Content uploaded by Laurie Miller
Author content
All content in this area was uploaded by Laurie Miller on Jun 23, 2016
Content may be subject to copyright.
A preview of the PDF is not available
The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers
... Comme le soulignait de Truchis dans la version précédente de cet article [8] , l'enfant adopté interroge sur les valeurs respectives du lien biologique et du lien social dans le processus de parentalité. Il requiert autant, si ce n'est plus, qu'un autre notre attention et nos soins [9] . ...
... Il est recommandé d'informer les nouveaux parents des comportements habituels des enfants en matière de sommeil, d'alimentation et d'élimination, en particulier des comportements typiques observés chez les enfants sortant d'institution. Ils doivent être avertis que leur enfant peut sembler mal à l'aise ou en détresse lorsqu'il est confronté à des pratiques inconnues ou nouvelles, notamment lors de l'alimentation et de l'endormissement [9] . ...
... Cet âge est aussi déterminant pour adapter la scolarisation. La date de [9] . ...
Resumen
El número de niños adoptados en Francia o a escala internacional ha disminuido desde 2004, con niños caracterizados por un aumento de la edad, de los hermanos, de las experiencias de rupturas y de las patologías físicas, de desarrollo, de comportamiento y/o psicológicas que requieren cuidados más o menos duraderos y que preocupan a los padres adoptivos. Se puede recurrir a los médicos en la preadopción sobre el expediente de un niño o para el asesoramiento pediátrico general. También pueden evaluar a un niño recién llegado clínicamente y mediante pruebas complementarias. También son preguntados por los padres cuyo hijo adoptado presenta trastornos somáticos y/o psicosociales durante o después del período de transición, y en particular durante las cuestiones de identidad de la adolescencia. El objetivo de este artículo es proporcionar un medio para comprender y tratar las situaciones que el profesional puede encontrar en la consulta de un niño adoptado. Las patologías que se observan con más frecuencia a su llegada son las infecciones intestinales y cutáneas, la desnutrición y los trastornos psicoconductuales. Algunas infecciones e intoxicaciones potencialmente graves y poco frecuentes se examinan sistemáticamente (tuberculosis, hepatitis vírica, sífilis, virus de la inmunodeficiencia humana, etc.) o en función de los factores de exposición al riesgo (paludismo, alcoholización fetal, intoxicación por plomo, etc.). Es necesario realizar una evaluación de la inmunidad y una posible puesta al día en una fase temprana. Durante el seguimiento, los motivos frecuentes de consulta son la dinámica del crecimiento, la incertidumbre sobre la edad, los trastornos del desarrollo (motricidad, lenguaje, sueño y/o alimentación), los trastornos psicoafectivos y de apego, y la pubertad avanzada. El conocimiento de los problemas actuales de la adopción es necesario para evitar atribuir cualquier síntoma a la adopción. En la mayoría de las regiones de Francia y en los países de adopción existen consultas multidisciplinares de adopción (pediatras, psiquiatras infantiles, psicólogos en conexión con una red de especialistas) que son centros de referencia para situaciones complejas.
... Il est important qu'ils connaissent les particularités psychoaffectives et comportementales d'un enfant abandonné, ayant vécu en institution ou en famille d'accueil, ayant subi plusieurs ruptures, voire de la maltraitance et/ou des abus sexuels, ainsi que les particularités de la transition et de l'attachement. [8] . ...
... 2018 [56] Besoin Les progrès du développement dépendent fortement de l'attachement. La vie dans un orphelinat, avec son cycle de soins en constant changement, ne favorise pas la formation d'attachements forts et sécures [8] . Les soins incohérents fréquents dans les orphelinats entraînent des attachements anxieux, insécures ou, dans des situations extrêmes, l'incapacité de former un attachement. ...
Résumé
Le nombre d’enfants adoptés en France ou à l’international diminue depuis 2004, avec des enfants caractérisés par un âge plus élevé, des fratries, un vécu de ruptures plus nombreuses et des pathologies physiques, développementales, comportementales et/ou psychologiques nécessitant des soins plus ou moins durables, qui préoccupent les parents adoptants. Les médecins peuvent être sollicités en préadoption sur un dossier d’enfant ou pour des conseils de pédiatrie générale. Ils peuvent aussi évaluer cliniquement et par des examens complémentaires un enfant récemment arrivé. Ils sont également interrogés par des parents dont l’enfant adopté présente des troubles somatiques et/ou psychosociaux pendant ou après la période de transition, et en particulier lors des questionnements identitaires de l’adolescence. Cet article a pour but de donner des moyens de compréhension et de prise en charge des situations de consultations d’enfant adopté que le praticien peut rencontrer. Les pathologies le plus fréquemment observées à l’arrivée sont des infections intestinales et cutanées, des malnutritions et des troubles psychocomportementaux. Certaines infections et intoxications potentiellement graves et rares sont dépistées systématiquement (tuberculose, hépatites virales, syphilis, virus de l’immunodéficience humaine, etc.) ou selon les facteurs d’exposition au risque (paludisme, alcoolisation fœtale, saturnisme, etc.). Une évaluation de l’immunité vaccinale et un rattrapage éventuel sont nécessaires précocement. Au cours du suivi, les motifs fréquents de consultation sont la dynamique de croissance, l’incertitude de l’âge, des troubles développementaux (motricité, langage, sommeil et/ou alimentation), des troubles psychoaffectifs et de l’attachement et la puberté avancée. La connaissance des problématiques actuelles de l’adoption est nécessaire et permet d’éviter d’attribuer n’importe quel symptôme à l’adoption. Il existe des consultations d’adoption multidisciplinaires (pédiatres, pédopsychiatres, psychologue en lien avec un réseau de spécialistes) dans la plupart des régions de France et des pays d’adoption qui sont des centres de référence pour répondre aux situations complexes.
