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Dr. Jane Aronson's Chat Transcript
March 1, 2000
Interpreting Medical Information for Russian & Chinese Adoption Referrals Hi folks I am Dr. Jane So ask my any questions you want about how to interpret referrals for Russian and Chinese kids....
03/01/00 08:57:38 <Guest8> I am just beginning the process of international adoption, and am coming across a lot of terms that are new. I have several questions. #1: What is perinatal encephalopathy?
<Dr. Jane> Hi Dr. Jane here The medical system in Russia is called Defectology
What this means is that doctors in Russia believe that children are defective adults.
They believe that over time, the child recovers with medications and physical therapy and then the diagnoses like perinatal encephalopathy disappear. So these diagnoses are what I call neutral, boiler plate, non-specific diagnoses. They do not reflect the specific child. They are used on all kids in Russia, not just orphans. I have many friends who have given birth to cute and healthy babies who are given the diagnoses that are found on orphan records.
<Guest9> so they don't mean the child really has something wrong?
<Dr. Jane> The child may have many abnormalities, but those diagnoses are not reflective of the true physical, emotional, psychological aspects of that child's specific health. These diagnoses are therefore generic and not useful. So what we need to look for is information that can help us interpret who the child really is... And to do this we look at growth points particularly head circumference.
None of the diagnoses on these medicals is useful. What is useful are growth points and pictures and video, good video.
03/01/00 09:04:12 <Dr. Jane> Everyone here who is interested in this topic should go to my selection on video and medical guidelines...http://www.adopting.org/DrJane/russvid.html... it is found on this web site as well as my own Dr. Jane.com
Q: Should everyone request a video then?
03/01/00 09:05:31 <Dr. Jane> I recommend that adoption in Russia be accompanied by a medical and video In fact I usually rec sequential videos because frequently the kids start out young in the video and we need to see how they progress, if they progress.
Q: <SteveT> What about China ? Should a video be requested / is a video usually available ?
Q: <Guest8> Another question: Are all crossed eye conditions correctable?
03/01/00 09:07:20 <Dr. Jane> Most children with lazy eye or strabismus can have some correction. It depends on the age at diagnosis. If you diagnose strabismus after 2-3 years of age, then the child may have amblyopia and this means diminution of vision. The cosmetic aspect can usually be corrected with surgery when there is amblyopia. Hopefully we get this diagnosed early in infancy and patching or glasses will suffice.
<Guest8> The little girl is about three years old - the condition appears to be very mild.
03/01/00 09:09:33 <Dr. Jane> The three year old with lazy eye needs to be assessed by a pediatric ophthalmologist
<Guest8> Do you recommend that these types of tests be completed in the child's home country, prior to finalizing the adoption?
03/01/00 09:10:34 <Dr. Jane> What type of test?
<Guest8> I mean - assessments, such as by a pediatric ophthalmologist.
03/01/00 09:12:27 <Dr. Jane> It is a waste of time to have any medical evaluations done on kids abroad because there just aren't the kinds of specialist that know what they are doing. They have not had the training. If you need good medical care after the adoption, then you can go to AMerican Medical Center in Moscow. I have been there and I know the doctors there. They will help you if you or the baby is ill,but this is after the adoption
Q: <JTR> Does China always send the medical reports in Chinese (without translating them)?
03/01/00 09:09:00 <Dr. Jane> All Chinese medical reports are in Chinese, but then it is the responsiblity of the agency to get them translated into English for the family.
Q: <JTR> When requesting a healthy infant from China, what are some of the conditions that may be considered acceptable as a healthy infant?
03/01/00 09:11:09 <Dr. Jane> rickets, anemia, malnutrition, failure to thrive are all condtions that may be considered acceptable as a healthy infant. Developmental delay is even acceptable because all of the kids do have some delay initially and then they catch up.
Q: What specific diagnoses should we look for as red flags....is there any way of knowing which of the developmental delay problems will turn into REAL problem kids?
03/01/00 09:14:30 <Dr. Jane> Red flags on medicals include prematurity, blood transfusions, a positive lab test like Hep B or C. You just never know whether the serology for Hep B or C is reliable So then you are faced with this positive test which then is repeated in the orphanage and reported as negative So you won't know until you bring the kid home. Prematurity is a very difficult diagnosis. These kids may have high risks for permanent delays because they did not get the needed interventions when they were first born.
Q: So the children should be evaluated by an adoption doctor in the states then?
03/01/00 09:16:57 <Dr. Jane> All children who are adopted from abroad should be seen by their pediatrician within a few weeks of arrival and the parents should bring with them a copy of the guidelines for what to do for the intial vist. Medical Evaluation at Arrival as found on this web site and on my web site has everything that a pediiatrician needs to know. The parent can also contact an adoption specialist.
