Medical Evaluation of Internationally Adopted Children

Hostetter, Margaret K.; Iverson, Sandra; Thomas, William; McKenzie, David R.; Dole, Kathryn; Johnson, Dana E.

doi:10.1056/nejm199108153250706

Cited by 139 publications

(123 citation statements)

References 22 publications

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“…These findings strongly support the need for timely adoptive placement of young infants. 21,22 The reasons for these deficits are unknown, although delayed growth and developmental milestones have been reported among children who were adopted from orphanages, [3][4][5][6][7]9,23,24 and the adverse effects of orphanage life on child development have been described comprehensively. [25][26][27][28][29][30][31][32] Among orphans in Iraqi Kurdistan, behavioral problems increased in children who resided in orphanages compared with those who were placed in foster care.…”

Section: E714mentioning

confidence: 99%

“…Adoptive parents, adoption agencies, and physicians who care for internationally adopted children have wondered whether the young age at placement and residence in foster care (rather than orphanages) reduce the frequency of health and developmental issues such as those described in children who are adopted from Russia, Romania, China, and other countries. [2][3][4][5][6][7][8][9][10][11][12] Other speculations include the possibility that Guatemalan children are less likely to be exposed prenatally to drugs or alcohol than children from other regions and that their vaccine records are more "believable" than those from some other countries. 13 Moreover, although foster care is widely believed to result in better health and developmental status for children without parents, a direct comparison of the status of children who are raised by these 2 methods of care has not previously been reported.…”

mentioning

confidence: 99%

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Health of Children Adopted From Guatemala: Comparison of Orphanage and Foster Care

et al. 2005

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ABSTRACT. Objective. Since 1986, American parents have adopted >17 300 children from Guatemala. This study assessed the health, growth, and developmental status of 103 Guatemalan adopted children (48 girls; 55 boys) after arrival in the United States. Physical evidence suggestive of prenatal alcohol exposure and adequacy of vaccinations administered were also reviewed.Methods. Retrospective chart review was conducted of 103 children who were evaluated after arrival in the United States in an international adoption specialty clinic, and a case-matched study was conducted of a subgroup of 50 children who resided in either an orphanage or foster care before adoption. Mean age at arrival was 16 ؎ 19 months. Before adoption, 25 children resided in orphanages, 56 resided in foster care, and 22 resided in mixed-care settings. The 25 children who had resided in orphanages before adoption were matched for age at arrival, interval from arrival to clinic visit, and gender with a child adopted from foster care. Health and developmental status of these matched pairs were compared, allowing the first direct comparison of children raised in orphanages or foster care before adoption.Results. Mild growth delays were frequent among the children. Mean z scores for weight, height, and head circumference were, respectively, ؊1.00, ؊1.04, and ؊1.08. Children from foster care had significantly better z scores for height, weight, and head circumference than those from orphanage or mixed care. Among children who were younger than 2 years at arrival, growth measurements correlated inversely with age at arrival. Infectious diseases included intestinal parasites (8%) and latent tuberculosis infection (7%). Other medical conditions included anemia (30%), elevated lead levels (3%), and (using strict criteria) phenotypic facial features suggestive of prenatal alcohol exposure (28%). Adequacy of vaccine records from Guatemala was assessed: 28% met American Academy of Pediatrics standards for vaccine administration. Unsuspected significant medical diagnoses, including congenital anomalies and ocular, neurologic, and orthopedic problems, were found in 14%. Most children were doing well developmentally (80 -92% of expected performance), but 14% had global developmental delays. Cognition, expressive and receptive language, and activities of daily living skills correlated inversely with age at arrival for children who were younger than 2 years at adoption. Among the 50 matched children, those who resided in foster care before adoption had better measurements for height, weight, and head circumference at arrival to the United States. Moreover, those who resided in foster care scored significantly better for cognitive skills than those who had previously resided in orphanages (96.3% of age-expected compared with 88.3% of age-expected); other skills did not differ between the 2 groups. No differences were found between the 2 groups of children related to prevalence of medical diagnoses or phenotypic evidence suggesting prenatal alcohol exposure.Conclu...