... As many modern adoption experts emphasize today -"love alone is not enough". In order to provide effective support and help, it is necessary to understand what the child survived, what difficult situations he or she was exposed to and how this affected him or her (Loehlin, 2015;Miller, 2005; Stańczak-Kuraś, 2016). Adopted children come from two worlds and during their lifetime they must connect these two worlds (Kolska, 2016). ...
... 3,4 There are also reports of higher rates of TB among adopted children taken abroad from India (0.5e5%). 5 Passive case finding alone can lead to missed cases or delayed diagnosis. Enhanced outreach activities to detect more TB cases are critical to universal access to care. 1 The inmates of orphanages and homes for the aged are less likely to seek health care from institutions compared to the general population. ...
Background: India accounts for one fourth of the TB burden globally. One of the objectives of
the National Strategic Plan is to achieve 90% notification rate of all TB cases. Screening of
high risk groups is one of the important components towards achieving this objective.
Inmates of homes for the aged and orphanages are at higher risk of having TB infection and
disease. Hence this study was conducted with the objective of identifying the prevalence of
TB among inmates of homes for the aged and orphanages.
Methods: A cross sectional study was done in homes for the aged and orphanages of Kollam
district of Kerala in India. Sample size was estimated as 466. Cluster sampling using
probability proportionate to size was used. There were 32 homes for the aged, from which 5
were selected. Out of 43 orphanages 8 were selected. Inmates were screened using a
questionnaire. Those with any of the symptoms suggestive of TB were examined by a
pulmonologist in a camp conducted at the institute. Those who needed further evaluation
were brought to Government Medical College, Kollam/other nearest government health
setting. All those who were detected to be having tuberculosis, were guided and given the
care as per the NTEP treatment protocol. Permission was taken from the Collector of
Kollam district. Informed written consent from the study subjects/legally accepted representative and assent were taken.
Results: 533 inmates were assessed from homes for the aged. The mean age was 56.70 (SD -
17.40). Five new TB patients were identified during the study. Of this three patients had
extra-pulmonary and two were pulmonary TB. Eight patients were receiving treatment for
TB at the time of study already, seven of which were pulmonary and one was extrapulmonary. So the prevalence of TB in homes for the aged was 13/533 ie 2.43% (95%CI e
1.36 to 4.03%) or 2430/lakh. A higher percentage of inmates with tuberculosis were females,
stayed in dormitory, had only primary education, had history of contact with TB and were
undernourished compared to inmates without tuberculosis.
We screened 478 children in orphanages of Kollam district. There were no children less
than 5 years. Most of the children were in the age group of 10e15 years (62.1%). Nine- children (1.9%) had history of contact with TB. One child had a previous history of TB.
There was only one child who was suspected to have Tuberculosis, She was evaluated by a
pediatrician and Tuberculosis was ruled out.
Conclusion: The prevalence of TB in inmates of homes for the aged is much higher than the
general population. This highlights the need for a more active case detection in such institutions, especially in the context of the country marching towards TB elimination. The
absence of tuberculosis among children in orphanages is a positive indicator that the
community is moving in the direction of TB elimination.
... Parents caring for adopted children with disabilities provide exceptional care. Their responsibilities include tasks related to navigating medical, therapeutic, educational and other resources and supports (Roundtree & Lynch, 2006), often due to complex pre-adoptive histories such as abuse, or institutional care (Hornfeck et al., 2019;Miller, 2005) that, when combined with the child's disability, may increase the amount of support needed. The data on adopted children with disabilities are limited. ...
Integrating work and family demands can be challenging for families caring for a child with one or more disabilities. The pandemic and its changes to work, schooling and service delivery potentially added to these challenges. This exploratory mixed methods study sought to understand how the pandemic affected adoptive parents' work–life fit and service use. A total of 200 participants responded to survey questions about parenting an adopted child with a disability prior to, and after, the onset of Covid‐19. More than half of the parents (59.2%) reported that it was somewhat to very difficult to integrate both work and family demands. Parents with greater access to workplace flexibility and supportive supervisors had significantly less difficulties combining work and family. Families who reported more problems with accessing mental health services, special education and respite care reported significantly more challenges with work–family fit. Parents reported increased stress due to the pandemic changes, but many also shared positive changes such as more time for family. Online services were experienced as effective for some children and reduced time spent driving to appointments. Recommendations for workplace and social service practice and policy supporting adoptive parents of children with disabilities are discussed.
