Americans adopting from Ethiopia have the unique privilege of meeting and visiting with the biological family, if they are known, in their villages. It is an opportunity which should be eagerly accepted because in years to come it will give your child tangible information about his/her ancestry, photographs for your child’s Life Book and yield important medical and psychological information about family genetics. This meeting will give a window into the circumstances for the adoption and provide the chance to obtain medical information from the birth family and officials and to take family pictures. These materials, as well as a few strands of hair from the birth mother, should be sent to your pediatrician while you are in Ethiopia or maintained for future genetic testing. In years to come DNA will provide a wealth of information to adoptive families and your doctor will be the repository of these materials and alert you to the latest findings.
When in Ethiopia your child will be cared for in the orphanage by nannies, nurses and doctors. Your youngster will also receive check-ups from an outside physician in his/her office. If you have questions and are uncomfortable with the answers feel free to ask for a team consultation, as I did, with all the professionals involved with you child. If you continue to be concerned contact your physician in America for clarification before bringing your child home. Most importantly know that your child will receive inoculations in Ethiopia and must be in good health to qualify for the America visa. Your child will receive a final check-up in Ethiopia to certify these requirements have been met.

In addition to knowing your child’s health and birth family you will meet the youngster you only “knew” from a photo within hours of your arrival in Ethiopia. Be aware that when you land in Addis Ababa you will be jetlagged from the long, exhausting trip. Therefore take the opportunity to get some rest, eat lightly and be refreshed when you meet your child. You want to feel your very best and be ready for one of the most joyous occasions you will experience. As you prepare to meet for the first time remember that your little one is not accustomed to many visitors or being held by newcomers. It will take both of you time to get acquainted. Enlist the assistance of the nannies who, although you may find them possessive in the beginning, will be a fund of information and full of helpful tips once you are assertive and they understand your good intentions. So spend as much time as you can during the first days in your child’s care center observing your child’s feeding schedule, appetite, sleep pattern and temperament. Get accustomed to feeding and bathing your child because in a few days the child you have been visiting daily will be placed in your custody. It will then be your decision to stay in the orphanage’s guest house or a hotel of your choosing, while you await completion of your paperwork. And in a few more days you and your child will journey home to America to start a new life. One of the great advantages of Ethiopian adoption is the streamlined procedures and the abbreviated schedule, which is usually completed within 5-7 days of your arrival in Ethiopia.

A few words of wisdom when you return home: minimize the number of visitors during the first weeks. This is a major life change for your youngster and time is needed to rest from the long flight and to adjust to new formula/food and the immediate family.

You and all those who love you and your new child will have a lifetime to celebrate.

Written by: ROBERTA KALMAR, LMSW
www.abcadoptionsonline.com

Ms. Kalmar, a specialist in adoption home studies and international adoptions, served as a social work consultant and child care center volunteer in Addis Ababa, Ethiopia during 2006. She accompanied one of her clients to adopt her 8 month old daughter. The above account is based on her experiences in Ethiopia and follow-up visits with the adoptive family. For further information: ROBERTA KALMAR www.abcadoptionsonline.com 718-499-8993

Poor visual acuity is one of the most important medical factors that can contribute to poor behavioral, developmental and academic achievement in a child if left untreated.

The actual country of birth of the child is irrelevant, but there has been a documented increased prevalence of eye problems such as Strabismus and ambyopia in the internationally adopted child, especially the ones that were adopted from Eastern European countries.

In infants and children, in order for visual development to proceed normally, visual experiences must occur with well aligned eyes that are free from eye pathology and other visual acuity errors. One of the consequences of not fulfilling theses visual requirements during the early years of life could lead to disorders like strabismus, ambyopia, and decreased visual acuity. In the general population, the aforementioned visual disturbances are reported to occur in 2%-3% of the general pediatric population. In the United States, physicians and school nurses are very good at screening for such problems. In the case of the institutionalized child, one would speculate that because of the lack of general medical care, conditions such as “Lazy Eye” or “Cross Eyed” would go undiagnosed and untreated for an extended period of time. Basic medical care is generally considered a luxury for those unfortunate enough to reside in an Institution. Routine vaccinations, correctable surgical conditions and basic medications such as antibiotics are often lacking, so why should we expect these children to have an annual vision screen. It therefore should not come as a surprise that many orphan children have amblyopia and strabismus.

