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 | 10 Health Problems of Newly Arrived Internationally Adopted Children
by Andrew Adesman, M.D. and Christine Adamec |
It would be wonderful if newly adopted children from other countries had perfect health. But many children have medical and developmental issues that need to be identified and treated. In many cases, such as parasitic infections or anemia, although the condition sounds terrible, it is usually not difficult for a physician to identify and treat.
Provided is basic information on the top 10 most prevalent health problems. Keep in mind some problems are seen more frequently in children from some countries compared to others. For example, iron deficiency anemia is common in children adopted from China, Korea and India. In other cases, such as intestinal parasitic infections or skin rashes, all children should be evaluated by a pediatrician, regardless of the country they came from.
Many new parents make two opposing mistakes about health issues. One mistake is to assume problems will magically vanish with a good environment. A loving family is extremely important, but does not matter at all to parasites infecting the child or to whatever is causing anemia. Medical treatment is needed, along with a loving family.
The second mistake is to assume every new behavior indicates a dire problem. In general, time and experience with a child resolves this tendency. Work with a doctor who understands the medical issues of children adopted from other countries and is collaborative and helpful.
Malnutrition or failure to thrive, including poor weight gain
Signs: Thin; minimal body fat; ribs visible on the chest wall.
Malnutrition and/or failure to thrive means the child is not growing normally. Failure to thrive is most often due to a neglectful environment, while malnutrition is most likely due to a diet that lacks adequate nutrients.
Failure to thrive may be caused by a variety of problems, all treatable. The criteria for failure to thrive vary, with some definitions focusing on weight, or weight relative to the child’s height. The body mass index is a helpful measure to consider a child’s weight relative to height and particularly helpful when evaluating the weight of children who are also of short stature, number three on this list.
Although a child’s growth percentiles reflect one important aspect of nutrition, children may have nutritional deficiencies despite normal growth percentiles. Iron deficiency can lead to anemia, number eight on this list, as well as adverse effects on development. Some micronutrient deficiencies are more easily recognized than others.
Parasitic intestinal infections
Signs of infection: Watery stools; diarrhea; foul-smelling stools; greasy stools that float; nausea and loss of appetite; poor weight gain; a history of recent weight loss; abdominal cramps or pain; bloating; flatulence; fatigue.
Although occasionally difficult to diagnose and treat, most parasitic infections are generally harmless once recognized and they are usually easy to treat. They are also common among newly arrived children.
Growth delays or short stature
Signs: Height below fifth percentile
Some children are much shorter in height than their peers, although children adopted from other countries often experience catch-up growth. U.S. growth curves doctors rely upon are appropriate when evaluating children adopted from Eastern Europe but may be less ideal in assessing a child from Asia or Latin America. Pediatricians should use ethnicity-specific growth curves when available. Ask your doctor if the percentile chart he or she is using is appropriate for a child adopted from your child’s birth country.
Language delays
Signs: Delayed spoken language and delayed understanding of language continuing after the child has been with the new family for several months.
Most children adopted from an institutional setting have at least mild delays in language development. Once adopted, they must learn a new language as well as adapt to a different culture, which takes time. If children have language delays but few or no other developmental delays, often they will rapidly learn a new language when properly stimulated.
Since language delays are also a prominent developmental finding in children with mental retardation or autism, another form of a developmental delay, it is important that parents consult their pediatrician about the need for further evaluation in children when language delays persist longer than a few months.
In addition to delayed language, children with mental retardation show delayed nonverbal problem-solving skills and self-care skills. Autistic children who may have below-normal, average or above-average intelligence have poor social skills. Children adopted from an institutional setting may have both language delays and attachment issues, which may suggest the diagnosis of autism spectrum disorder. In these cases, evaluation by experienced professionals is essential, and it may take several years before one will know a child’s true developmental potential. Hearing testing should be performed in children with language delays and any children with suspected hearing difficulties.
Note: A study published in the 2005 issue of Early Childhood Research Quarterly offered hopeful news. The study indicated that among 186 Chinese children with language delays who were adopted between the ages of 18 and 35 months. Within about 16 months, not only did the children catch up to children in the United States, but after that period, some surpassed the norm for language development in the United States. This does not mean all Chinese children will have superior language skills, but it is an encouraging study nonetheless.
Global developmental delays
Signs: Language delays, plus delays in other areas — most typically, nonverbal problem-solving. Difficulty with age-appropriate toys, puzzles and self-care skills such as toilet training are examples. Occasionally, the child exhibits other age-inappropriate behaviors, such as temper tantrums and hyperactivity.
