Saturday, December 18, 2010

Armenian Adoption Adventure- Selecting a Pediatrician

Although your child will have some kind of medical record, in International Adoption it is never certain. In Armenia, your child will have a medical check up before you have your exit visa issued. Ask for additional panel tests, especially for the genetic leukemia test that is prominant in the Armenian genetics. The Armenian Bone Marrow Registry has additional information about this.
Interviewing and securing an International Pediatrician that you feel comfortable with should be a priority while you are in the waiting game. One word of advice, if your child is older like mine, it is advisable to have an Armenian Pediatrician so the child doesn't feel intimidated or frightened, they speak the same language. Or take a translator with you to the first doctors appointment. Try to coordinate your first Pediatrician appointment within 2 weeks after you arrive home with your child(ren).

From the John Hopkins website:
The Pediatrician’s Role in International Adoption
December 15, 2010
A young couple calls you for a consultation regarding their plans to adopt a child from another country. What should they be wary of? What do they need to know? What is your role as a pediatrician in such cases, and can you guide prospective parents considering an international adoption?
Yes, says pediatrician and pediatric anesthesiologist Deborah Schwengel, who recently presented on the issue at Johns Hopkins annual Pediatrics for the Practitioner Update. But the pediatrician’s role is not to judge whether parents should or should not adopt a child, but to inform prospective parents of the health issues, especially any special needs and what those special needs mean for the family.
“Some kids have medical issues, some psychological issues, and families need to be very aware of that as they’re preparing to adopt a child,” says Schwengel. “It’s not always a fairy tale ending.”
Typically in international adoptions, Schwengel explains, parents pick a country and an international adoption agency, meet with a social worker regarding their desires to adopt, submit the paperwork and await the referral of a child. When that arrives, adoption agencies either require or recommend that adopting parents seek the advice of a pediatrician, someone comfortable with reviewing all of the child’s health information. But often this international medical record is brief, Schwengel notes, putting the pediatrician in the position of making educated guesses about the child’s health status and future needs. Lab test results may be incomplete, too, and there’s always the chance of infection between the time the child is tested and the time of adoption.
“If you only get a couple growth points and a minor amount of developmental information, you might be guessing a bit,” says Schwengel. “Sometimes we have a bad measurement, an incomplete assessment, and when you ask the orphanage for a little bit more information you may get another report. More information is always helpful.”
Knowing the reasons for relinquishment of a child – abuse, alcohol and drug addiction, death of a parent, mental illness and poverty – and the health issues common in countries offering children for international adoption are helpful, too. Schwengel cautions pediatricians and parents to not assume the child is well because he appears well in a photograph. Not only may the child come from a country endemic with conditions like hepatitis, HIV and intestinal parasites, but he may have been neglected in his first year or two of life.
“For instance, Ethiopia, an up-and-coming country with a lot of adoptions, has a lot of poverty, HIV, tuberculosis and other disorders that you have to be aware of,” says Schwengel. “Some of those kids are placed in a good orphanage from the start, have good nutrition and are in pretty good shape, but some may have lived with a family barely making it before being left on a doorstep with absolutely no information.”
Some children, Schwengel adds, may suffer from reactive attachment disorder, a condition in which they can’t attach to a new family because they haven’t developed a trusting relationship. If you lived in an orphanage with 20 babies per caregiver and you were never picked up, Schwengel says, you learn not to trust people: “The world can be a threatening place, and in order for humans to thrive, they need food, love and attention. If no one ever shows you that love and attention, it’s easy to build barriers.”
The worst thing for prospective parents to do, Schwengel says, is to fall in love with a photograph of a child. That emotional connection becomes difficult to entangle when the parents learn that the child shows signs or risks of developmental and/or language delays. Then they may feel emotionally torn and guilty about saying “no” to a child.
“They’ll ask, ‘If I say no what’s going to happen to this child? Who will adopt this baby if I don’t,’” Schwengel says. “I feel it’s my job to say, ‘That’s not your concern.’ One of the worst things that can happen is the child arrives here and the family can’t handle the situation, and that kid ends up in foster care. You have to be very thoughtful and realistic about what you can do as a family.”
Pediatricians can consult with parents on their own and also enlist the assistance of pediatricians specializing in international adoption issues, like Schwengel and physician Cecilia Davoli, who run the International Adoption Clinic of the Kennedy Krieger Institute and Johns Hopkins Children’s Center. They provide the initial assistance, physical exam and lab tests, recommendations regarding specialists, and immunizations to catch up on. The clinic also employs translators, who are especially helpful in screening older children.
“You can’t expect everyone to have expertise in international adoptions,” says Schwengel. “Pediatricians come to us for guidance regarding certain circumstances.”
So, what’s in it for pediatricians?
“Satisfaction, and the ability to follow that patient from the beginning,” says Schwengel. “We see them only at a point in time and recommend how the pediatrician should follow up. They stay with the child until adulthood.”

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