Amblyopia is reduced vision in an eye that has not received adequate stimulation or usage during early childhood. It basically means “without sight.” Amblyopia has many causes, among them being a “lazy” eye. Amblyopia most often results from this “lazy” or misalignment of the child’s eyes. A “lazy” eye is seen by an observer as crossed eyes, or divergent eyes. Amblyopia also results from a difference in image quality between the two eyes (one focusing better than the other). In both cases, (misalignment and weaker focusing), one eye becomes stronger than the other. If this condition persists, the weaker eye may become useless. Visual acuity tests and newer technology such as the Visual evoked potentials are some of the best ways to screen for these visual disturbances. These screening tests are generally performed at the routine well child visits, vision screen performed by an ophthalmologist or by the school nurse. The test may pick up abnormalities if they are present at the time of the examination. A child may have normal vision on today’s examination, and over the course of the following year, visual disturbances occur and it is picked up at the next check-up examination. This is why annual vision screens are performed in children.

Strabismus is a misalignment of the visual axes of the two eyes. The eyes can turn inwards or outwards Children appear to be cross eyed. Strabismus may cause or may be due to amblyopia.

With early diagnosis and treatment, the vision in the “lazy eye” may be restored.
The earlier the treatment, the better the opportunity to reverse the vision loss. Before treating Amblyoia, it may be necessary to first treat the underlying cause. Glasses are commonly prescribed to improve focusing or misalignment of the eyes. In extreme cases, surgery may be required to allow both eyes to work together.

Eye exercises are a limited form of treatment. The correction may be followed by: Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the “lazy” one to work, thereby strengthening its vision. Medication – in the form or eye drops or ointment – may be used to blur the vision of the good eye in order to force the weaker one to work. This is generally a less successful approach.

I am not sure of the exact percentages of Strabismus or Amblyopia for children that resided in institutions. In my own personal experience I have found that there is an increased incidence of referrals that I make to the pediatric ophthalmologist in my International adoption cases, especially for those children from Eastern European countries.

Written by George Rogu M.D. for Adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship

George Rogu M.D. Medical Director and founder of Adoptiondoctors.com and adoptioneducationclasses.com Adoptiondoctors.com is an innovative adoption medicine educational service, dedicated to helping parents and adoption agencies with the complex adoption related medical issues encountered in the internationally adopted child. Pre-Adoption medical record evaluations and Blind Referral support services are also provided via this website. Post-Adoption Medical Care provided in our Adoption Friendly General Pediatric Private practice, in Long Island New York. For more information Adoptiondoctors.com

Hepatitis C viral tests detect substances in the blood that indicate a hepatitis infection is active, chronic, or has occurred in the past. The tests detect proteins (antibodies) or genetic material (DNA or RNA) of the virus that causes hepatitis. It is important to identify the type of hepatitis virus causing infection so that its spread can be prevented and the proper treatment can be started immediately. Anti-HCV antibody tests detect the presence of antibodies to HCV in the blood, indicating an HCV infection has occurred. However, this test makes no distinction between an acute or chronic infection.

The enzyme immunoassay (EIA) may be the first test done to detect anti-HCV antibodies. Sometimes a supplemental test called the recombinant immunoblot assay (RIBA) may be done to confirm a positive EIA test result.
This test can tell whether a positive result was from an actual HCV infection or whether the result was a false-positive.

HCV genetic material (RNA) testing uses polymerase chain reaction (PCR) to detect the RNA of an active hepatitis C infection. The RNA can be detected in a person’s blood within 1 to 2 weeks after exposure to the virus. HCV RNA testing may be done to confirm a positive result on an HCV antibody test, define the level of virus in the blood (called viral load), or predict the likelihood that a person with HCV will respond to medical treatment. Another RNA test called genotyping can define the strain of hepatitis C and indicate how likely it is to respond to treatment.

HCV quantitative test or viral load is often used before and during treatment to determine how long treatment needs to be given and to monitor your response to treatment. HCV viral genotyping is used to determine which genotype of the HCV virus is present. HCV has 6 genotypes, and some are more responsive to treatment than others. There is no preventive vaccine available for Hepatitis C. It is recommended that all children at risk for Hepatitis C be immunized for both Hepatitis A and B.

Nicholas Rogu, M.D. of www.rbkpediatrics.com for www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship.