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Section: E714mentioning

confidence: 99%

mentioning

confidence: 99%

Health of Children Adopted From Guatemala: Comparison of Orphanage and Foster Care

et al. 2005

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“…1,2 Children and youth in the care of various child-care settings (eg, orphanage, foster care, boarding school, adoption center, or child welfare system) represent a unique population with disproportionately increased rates of developmental disabilities, congenital malformations, and mental health diagnoses. [3][4][5][6][7] In addition, children in care have an increased prevalence of social maladjustment 8 and greater difficulty forming secure attachment relationships than do home-reared infants. 9 Internationally adopted children experience high levels of deprivation before adoption.…”

mentioning

confidence: 99%

“…In a sample of 415 patients with FASD, 30 females gave birth to a child; of these, 57% no longer had the child in their care, 40% were drinking during pregnancy, 17% had children diagnosed with FASD, and an additional 13% had children who were suspected of having FASD. 18 It is clear that children and youth in care represent a significant population with special needs, [3][4][5][6][7][8][9] and a better understanding of their deficits and impairments is needed to target interventions and provide appropriate services.…”

mentioning

confidence: 99%

Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Meta-analysis

et al. 2013

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BACKGROUND: Children often enter a child-care system (eg, orphanage, foster care, child welfare system) because of unfavorable circumstances (eg, maternal alcohol and/or drug problems, child abuse/neglect). Such circumstances increase the odds of prenatal alcohol exposure, and thus this population can be regarded as high risk for fetal alcohol spectrum disorders (FASD). The primary objective was to estimate a pooled prevalence for fetal alcohol syndrome (FAS) and FASD in various child-care systems based on data from existing studies that used an active case ascertainment method. METHODS:A systematic literature review, using multiple electronic bibliographic databases, and meta-analysis of internationally published and unpublished studies that reported the prevalence of FAS and/or FASD in all types of child-care systems were conducted. The pooled prevalence estimates and 95% confidence intervals (CIs) were calculated by using the Mantel-Haenszel method, assuming a random effects model. Sensitivity analyses were performed for studies that used either passive surveillance or mixed methods. RESULTS:On the basis of studies that used active case ascertainment, the overall pooled prevalence of FAS and FASD among children and youth in the care of a child-care system was calculated to be 6.0% (60 per 1000; 95% CI: 38 to 85 per 1000) and 16.9% (169 per 1000; 95% CI: 109 to 238 per 1000), respectively. CONCLUSIONS:The results confirm that children and youth housed in or under the guardianship of the wide range of child-care systems constitute a population that is high-risk for FASD. It is imperative that screening be implemented in these at-risk populations.

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“…6 During 1993-1998, the tuberculosis case rate was 32.9 per 100 000 population in foreign-born persons, compared with 5.8 per 100 000 population in US-born persons. 7 Furthermore, immigrant children may not have been screened at birth for diseases such as congenital syphilis, hemoglobinopathies, and inborn errors of metabolism. Pediatricians in the United States may not be experienced in accurately evaluating, diagnosing, and treating some of these diseases, particularly when they first see patients in the later stages of illness.…”

Section: Immigrant and Refugee Childrenmentioning

confidence: 99%

Providing Care For Immigrant, Homeless, and Migrant Children

2005

Pediatrics

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ABSTRACT. This policy statement, which replaces the retired statements "Health Care for Children of Immigrant Families" (1997) and "Health Needs of Homeless Children and Families" (1996), is a broader discussion and addresses not only immigrant but also homeless and migrant child populations. It provides pediatricians with the necessary framework for addressing underserved children: those who face substantial barriers that limit access to appropriate health care services. This statement supports a community-based approach to health care delivery to ensure that underserved children have a medical home. Pediatrics 2005;115:1095-1100; immigrant, migrant, homeless children, underserved communities.

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Medical Evaluation of Internationally Adopted Children

Abstract: Directed screening tests should be a routine component of the medical evaluation of all children adopted from abroad, regardless of age, sex, or country of origin.

Cited by 139 publications

References 22 publications

Health of Children Adopted From Guatemala: Comparison of Orphanage and Foster Care

Health of Children Adopted From Guatemala: Comparison of Orphanage and Foster Care

Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Meta-analysis

Providing Care For Immigrant, Homeless, and Migrant Children

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