Physician: Screenings for Post-Institutionalized Children

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What are the recommended screening tests and evaluations for newly adopted post-institutionalized children?

In the U.S., generalized routine laboratory screening of healthy children is not standard of care. In children who are internationally adopted, extensive screening tests are performed for a multitude of reasons. These screening tests are recommended by the Pediatric Red Book of Infectious Disease and the Academy of Pediatrics.

It is only through extensive laboratory testing that a physician may:

  1. Uncover a medical condition that has not yet presented itself clinically.
  2. Rule out a diagnosis or condition that was reported on the pre-adoption evaluation.
  3. Help to confirm the adequacy of treatment of a particular ailment and/or document cure.

Some parents feel that maybe they do not need to test their children because they had some blood work performed by the orphanage, and that the child was already seen by a physician in order to qualify for a visa. While these are all good thing to have done for your child, they are not enough. The visa medical examination focuses primarily on detecting certain serious contagious diseases that would make the child ineligible for entry in the U.S. The procedure usually consists of a very brief physical examination and medical history. A chest x-ray is performed to look for active tuberculosis, and blood test are performed to screen for HIV infection and syphilis. These tests are performed only if the child is older than 15 years or age; in those younger than 15 years, they are only performed if there is a suspicion of medical illness. Chances are that since the child really has no available history and there is little or no testing performed, that the visa examination consisted of documenting that the child is breathing at the moment of the examination and is not terribly ill with any contagious disease.

As for testing by the orphanage, caution should be used when interpreting it. While these tests are important in the pre-adoption evaluation process in order to help the family in making their decision, the validity of these tests needs to be confirmed and they should only be considered as a screening tool. Confirmation of a medical diagnosis should never be made solely on these test results.

Because there is a wide variation in the geographic regions where children are placed for international adoption, different medical problems can be encountered in different regions. Screening is also important because of the unknown medical background of the child, inadequacy of health care, and poor living conditions encountered in the institutional care setting.

A physician should see an internationally adopted child within two weeks of arrival in the United States. A child who is ill upon arrival with either an acute or chronic medical condition should be evaluated for that problem immediately.

After the arrival of the child, this is a very good time for parents and child to get to know one another. The process of attachment and bonding needs to progress. Some parents may feel the need to have large family gathering and parties, go on elaborate vacations to Disneyland, and buy everything at Toy R UsÒ for the child. While their intentions are good, this will only overstimulate the child and stress her out. Just like these painless examples, an immediate visit to a doctors office, and multiple visits to the blood laboratory are another type of excursion that does not need to be made immediately unless the child is acutely ill. Too much love is also no good.

The initial post-adoption evaluation will include the following:

  1. A thorough review of the child's medical history and concerns discovered on the pre-adoption evaluation
  2. Complete physical examination
  3. Evaluation of developmental milestones (Denver developmental screen)
  4. Immunization status needs to be evaluated and confirmed with vaccine titers. There is no harm in a child’s receiving an extra vaccine, but there may be harm if the child remains susceptible to these childhood illnesses. The doctor will use the same catch-up schedule that would be used if the child was born in the U.S. and was behind in the vaccines.
  5. Laboratory screening for a multitude of medical concerns.
I would like to try to explain what each test is generally screens for.

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