The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers Laurie C. Miller, MD OXFORD UNIVERSITY PRESS The Handbook of International Adoption Medicine This page intentionally left blank T H E H A N D B O O K O F I N T E R N AT I O N A L A D O P T I O N M E D I C I N E A Guide for Physicians, Parents, and Providers Laurie C. Miller, MD 2005 Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi São Paulo Shanghai Taipei Tokyo Toronto Copyright © 2005 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York, 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Miller, Laurie C. The handbook of international adoption medicine: a guide for physicians, parents, and providers/Laurie C. Miller. p. ; cm. Includes bibliographical references and index. ISBN 0-19-517681-2; 0-19-514530-5 (pbk.) 1. Adopted children—Medical care—United States. 2. Adopted children—Health and hygiene—United States. 3. Adopted children—Diseases—United States. 4. Intercountry adoption. 5. Interracial adoption. I. Title. DNLM: 1. Adoption. 2. Child Welfare. 3. Internationality. 4. Physician–Patient Relations. WS 105.5.F2 M648h 2004 RJ101.2.M54 2004 618.92—dc22 2003069102 The science of medicine is a rapidly changing field. As new research and clinical expe- rience broaden our knowledge, changes in treatment and drug therapy do occur. The author and publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is accurate and complete, and in accordance with the standards accepted at the time of publication. However, in light of the possi- bility of human error or changes in the practice of medicine, neither the author, nor the publisher, nor any other party who has been involved in the preparation or publi- cation of this work, warrants that the information contained herein is in every respect accurate or complete. Readers are encouraged to confirm the information contained herein with other reliable sources and are strongly advised to check the product infor- mation sheet provided by the pharmaceutical company for each drug they plan to administer. 246897531 Printed in the United States of America on acid-free paper To all children of the world who wait for families— you are not forgotten This page intentionally left blank P R E F A C E I t has been an extraordinary pleasure ofmy When I visit orphanages, I often find professional life to care for internationally myselfwishing I could write “orders” for each adopted children and their families. Every child who lives there. I’d love to write a pre- pediatrician recognizes the surprising ability of scription for each child to have a loving, atten- children to overcome illness and misfortune. tive family. No amount ofmedical care, educa- Nowhere in pediatrics is the incredible re- tion, interventions, or special activities can silience of children so obvious as in interna- replace family love. For children from difficult tional adoption. Although it is disheartening to backgrounds, adoption is the perfect remedy. see children live (or in some cases subsist) in or- The medical model sometimes overlooks phanages, their transformation after adoption is the importance of this fundamental human miraculous. Abandoned children who have suf- need. When I show colleagues the phenomenal fered multiple adversities change into happy, growth recovery charts or “before-and-after” healthy, thriving kids by the “simple” act of photos of recently arrived international adoption. The metamorphosis is sometimes vis- adoptees, I’m often asked what was done to ible within days. evoke such a transformation. Did the child have The opportunity to work with prospective a medical problem that had been missed? Was adoptive parents has also been a privilege. Most a surgical procedure performed? Was some par- prospective parents deeply yearn for a child. It ticular medication prescribed? Mistakenly, is a joy to behold the fulfillment ofthese dreams credit is given to a medical therapy, rather than as a family is created or enlarged. The energy, the most profound intervention of all: adop- devotion, and love of pre- and post-adoptive tion. Adoption allows children to belong to a parents is unsurpassed. family. It is no news to pediatricians that chil- viii Preface dren need caring, attentive adult(s) in their plus Health Information Medical Encyclope- lives, but nowhere is this more dramatically il- dia, available at: http://www.nlm.nih.gov/ lustrated than in international adoption. medlineplus/encyclopedia.html for general This book is primarily intended for pedi- medical topics, and (3) National Institute of atricians and other physicians who care for in- Mental Health “For the Public,” available at ternationally adopted children. It is not in- http://www.nimh.nih.gov/publicat/index. tended as a comprehensive text covering every cfm for information on specific mental devel- topic that might affect an international adoptee. opmental disorders, and the related site http:// Rather, it is meant to provide basic information www.nimh.nih.gov/publicat/childmenu.cfm for the practitioner caring for these children which specifically addresses child and adoles- and to minimize the need to seek other sources cent mental health. to guide management of common problems. A word about structure. The book is di- Some topics are covered in more detail than vided into seven sections that follow an intro- others, either because of their relative impor- ductory chapter. These sections are designed to tance to the field of adoption medicine or be- introduce topics ofimportance to international cause pediatricians may lack readily available adoption medicine. Most chapters end with Key resources about them. Some sections of this Points for Internationally Adopted Children. book will also be applicable to immigrant chil- Many chapters have case vignettes as sidebars. dren, especially those from less privileged back- It should be emphasized that these vignettes are grounds (see Chapters 3, 8, 10–28, 31, 32). composites ofcases from clinical practice fab- Some sections relate to children living in foster ricated to illustrate important points. The care in the United States (see Chapters 2, 5–9, names were chosen arbitrarily and do not iden- 12, 13, 29, 30, 32, 34, 35). Some chapters may tify actual children. The book ends with a list of assist physicians caring for children in difficult resources. This duplicates items listed else- congregate settings such as refugee camps or where in the book, but is consolidated for the orphanages (see Chapters 2, 3, 8, 10–35); some convenience ofthe reader. Additional informa- are applicable to children living in poverty tion on all topics addressed in this book is avail- anywhere (see Chapters 5–8, 10–22, 24–26, 28, able in many standard texts as well as on the In- 32). ternet. Every effort has been made to ascertain Although written with physicians in mind, the accuracy and availability ofcited Web sites. I hope that social workers, other adoption pro- However, these sites frequently change, move, fessionals, health, therapy, and educational or are updated. It is hoped that sufficient infor- providers who work with adopted kids and their mation has been provided to allow the reader to families, and adoptive parents also find this find the cited sources when desired. book a useful reference. Conversations over the Photographs are used throughout this years with adoptive parents and adoption pro- book. Many were taken in orphanages through- fessionals persuaded me that complex medical out the world. Because ofthe sources ofthese details and sometimes dense terminology would photos, there was no mechanism to obtain ex- not hinder those interested in these subjects. plicit permission for the use ofthese images. I Readily available material on the Internet offers include these photographs to illustrate impor- the reader useful introductions to less familiar tant points about orphanage life for children, topics and explanation of terminology. Sug- with enormous respect and compassion for each gested sites are (1)Centers for Disease Control of them. Some of these children may subse- and Prevention, “A–Z” index ofhealth topics, quently have been adopted. If so, I hope that available at: http://www.cdc.gov/az.do for in- they and their adoptive families accept the spirit troductions to infectious diseases, (2)Medline- in which these images were used. Preface ix This book is based on my experience in in- opment, behavior, school performance, and ternational adoption medicine for the past 15 family adjustment. Today, the field is emerging years. As such, I am certain my biases and idio- and dynamic. Most children’s hospitals are es- syncrasies are apparent. For many years, there tablishing clinics devoted to international was no field of “international adoption medi- adoptees. The corresponding influx ofnew en- cine.” From an initial focus on infectious dis- thusiasm, ideas, and investigations is a wel- eases, international adoption medicine has ex- come addition to the field. panded to include a wide variety of pediatric concerns, including growth delay, child devel- Boston, Massachusetts L.C.M.