Not for profit. Just for kids.
The purpose of this guide is to support adoptive and foster families by strengthening the abilities of pediatricians to:
The following are coding tips for evaluations involving screening and anticipatory guidance related to trauma and other mental health/developmental concerns.
Download the guide here (PDF)
Creating A Family will host a panel of four adoption professionals to talk about how mental and physical health issues in pre-adoptive parents are treated by adoption professionals in domestic and international adoption, and what pre-adoptive parents need to know.
Questions are welcome to be submitted in advance to info@creatingafamily.org. You can listen/download the show here.
Thousands of U.S. families adopt internationally each year. The Sparrow Fund is an organization committed to encouraging and supporting these families in the adventure of adoption. They do this by providing regular training opportunities as well as grants to families in financial need to enroll in programs specifically designed to provide counsel and comprehensive medical reviews of their referred child. Check them out!
If you have friends who also are parenting children who are ill or who have a disability, please share this link with them and encourage them to help, too.
If you have friends who are parents whose children are healthy and have no disabilities, please share this link with them and ask them to complete a similar survey for families without health care needs.
By Christopher Balding
This article, which is based on a working paper presented at the Ninth Annual Adoption Law and Policy Conference in March 2012, utilizes the 2006-2008 National Survey on Family Growth (conducted by the U.S. Centers for Disease Control), the USAID/ UNICEF Demographic and Health Surveys, and UN and U.S. Census Bureau data in order to profile adoptive parents in the United States and examine the serious and often life-threatening dangers faced by orphaned and vulnerable children.
Tuesday, March 12, 2013 - 7:00PM-8:00PM Central Time - Q&A: 8:00PM
Secure parent-child attachments are essential for children. Often, adoption can pose challenges to the attachment process. Circumstances prior to adoption, either in utero, in an orphanage or in foster care, can create serious barriers to attachment.
Join us for a webinar with Deborah Gray, an adoption therapist specializing in attachment, grief and trauma issues in children. Deborah will provide practical steps that move parents toward secure attachments with their child.
Thursday, January 17, 2013 – 7:00PM – 8:00PM Central Time – Q&A: 8:00PM
Is your child emotionally acting much younger than their age? Have special needs you weren’t expecting? Behaviors that resemble ADHD?
You are not alone. These challenges are common for post- institutionalized children. Finding help, however, can be difficult.
Join us for a webinar featuring Martha Osborne, adopted person, adoptive mom and founder of the largest special needs adoption advocacy website, RainbowKids.com. Martha will lead an “in the trenches” discussion on how parents can get connected and supported.
By Carolyne Krupa, amednews staff. Posted Dec. 17, 2012.
When Eleanor Rybicki first came to the office of Elaine Schulte, MD, MPH, in August, she was a frail and tiny baby — so small she didn’t register on U.S. growth charts for her age group.
Joseph and Kimberly Rybicki, who adopted Eleanor from a Chinese orphanage, were nervous, but Dr. Schulte quickly put their fears to rest.
“Eleanor was malnourished and understimulated, both cognitively and physically,” Kimberly Rybicki said. “She could sit up, but just barely. She was not crawling, and it was clear that she had not spent much time on her stomach. Dr. Schulte was very helpful. Because of the experience she has had seeing these children over the years, she didn’t panic.”
Dr. Schulte assured them that Eleanor’s condition was common for children who had spent their earliest months in institutions and advised them that the child would improve with proper care, love and stimulation.
As an adoption medicine specialist and medical director of the International Adoption Program at Cleveland Clinic Children’s Hospital, Dr. Schulte routinely sees children who come from challenging circumstances. She is one of about 65 physicians in 31 states who focus much of their practices on treating adopted children, according to the American Academy of Pediatrics’ Council on Foster Care, Adoption and Kinship Care.
Adoption medicine is not a board-certified specialty. Most pediatricians see at least some adopted patients, but adoption medicine specialists have a specific interest in this patient population. Many have adopted children themselves, and they understand adoptees’ needs and focus on helping families meet those needs.
Most adoption medicine physicians are primary care doctors, or they specialize in infectious diseases or developmental-behavioral pediatrics, said Sarah Springer, MD, a general pediatrician with Kids Plus Pediatrics in Pittsburgh and medical director of International Adoption Health Services of Western Pennsylvania.