Q: <Guest8> Dr. Jane: I have seen videos on two girls almost the exact same age (at two different institutions). The first girl was very playful, with several toys very good eye hand coordination, very observant, etc. The second little girl was not nearly as alert or dexterious. Do you think the orphanage atmosphere has a great deal to do with this, or do you think it might indicate some long term problems?
03/01/00 09:18:27 <Dr. Jane> I think that this is a complex question, but certainly I know from my trips to orphanages and my foundation work were I send students and healthcare professionals abroad to work in orphanages, that some orphanages are better than others. Some orphanages just have better resources or better yet, better leadership.
Q: * pixie Can you tell us what to consider when we get head circumference info at time of referral?
03/01/00 09:20:42 <Dr. Jane> Head circumference is really critical to the process of evaluating a medical of a child pre-adoptively. There are normal growth curves and we know that heads generally across the board are the same from culture to culture except maybe for China and central AMerica So we plot the heads and if the head is below the 5th then we know that the brain is not growing properly. If the child is under one year of age and the head is borderline, there is probably still time for growth and catch-up Once a kid is a toddler and the head is below the 5ththen it is unlikely that the child will catch-up as far as the growth of brain cell in numbers. obviously there will be new synapses and new relationships.
Q: <SteveT> Do you mean that head circumference for a child from China is not a cause for concern? Are there guidelines ?
03/01/00 09:29:21 <Dr. Jane> heads In China the heads are flat in the back and there are separate growth curves for kids in China As long as the kid is on that curve the kid is fine.
Q: <JTR> How often are birthdates challenged as a result of the medical reports in China?
03/01/00 09:30:18 <Dr. Jane> Birthdates are probably on off by a few weeks in the younger infants who are found early after birth. Where birth dates matter is with older kids who have lived with their families for a few years and then are abandoned. This can be figured out fairly easily by waiting about one year from the time of adoption giving the child a chance to adapt to the new environment after a year the child can be evaluated developmentally The teeth can be x-rayed and the left hand and wrist can be x-rayed for a bone age. Nothing is exact, but the combination of bone age, dental age, and developmental age gives us a good chance to estimate pretty closely. In fact most parents know how old their children are after a number of months after adoption just from how the child is socially, emotionally, psychologically Parents know their kids!
Q: * pixie What is the chance that our child from China will have an Ascaris worm infection?
03/01/00 09:35:10 <Dr. Jane> Ascaris infection is not that common. I have seen it probably in a handful of kids from China and I have seen probably well over 500 girls from China
* pixie Thank goodness!!
Q: <Guest39> How common is rickets in Chinese adoptions?
03/01/00 09:35:10 <Dr. Jane> All children in orphanages have rickets and some will require added vitamin D based on the lab test done initially on arrival, but most other children have mild rickets and they get better through good nutrition and exposure to
sunlight.
Q: <JTR> Does the info on the Chinese medical reports tend to be reliable and most often done by qualified personnel?
03/01/00 09:38:11 <Dr. Jane> The Chinese medical is performed by a usually non-university trained physician;it is a perfunctory exam. The labs are probably done at local hospitals and are not reliable. Hepatitis B serology should be understood to be unreliable;it is usually done when the child is first admitted to the orphanage and so it does not reflect the lengthy incubation periods of this virus.So one must understand that 3-5% 0f girls adopted from China will be carriers of Hep B when they arrive in the U.S. or within six months of arriving. That means that 95-97% 0f kids from China are healthy and well.
Q: <Guest39> What is the prognosis of the 3-5% test positive for Hep B?
03/01/00 09:41:21 <Dr. Jane> Excellent Most kids with Hep b are well for many years Eventually Hep B carriers have liver disease and are at risk for cirrhosis and liver cancer, but there are so many new treatments available now interferon, epivir, etc. and new drugs coming down the pike that I am convinced that this is a manageable problem.
Q: <Janet> Do children with Hep B have to be kept away from other children?
03/01/00 09:42:31 <Dr. Jane> No precautions. We live in a world with standard precautions for all. We never know who has HIV or Hep B. All children in the
U.S. must be vaccinated against Hep B to be in school so it is easy to protect them because they are vaccinated. All parents who are planning to do an international adoption should be vaccinated for Hep B, A, updated tetanus/diphtheria
Measles, Mumps, Rubella for those born in 1957 and beyond. Influenza vaccines is rec for those with heart or lung problems in the winter months.
Q: <JTR> Is it common to get a sick child delivered to the adoptive parents while in China?
