
institutionalized children in China here.
Assessing
the age of your Chinese adopted child by Jane Aronson.
On our Chinese daughters as
survivors. Dr. Aronson's narrative about the
health of Lili.
The tests below are listed (July
2000) by Dr. Jane Aronson at http://www.orphandoctor.com/screen.htm
Laboratory Screening tests for International Adoption
CBC with differential and platelets (RDW, Retics)
Urinalysis with microscopic examination
Stools O&P X4 with Giardia antigen and Cryptosporidia smear (acid fast)
Stool C & S X1 (Salmonella, Shigella, Campylobacter, Yersinia)
Liver enzymes (SGOT, SGPT)
Rickets screen (Alkaline phosphatase, Calcium, Phosphorus)
Lead (venous)
Syphilis serology (RPR, FTA-ABS)
Hepatitis B surface antigen Hepatitis B surface antibody Hepatitis B
core antibody total (these should be repeated in 6 months again) Hepatitis
B core antibody IgM (these 3 tests should only be done if patient is
Hep B sAg positive) Hepatitis B e antigen Hepatitis B e antibody
Hepatitis C antibody HIV-1
Elisa Thyroid function tests (Free T4, T4RIA, TSH)
Metabolic screen (PKU, Galactokinase, Biotinidase, etc.)
PPD (Mantoux test) Must be checked by health professional in 48-72 hours
Hearing and vision evaluations (especially in premature infants)
This is a note from a nurse
practitioner on the AOK-listserve about some/all? of the tests she performs
on children (including older) adopted internationally:
I am a pediatric nurse practitioner and do exams on children
adopted internationally. The American Academy of Pediatrics and the
CDC have guidelines for the labs and workups to be done on internationally
adopted children. The following is a list of labs that should be performed
as well as some that I recommend. CBC with diff. This is a complete
blood count to look at the different components of the blood. Lead screen-
many children in orphanages are exposed to lead based paints and many
have been found to have elevated levels. SMA 22 - not always recommended,
but provides useful information about the different electrolytes in
the body. RPR - to rule out syphilis. Hepatitis B panel - (Hepatitis
B surface antigen, Core antibody, and surface antibody) Important to
rule out exposure or protection against hepatitis B. In include a Hepatitis
C antibody, not a specific or definitive test for Hepatitis C. Thyroid
panel - T4, T3, and TSH, thyroid problems are common in chinese children.
HIV testing. Urinanalysis (I include a Urine culture, as a fair number
of chinese children have mild underlying urinary tract infections).
Stools for ova and parasites, culture and ghiardia antigen - a recent
article I read showed some children infected with ghiadia, which is
a parasite rarely detected with a stool culture, therefore I have included
it in my testing. Hearing and vision screening is also recommended,
some doctors or PNP's may not think this is important, but keep in mind
you have no birth, pregnancy or newborn history. I recommend seeing
an opthamologist and an ear/nose/throat specialist for these screenings.
My child had a eye problem that was unknown to me and several of the
children I've seen had hearing difficulties, correctable, but very important
to correct for language aquisition. PPD - to check for tuberculosis,
this should be done even if a child has received BCG. Antibody testing
can be done to see if the child developed immunity to the vaccinations
given, current recommendations are to restart all immunizations. All
children should receive some developmental testing. If the child is
under 3, the state will provide services such as occupational, physical
and speech therapy. For children over 3, speech therapy is available
through the school system. For more information on speech for children
3 and over, contact Special Education at your board of education. Your
doctor may not be aware of these recommendations. You may suggest he
reference the RED BOOK.
Study
of Health of Children from Chinese Orphanages
A recent publication (June, 2000) in the journal Pediatrics
provides recent information regarding the health statistics of children
adopted from China. In this publication, the health conditions of over
400 children adopted from China are presented. Data were collected from
two sources- a pediatric clinic in the NE US and a survey of families
using one agency in the NE US. Among these children, the incidence of
chronic carriage of hepatitis B surface antigen (carriers of the hepatitis
B virus as detected by hepatitis B surface antigen in a blood test)
was 5%. The incidence of exposure to hepatitis B or vaccination to hepatitis
B was aproximately 20% (as detected by hepatitis B surface antibody).
This percent of 5% is similar to that reported by other smaller studies
previously. Thus, one might expect that aproximately 1 in 20 children
adopted from China are found to be carriers of hepatitis B. Factors
that appear to increase the likelihood of being a carrier include being
older, and being from an orphanage that does not vaccinate children
against hepatitis B. While most transmission of hepatitis B occurs from
mother to child at the time of birth, additional transmission among
toddlers and small children may occur in an institutional setting among
unvaccinated children. There is a blood test for hepatitis B that most
adopted children receive in China however the results of the testing
in China may not reflect the results of testing subsequently done in
the US. This is the most common significant infectious disease present
in China. There is a vaccine currently available for children and adults
in the US. Families who will be adopting from China may benefit from
receiving the vaccine for both parents and children in the household
setting. Transmission of hepatitis B in a household setting is uncommon
as hepatitis B is transmitted by close contact with blood or body fluids.
Vaccination (which requires a schedule of 3 injections) will further
minimize the potential for any transmission. [PAC note from Hetty (can
you tell I have a background in public health?)]
tuberculosis issues
RE BCG and
TB test results ... the latest advice from the American Academy of Pediatrics
is that docs should evaluate a TB test exactly as if reading a test
for a child who had not gotten a BCG shot. The Mantoux (transdermal)
test is recommended rather than the tine test. If the test reads positive
than a chest x-ray would be ordered for further study. The website of
the American Academy of Pediatrics (listed above) has a complete list
of post-adopt tests: www.cyfc.umn.edu/Adoptinfo/screening.html
Other relevant links:
http://www.rainbowkids.com/500tbinadoptees.htm
http://www.fwcc.org/TB_BCG.htm
attachment
issues
A
short article by "Jessica" on institutionalized
infants and attachment that has an excellent section on promoting
attachment when you first adopt your child.