“It is definitely a focus of interest that is really interesting and fulfilling,” she said. “You get to know some amazing kids and some amazing families. It’s really fun to see kids blossom who may not otherwise have had the chance.”
Drawn to treating adoptees
Jane Aronson, DO, has treated adopted children for about 25 years. An infectious diseases specialist, she started getting inquiries from adoptive parents, and those questions increased as international adoptions spiked in the 1980s and 1990s. For many years, she had a primary care adoption practice in New York.
“I became aware that there were millions of orphans living in developing countries who weren’t getting the care they needed,” she said.
In 1997, she founded the Worldwide Orphans Foundation with the goal of improving living conditions for orphans around the world and helping them become healthy, independent and productive adults. The foundation has helped orphans in 14 countries and remains active in five.
Being an adoption medicine specialist means focusing not just on the unique medical needs of adopted children, but also on their mental, behavioral and developmental health, said Dr. Aronson, who has two adopted sons from Vietnam and Ethiopia.
“Most pediatricians and family doctors are not aware of the issues of adopted children,” she said.
Dana E. Johnson, MD, PhD, a professor of pediatrics with the divisions of neonatology and global pediatrics at the University of Minnesota Medical School, got into adoption medicine after he and his wife adopted their son from India in 1985. At the time, it was difficult to find anyone specializing in treating adopted children. Many adoption agencies seemed to deny that the children had any special needs, he said.
“When we first posed the idea of an international adoption clinic in 1986, we were told no one needs it, because these kids are doing so well,” Dr. Johnson said.
Orphanages provide a rough start
Children who are institutionalized can have a variety of emotional, developmental or behavioral problems, said Dr. Johnson, who has visited orphanages in Russia, Romania, India, China, Nepal and Kazakhstan. Such children don’t receive needed stimulation early in life. They are seldom touched, and that can lead to problems such as trouble with personal contact or balance. The longer children are in an institution, the worse their problems, he said.
For many adopted children, the challenges begin before they are born, Dr. Aronson said. They may have birth defects, or are born underweight or premature, because their biological mothers did not get appropriate prenatal care or used drugs or alcohol while they were pregnant.
Many adopted children also come with emotional challenges because of their experiences. Dr. Schulte said many adopted children have attention, learning and behavioral issues. They often struggle with anxiety issues akin to posttraumatic stress disorder.
Because of these children’s unique needs, physicians should perform comprehensive evaluations of newly adopted children, according to an American Academy of Pediatrics’ clinical report in the January issue of Pediatrics.
“There are so many issues that we as pediatricians may not normally think about,” said Veronnie Faye Jones, MD, PhD, MSPH, the report’s author. She is a pediatrics professor and an associate dean for academic affairs at the University of Louisville School of Medicine. “There may be genetic predispositions that you may not know about. A lot of these kids may have unsettling pasts, and there may be a lot of issues that are lingering for them.”
More than 100,000 children are adopted in the U.S. each year, including about 22,000 international adoptions, the report said.
Increasingly complex cases
Dr. Springer said it’s important to educate physicians about the needs of adopted patients. She routinely sees children with physical, mental or developmental disabilities, such as complicated heart problems and neurodevelopmental disabilities.
International adoptions have decreased in recent years as countries like China and Russia have increased restrictions. As a result, more special-needs children are being adopted from abroad, Dr. Springer said. “The numbers of kids are way down, but the complexities of their needs are way up,” she said.
Adopting a healthy child from China can take several years, so the Rybickis adopted a child with special needs. They selected from a list of special needs they thought they could handle. They were matched in March with Eleanor, who was born with a cleft lip and palate, and held her for the first time Aug. 6.
“The nanny walked up and just handed her to us. It was completely surreal,” said Kimberly Rybicki, a registered nurse in the cardiac progressive care unit at Cleveland Clinic. “There is nothing that can prepare you for that experience.”
Eleanor’s lip was repaired in China, and she had surgery to fix her palate in mid-November. Dr. Schulte has been a guiding force through it all, Rybicki said. Early on, she ordered several tests to make sure Eleanor didn’t have any other health issues and brought her up to date on vaccinations. She also helped the Rybickis find the best way to solve Eleanor’s sleep problems as she adjusted to her new environment.