Global developmental delays refer to delays in language, problem-solving and other areas. Although global delays may suggest the diagnosis of mental retardation, doctors should be cautious in considering this diagnosis for a child adopted from overseas who spent a sustained period in a neglectful institutional environment. This environment alone may have impaired the child such that true intelligence has been hidden. Some children have significant improvements in apparent intelligence after adapting to their new family, but this does not always happen, and it should not be assumed it will always occur. Since many children adopted from overseas with global developmental delays initially will demonstrate tremendous “catch-up” and exhibit normal development over time, a diagnosis of mental retardation should generally not be given to a child adopted from overseas before 3 or 4 years of age.
Sensory integration disorder
Signs: Under-responsive or over-responsive to sensory stimuli like sounds, textures and foods; sniffing or licking nonfood objects; dislike of getting their hands dirty in things like Play-Doh; repetitive movements like jump, spin, rock and swing; clumsy behavior.
A sensory integration disorder is a disorder in which the affected child is either hypersensitive or abnormally insensitive to touches, smells and sounds. Many symptoms suggestive of sensory integration disorder are seen in children with autism spectrum disorder. Expect newly adopted children to be hypersensitive or hyposensitive to new stimuli. They need time to adjust.
Attachment issues and separation issues
Signs of attachment difficulties or reactive attachment disorder: The child does not seek or enjoy affection; reduced eye contact; an inconsistent response to his or her name sometimes responding, and other times not; and evidence of detachment. Other signs include rocking, head-banging and little emotion. In some children, inappropriate familiarity or affection with strangers is a sign of an attachment difficulty.
Signs of separation difficulties or separation anxiety: marked fear or anxiety when apart from the parent; refusal to go to school or “school avoidance;” sleep issues. Occasionally, recurrent headaches or stomachaches may be signs.
Attachment issues refer to a difficulty or inability to bond with a new family, while separation issues allude to a child’s problem with handling new parents’ temporary absence. You can’t be with your child every minute, no matter how much you love him or her.
Mild transient separation or attachment issues are often seen shortly following the placement of a child. Also, keep in mind nonadopted children around 10-12 months old often experience separation anxiety as a normal part of development. They are worried their parents won’t come back because they haven’t developed the ability to know they always return. Parents should seek a medical consultation if severe symptoms persist.
Anemia
Signs: Pallor; weakness; lethargy or sluggishness; rapid heart rate. Also, depending on the cause of the anemia, a child may have jaundice, dark urine or pica, the desire to ingest nonfood items, such as dirt or ice. This does not include the toddler’s normal desire to put everything in the mouth.
Although anemia (reduction in the red blood cell number or size) is apparent to doctors when it is severe, healthy-appearing children can have anemia as well. A blood test for anemia is generally recommended upon the child’s arrival into the country. Iron deficiency is one common cause of anemia. However, other types of anemia are commonly seen in Southeast Asian children and are not due to nutritional deficiencies.
Skin rashes, including lice, scabies and yeast rashes
Signs of lice: Rashes; itchy skin; scratch marks, enlarged lymph nodes or “swollen glands;” hives or eczema; can involve head, body or groin areas. If the child is infested with lice, the lice may be seen, usually in the child’s hair. However, the child should be screened, even if you don’t see any lice.
Signs of scabies: small bumps, blisters or pimples; intensely itchy, especially in the evening, usually between the fingers, around the wrists, and on the elbows, navel, nipples, lower abdomen and genitals. There may be “burrow lines,” which refer to lesions as thin as pencil lead that mark where the scabies mites have burrowed into the skin, although they are only seen in about 25 percent of cases. Scabies does not generally involve the face or scalp.
Some parents are upset by skin rashes caused by lice, scabies or yeast infections, but once properly diagnosed, these conditions are easily treated with medication.
Sleep disorders
Signs: Difficulty falling asleep; difficulty staying asleep; waking early; nightmares or night terrors.
Sleep disorders, such as insomnia, nightmares and other problems, generally resolve fairly quickly. In the United States, children are expected to sleep on their own from infancy. However, in other parts of the world, “cosleeping,” where the child and parent are in the same bed, is not uncommon. As a result, the child may simply need to adapt to sleeping alone. Sometimes sleep behavior problems or issues are a sign of a separation issue.
This discussion has concentrated on the top 10 health issues that may occur with internationally adopted children, but other health issues also commonly occur and should be considered, including aggression or hyperactivity, fetal alcohol syndrome or fetal alcohol effect, hepatitis, tuberculosis exposure, HIV infection, prematurity, lead poisoning, rickets and syphilis. The doctor should screen the child for these medical problems.
~Andrew Adesman, M.D., is a pediatrician and an acknowledged expert in international adoption medicine. He is also a popular lecturer on medical topics related to adoption and is the co-author of “Parenting Your Adopted Child.”
~Christine Adamec is a freelance writer who has often written about adoption, most recently authoring the second edition of “The Complete Idiot’s Guide to Adoption.”
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