Cleft Care of Internationally Adopted Children From China

Abstract

Chinese adoptees have more complex presentations and delayed surgical care compared to their domestic counterparts. Engaging prospective families starting before adoption helps to manage expectations. Long-range planning, timely surgery, aggressive therapy, and close careful follow-up can mitigate some of these differences. Speech and language problems including articulation disorders, expressive delays, and hypernasality are frequent and can persist despite interventions.

Internationally Adopted Children With Unilateral Cleft Lip and Palate—Consonant Proficiency and Perceived Velopharyngeal Competence at the Age of 5

“…Previous studies of IA children have used several different assessment methods and types of speech material (Larsson et al, 2017; Morgan et al, 2018; Scherer et al, 2018) or did not report at all on the methods used (Swanson et al, 2014; Kaye et al, 2019). This makes it difficult to compare results across studies.…”

“…Certain IA children have had palatal surgery prior to adoption, using unknown surgical methods, but some of them need secondary velopharyngeal (VP) surgery owing to VP incompetence. In addition, many IA children have more surgical complications than do nonadopted (NA) children, for example, fistulae and dehiscence (Kaye et al, 2019).…”

“…However, one common type of special need and diagnosis seen in children adopted to Europe and the United States is cleft lip and palate (CLP) (Hansson et al, 2012; Swanson et al, 2014). According to international reports from CLP centers (Hansson et al, 2012; Swanson et al, 2014; Kaye et al, 2019), the cleft type most commonly seen in internationally adopted (IA) children is unilateral cleft lip and palate (UCLP). These centers reported that a majority of the IA children they see arrive with an unoperated palate, necessitating late primary palatal surgery around a median age of ∼24 months (range: 16-42 months).…”

“…There are also other studies reporting speech outcome in IA children with CLP (e.g., Swanson et al, 2014; Follmar et al, 2015; Kaye et al, 2019). Whilst all retrospective chart reviews with numerous uncontrolled variables, they all reported that there is an increased risk of VP incompetence in children who undergo late palatal repair, postadoption as well as preadoption, and hence also a likelihood that the frequency of secondary speech surgery will be higher in this group of patients.…”

Perioperative care for internationally adopted children: Medical, surgical, and psychosocial considerations for a population of concern

“…A series describing international adoptees from China with cleft lip and/or palate supported this, finding unexpected medical conditions in 57.4% of children, with common diagnoses of attention deficit hyperactivity disorder, hearing loss, or hepatitis B. Children also were commonly found to have syndromes (ie, Down syndrome, Wilson's disease, and Goldenhar syndrome) and congenital heart defects 6 . Similarly, systematic screening of children with known anorectal malformations revealed high rates of VACTERL (Vertebral, Anorectal, Cardiac, Tracheoesophageal fistula, Renal, and Limb) associated anomalies that were undiagnosed prior to adoption 7 …”