03/01/00 09:44:41 <Dr. Jane> It is not common for kids to be very sick when first adopted, but rather a bit floppy secondary to rickets, and maybe a bit distant due to unfamiliarity with a new situation. And most of them get colds in the winter months.
Q: <Janet> What medical conditions should make us think twice about accepting a referral?
03/01/00 09:46:03 <Dr. Jane> Too broad a question Janet
03/01/00 09:49:05 <Dr. Jane> Janet Did you think of some specific questions for me?
Q: <Janet> I'm not sure what to ask... What about tuberculosis? If your child has it, again, does she need to be kept from other children? How do you care for it?
03/01/00 09:55:05 <Dr. Jane> There is TB infection or exposure and there is TB disease. The kids from orphanages have a fair amount of exposure to TB in the orphanage from adults who have no health care IF the PPD or TB skin test is greater than or equal to 10 mm then the child needs a chest film and if that is normal, the child should receive 9 months of preventive therapy with Isoniazid. We rarely see a kid with actual TB disease, but we see TB exposure in 870526540f kids from China and 2570537020f kids from Russia.
03/01/00 09:45:42 <JTR> How comfortable should an adoptive parent feel toward using a Chinese hospital if the child is sick?
03/01/00 09:46:39 <Dr. Jane> There are western style hospitals and clinics in many big cities in China These are good places to know about before traveling. I am always available for consultations by phone when people are abroad I am a good anxiety decreaser.
03/01/00 09:47:01 * pixie If our child has scabies, do we need treat ourselves also?
03/01/00 09:47:54 <Dr. Jane> Everyone who is with the child with diagnosed scabies should be treated to prevent the infection from occurring within the next 4-8 weeks
Q: <SteveT> Re: videos : are they usually/ever available from China ?
03/01/00 09:47:19 <Dr. Jane> No videos available for China unless the kid is older and disabled.
Q: <JTR> If there is a good medical reason to decline a child in China, do you know if the adoptive parents have to wait another 6-7 months for a referral?
03/01/00 09:50:24 <Dr. Jane> It is unusual for this to happen, but every so often it is clear that the child has some serious underlyng disease and a new child is offered to the family on the spot.
Q: <Guest39> Do you have any advice for selecting a pediatrician?
03/01/00 09:52:34 <Dr. Jane> Selecting a pediatrician is a topic for all parents You need to interview the person and feel connected to this person philosophically Of course they need to be available physically The most important issue is that the doctor is a good listener and seems to enjoy the work. That the doctor seems to enjoy being with children is essential But mostly that the doctor listens to you and respects your questions and is able to tolerate the stupid questions especially The doctor should be willing to refer your child to specialists easily as well.
Q: <JTR> I have seen a situation where a child was taken in by the Chinese orphanage at about 1 week old and she was not placed until 11 months old. Is this common? Why such a long wait?
03/01/00 09:54:29 <Dr. Jane> Children who are abandoned early in life in China are commonly not referred until they are close to one year. Just the style of the government
03/01/00 09:53:56 * pixie I have heard that many of the orphans in China has respiratory infections. Why is this so prevelant?
03/01/00 09:57:25 <Dr. Jane> Respiratory infections are common in kids in orphanages because of close proximity in the institution, but kids in the first few years of life have alot of colds anyway.
Q: <JTR> Are the caretakers in China open to answering questions about the child being adopted such as "How often and what time does the child nap each day?'
03/01/00 09:58:59 <Dr. Jane> Yes they are very open to discussing the child's habits in the orphanage
Q: <JTR> What areas should an adoptive parent be sensitive about in terms of crossing cultural boundaries when asking care questions?
03/01/00 10:00:32 <Dr. Jane> I don't think that there are any cross cultural issues to worry about. Just ask about the kids naps, feeding, personality... Just be respectful and friendly Look at the caregiver kindly Be yourself Be sincere Sincerity is cross cultural.
Q: <JTR> Are most orphanages open for a visit in China these days or is it still a matter of some are and some aren't?
03/01/00 10:01:41 <Dr. Jane> Most orphanages in China are not open for a visit. Remember this is still a communist country.
Q: <JTR> If the orphanage isn't open for a visit, one of the actual caregivers usually delivers the child to the adoptive parent?
03/01/00 10:03:42 <Dr. Jane> Yes, the caregivers deliver the babies to the parents.
03/01/00 10:02:28 <Dr. Jane> I need to sign off folks. My patients are arriving. I hope that this has been helpful See you next week. We should discuss developmental issues in children adopted from abroad next week
Thank you Dr. Jane...
Glad to be of help Best of luck Next week is March 8 and I will be back, but let's make is for 30 minutes only.
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