A
brief note on attachment from an adoptive mother
(quoted with permission from Post-Adopt-China list)
"Almost every symptom of attachment disorder can be considered
normal for some children. It's the combination, depth and frequency
that can define attachment disorder from just a normal stage of development.
Also, attachment disorder can be seen in bio children too! It isn't
just reserved for the adoption world. There is a difference between
"securely attached" and "anxiously attached." 4 main types of attachment
are discussed on the attach-china website (and can be found on all attachment
disorder websites; there are quite a few sites out there) and "insecure/anxious
attachment" is one type of attachment disorder. The symptoms can be:
* Less confident and assertive * Clingy/shadowing * Whiny, dependent,
demanding * Too eager to please * Intrudes into adult space * Pouts
when limits set * Separation anxiety (school, activities, doctor visits,
etc) * Demanding of affection. A child may not have all of these; even
if they only display one or two of these symptoms, they can still be
diagnosed with Attachment Disorder. "My daughter bonded to us in
seconds and stuck to us like Velcro," say some parents about their
initial rapport with their adopted child. This is a common statement
heard from newly adoptive parents and I believe it is a mis-conception
for the most part. Since true bonding and attachment are formed based
on a cycle of: need, need expressed, need met and calmness/quiescence
that happens hundreds and thousands of times between a parent and child,
it is unlikely that "instantaneous" true attachment is possible....
Attachment is a continuum and never a black and white issue."
For
a brief introduction to attachment issues in Chinese children, see the
following brochure produced by Families With Children From China - Metro
Detroit who have put together "a concise,
easy-to-read 20 page newsletter devoted to attachment parenting / attachment
disorder and China adoption. With a little of everything, it is
a great overview of the attachment process, ways to promote bonding,
'What I Would Do Differently', book resources, and personal stories.
Much of the factual information was used, with permission from Lynne
Lyon, from the attach-china website, and has been endorsed by attachment
therapists in the metro Detroit area. Having this topic in print, in
a non-threatening format, makes it easy to share this important info
with family members, day-care providers, and pediatricians. It is a
wonderful tool to introduce what we may be experiencing with our children,
to the people in our lives that we care about....The newsletter also
contains information that families-in-waiting should read before traveling...there's
lots of good tips listed to enhance attachment, without deliberately
scaring away the new parents who might need this information most. Consider
purchasing several copies for yourself to educate your friends and family,
or buy in packs of 10 or more for your local FCC. $2.50 each for copies
up to 10, $2.00 each for 10 or more. Professionally printed on heavy-stock.
Checks made out to FCC-MD are tax-deductable. For more info please contact
Jean MacLeod at jmac1@home.com or Laura Hodges at Yichanglrh@home.com.
A message
from the moderator of attach-china listserve on their website
(Wed, 26 Apr 2000) It is important
for adoptive families to recognize how a child's early experiences can
impact their future emotional development. Children adopted
from China have experienced the loss of their birthmothers, physical
abandonment, and multiple caretakers. Most have suffered deprivation
and/or neglect in varying degrees. To find out more about this, visit
the newly updated Attach-China website at our new internet address:
www.attach-china.org The updated site has new information
on every page, and has added a very exciting new section called "Our
Voices". The families on the attach-china e-mail listserv have come
together to share our personal experiences, in the hopes that readers
will gain insight into how attachment issues present themselves in children
adopted from China. This is the new table of contents:
THE BASICS - When the Bonding Cycle is Broken - Attachment & Bonding
by Walter D. Buenning, PhD (originally appeared in Chosen Child, reprinted
with permission) - Types of Attachment -
Treatment OUR VOICES - Why Chinese Adopted Children are at Risk for
Reactive Attachment Disorder: --
Part I: Secure Attachment and Reactive Attachment Disorder -- Part II:
The RAD Continuum -- Part III: Healing and Treatment -RAD symptoms -
a new, comprehensive list linked to actual descriptions as experienced
by attach-china families -FAQs - frequently asked questions - Promoting
Attachment - activites and games to do with your child -Our Stories
- 2 stories from Attach-China families RESOURCES - Adult Reading List
- Children's Books recommended by the attach-china families - Special
Events - workshops and speaking schedules of adoption experts - Therapists
- Links to related web sites
For recommended activities
to promote attachment in your adopted child see: http://members.aol.com/RADchina/activities.html
For extended discussion
about attachment
issues in Chinese
adopted children, join the listserve at www.attach-china.org
Attachment
parenting lists:
www.kuddlekids.com
www.members.aol.com/toddleroo/activities/list.htm
www.netaxs.com/~sparky/adoption/attach_2.htm
www.radinfo.homestead.com/InfantReparentingNurturing~ns4.html
www.rtc.pdx/edu/fp/spring96/parent.htm
See
also information at 'The Attachment Centre at Evergreen'
"What You Should Know Before You
Adopt a Child" (note: this concerns American domestic adoption primarily but
some of the issues are relevant to Chinese adoption. Attachment disorder
is NOT unheard of with Chinese institutionalized children, even though
it appears to be less prevalent than many of those from other groups.)
"International Adoption: Challenges
and Opportunities." from the Parent Network for the Post-Institutionalized
Child - International Site
"Does Attachment Therapy Work?:
Results of Two Preliminary Studies" by Liz Randolph, PhD and
Robin Myeroff, PhD
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