“Dr. Schulte was very, very helpful in helping us know what to do and what to expect,” Rybicki said. “Adoption in and of itself is a special need. You want a primary physician who understands the needs of your child.”
Resilient young patients
Like Eleanor, many of Dr. Schulte’s patients are malnourished and understimulated initially. Dr. Schulte became an adoption medicine specialist after adopting two girls — now 15 and 16 — from China in 1997 and 1998. In 2007, she started Cleveland Clinic’s International Adoption Program.
“One of the greatest pleasures for me to observe as a physician is to see what happens between the first visit and the follow-up visit [four months later],” said Dr. Schulte, also chair of the Dept. of General Pediatrics at Cleveland Clinic Children’s Hospital and professor of medicine at Cleveland Clinic Lerner College of Medicine.
Dr. Johnson said the specialty can be rewarding and challenging. In one instance, a family he worked with was preparing to pick up their child in India when the government raided the orphanage. The adoption was delayed, and the child spent more than six months in a government institution. Her growth stagnated as a result, Dr. Johnson said.
When the family finally brought her home, she was put into therapy. Now a teenager, the girl is thriving. She plays the violin and speaks at fundraisers for international adoption.
“She is a star and just a shining example of how resilient children are and how important families are,” Dr. Johnson said. “It is just enormously gratifying to see something like that.”
Dr. Springer, who adopted two children in the U.S., said as many as 75% of her patients are adopted or in foster care. They provide many inspirational moments.
“You see miraculous changes in kids all the time,” Dr. Springer said. “With the right family and the right support, kids can do more than you would ever imagine.”
Posted by Dawn – February 23rd, 2010
www.creatingafamily.org
Sitting as I do with one foot in the infertility world and one foot in the adoption world, a question I hear a lot from people is whether they have to stop infertility treatment before they can apply to adopt. I suspect adoption agencies and social workers don’t hear this question as much since most people aren’t comfortable asking them this question. Quite frankly, it is a bit of a sensitive hot topic in adoption circles.
Over the years (Gulp, that sure makes me sound old!), I have talked with many adoption experts and therapists about this question, and there is disagreement about the advisability of continuing to pursue infertility treatment and adoption at the same time. Those that oppose pursuing both are concerned that on some level (perhaps unconsciously) you will consider adoption second best. They view continuing treatment as a red flag that you have not come to terms with your infertility losses and may have trouble bonding with your adopted child. The financial drain of pursuing both may also put undue stress on the family. Others do not think pursuing infertility treatment and adoption are mutually exclusive and that it is possible to pursue both without lessening your commitment to either.
I have mixed feelings. While I see it as possible to pursue both in an emotionally healthy way, I also think that it’s harder than most people anticipate. Infertility treatment is all consuming—emotionally and financially. As long as you are in treatment, there is still hope, and as long as there is hope, you have not had to come to terms with all the losses that infertility presents. Infertility is not just the loss of being a parent; it is also the loss of having a genetic connection to your child, the loss of being pregnant, the loss of the opportunity to breastfeed, the loss of seeing the “perfect” mixing of your and your spouse’s genes, and the loss of your dream about how your life would play out. Adoption only addresses the loss of being a parent, not all the other issues you need to grieve. It is not until you stop treatment that many of these losses hit you full force. Before that point, they are just theoretical. I’m here to tell you that there is a world of difference between a theoretical loss and a real loss.
From my experience, it takes time and commitment after fertility treatment stops to work through the various losses associated with infertility. It also takes time and commitment to pursue an adoption. You owe it to yourself to work through your infertility grief, but mostly you owe it to your soon-to-be child to do this work. You also owe it to yourself and your child to not get pregnant right before or right after she comes home. In an ideal world every child deserves the limelight alone for a little while. If you decide to pursue both, seriously consider talking with a therapist who specializes in infertility to make sure you are really ready to whole heartedly parent an adopted child. No child deserves to be anything but first in his parents’ eyes.
P.S. I strongly recommend the fabulous book Adopting: Sound Choices, Strong Families by Patricia Irwin Johnston. The first part of that book addresses the various losses of infertility and suggests a plan to help you work through your grief and decide if adoption is right for you. I also recommend this Creating a Family show on Transitioning from Infertility Treatment to Adoption.
Read Highlights or Listen/Download.