The heart is divided into four basic chambers. The septum is a wall that separates the heart’s left and right sides. Septal defects are sometimes called a “hole” in the heart. A defect between the heart’s two lower chambers (the ventricles) is called a ventricular septal defect (VSD). When there is a large opening between the ventricles, a large amount of oxygen-rich (red) blood from the heart’s left side is forced through the defect into the right side. Then it’s pumped back to the lungs, even though it’s already been refreshed with oxygen. This is inefficient, because already-oxygenated blood displaces blood that needs oxygen. This means the heart, which must pump more blood, may enlarge from the added work. High blood pressure may occur in the lungs’ blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls. If the opening between the ventricles is small, it doesn’t strain the heart. In that case, the only abnormal finding is a loud murmur.

Surgical closure of small VSD’s may not be needed. They often close on their own in childhood or adolescence. But if the opening is large, even in patients with few symptoms, closing the hole in the first two years of life is recommended to prevent serious problems later. Usually the defect is closed with a patch. Over time the normal heart lining tissue covers the patch, so it becomes a permanent part of the heart. Some defects can be sewn closed without a patch. Repairing a VSD restores the blood circulation to normal. The long-term outlook is promising.

Children with this VSD’s should be examined regularly by a pediatric cardiologist. They will make sure that the heart is working normally. Most patients won’t need to limit their activity. However, if they develop pulmonary hypertension or the heart doesn’t pump as well as it used to, their activity may need to be somewhat limited to ensure their safety.

Most people with uncomplicated ventricular septal defects that have been repaired early in life don’t have any significant long-term problems. In some individuals, the heart muscle may be less able to contract. This requires diuretics, agents to help the heart pump better and drugs to control blood pressure. In addition, if pulmonary hypertension develops (it’s uncommon), the child may require additional treatment. In children with surgically repaired ventricular septal defects, additional surgical correction is rarely needed unless residual defects are seen afterwards. If this occurs, whether they will require surgery depends upon the size of the residual defects.

Written by Nicholas Rogu M.D. of www.rbkpediatrics.com for www.adoptiondoctors.com

* Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it — only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship

The etiology of ADHD is difficult to ascertain and in the patient who has a history of spending part of their life growing up in an orphanage, the challenge usually is not so simple as to say whether or not someone had ADHD, but do they also have co morbid conditions which further complicate their diagnosis and their treatment.

ADHD is a clinical diagnosis depending on a variety of factors and is undoubtedly caused many genetic and environmental factors.

There is no test that we can do which will state whether a person has ADHD from spending time in an institution as a child or whether it is due to factors experienced perinatally or that are genetic in origin.
The problem with ADHD in the internationally adopted child is that if there could be an unrecognized history of alcohol/drug use, which can cloud the issue, which is very prevalent in certain countries. The same lack of information may hide from us a family history of ADHD, mental illness, learning disabilities, minor genetic abnormalities or neonatal/ intrauterine exposure to environmental toxins. An example of this would be a baby born after a difficult delivery who had a prolonged period where the child did not get any oxygen, a child such as this later in life may have school problems similar to ADHD but without this significant history we have no way of knowing the etiology when the child is eight years old.

The view of a physician, like myself, who tries to help a child with a learning deficit is to try to take an individual child who is different from every other child on the planet and fit them into a described syndrome and treat them accordingly.
The patient who is internationally adopted by definition needs increased surveillance for learning disabilities and early referrals to early intervention programs and as appropriate various therapies and educational supports if they are required.
by James Reilly, M.D.

Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it – only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

© James Reilly, M.D.

When we suspect that early traumatic exposure may be contributing to a child’s behavioral problems, we must consider the impact of these early experiences on the child’s feelings, thoughts, actions and physical reactions. We must not rush to treat symptoms without first considering the potential etiology, or cause of the problem. For example, the neglected, abandoned or abused adoptive child who is evidencing attentional difficulties may be acting-out due to conflicted feelings and thoughts. Stimulant medication, or the implementation of behavioral techniques, may only serve to exacerbate this hidden conflict and result in additional problems (e.g., emotional, social, behavioral, academic, etc.).

If we know or believe that a child has experienced early traumatic exposure, our treatment should reflect this. For example, the establishment of a therapeutic relationship and the utilization of cognitive-behavioral intervention must be entertained. Whether a child is living with his/her birth family, or adoptive family, should not overshadow the need to consider what may be at the root of a child’s attentional difficulties. In light of the fact that the incidence of both ADHD and traumatic exposure is higher among adoptive children, we must work to understand the factors that may be contributing to an adoptive child’s attentional problems.

by Mark Lerner, Ph.D.

Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it – only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

© Mark Lerner, Ph.D.