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.
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.