... 6 Other texts are available for the clinician that focus on adoption medicine. 7 Ultimately, Kay and Marco's story illustrates the need, both within and beyond the scope of adoption, for us all to embrace the power of acknowledging, exploring, and celebrating our full selves. Windblown was initially written by Larry W. Halverson, MD, as a tribute to his friend and mentor, Richard S. Buker, Jr, MD, at the time of Buker's death in 2018. ...
The Chapter “Change A Life” focus shifts towards the foster care system and adoption process when the child is in foster care. The chapter also delves into international adoption and specifically sheds lights on the most preferred countries that the children are adopted from to the United States.
This book presents specific methods for the physical rehabilitation, mental health restoration, and academic remediation of post-institutionalized international adoptees. The focus of the book is on the neurological, psychological, and educational consequences of complex childhood trauma in the context of a fundamental change in the social situation of development of former orphanage residents. A discussion of after-adoption traumatic experiences includes a critique of certain “conventional” approaches to the treatment of mental health issues and different disabilities in international adoptees. Using his 30-year background in research and clinical practice, the author expertly describes and analyses a range of methodologies in order to provide an integrated and practical system of “scaffolding” and “compensation” for the successful rehabilitation and remediation of children with ongoing traumatic experiences. This is essential reading for researchers and practicing clinicians concerned with childhood trauma, remedial education, and issues of international adoption.
Any child adopted from any country in the world could have been exposed to alcohol prenatally. Intercountry adopters are advised to obtain comprehensive, local information about alcohol misuse in pregnancy in their chosen country. This information is frequently difficult to obtain and may not be reliable. Diagnosis in intercountry adopted children is difficult because the history of alcohol exposure is usually unknown. Growth delays, learning, emotional and behavioural problems in institutionalised children may have other causes. Even if the information is incomplete, an intercountry adopted child should not be denied a diagnosis because early diagnosis improves the long-term prognosis. The preparation of intercountry adopters for the possibility that their child may have been exposed to alcohol is essential. Although not currently recommended in most of the UK, all intercountry adopted children, irrespective of their country of origin, deserve to have a comprehensive health assessment and screening after adoption.
Longitudinal language development data were collected on 130 infants and toddlers adopted from Eastern Europe. The children were followed by means of parent surveys from the age at adoption up through age 36–40 months. The surveys collected data on expressive vocabulary growth, mean length of the three longest utterances, and development of four bound grammatical morphemes. Additional language data were collected using a modified version of the Rossetti Infant-Toddler Language Scale (1990). A multivariate factor analysis found no significant correlation between preadoption medical and developmental risk factors and eventual language development outcomes. The majority of children acquired English using the same developmental trajectories as nonadopted peers. By age 36–40 months, children adopted at younger ages had fully caught up to English language norms. Children adopted at older ages lagged behind, with the length of delay related to age at adoption. On the basis of these data, clinical guidelines are provided for assessing and treating speech and language disorders in internationally adopted children.
Context.
—Children born in the countries of the former Soviet Union and Eastern Europe are now a main source of international adoptions in the United States, but often little information is available about these children prior to adoption.Objective.
—To analyze the preadoptive medical reports of children adopted from Eastern Europe and the former Soviet Union and to compare these reports with their evaluations after arrival in the United States.Design.
—Case series.Subjects and Setting.
—A total of 56 children adopted from Eastern Europe and the former Soviet Union were evaluated in 2 international adoption clinics. Preadoptive medical records were available for 47 of these children.Results.
—There were 43 (91%) of 47 medical reports available from the children's birth countries that included multiple unfamiliar neurologic diagnoses. Evaluations in the International Adoption Clinics frequently revealed growth delays (z score -le-1 for weight in 44% of children, height in 68%, and head circumference in 43%). Children had 1 month of linear growth lag for every 5 months in an orphanage (r=-0.48, P<.001). Developmental delays were also common (gross motor delays in 70% of children, fine motor in 82%, language in 59%, and socialemotional in 53%). While serious medical problems were found or corroborated in 11 (20%) of the 56 children evaluated in our clinics, neurologic diagnoses cited in preadoptive medical reports were not confirmed.Conclusions.
—Preadoptive medical records from these international adoptees included multiple diagnoses suggesting severe neurologic impairment. Although these diagnoses were not confirmed when the children were evaluated in the United States, substantial growth and developmental delays were identified.
One hundred and two patients suffering from giardiasis and/or chronic gastritis were subjected for upper gastrointestinal endoscopy. Purified immune rabbit's serum against Giardia lamblia was used in ELISA and immunoperoxidase (IIP) techniques for detection of Giardia antigen, in the stomach. Results showed that out of 70 cases with intestinal giardiasis, 8 (11.4%) by ELISA and 6 (8.6%) by IIP showed gastric giardiasis. Higher percentage of gastric giardiasis (14%) was encountered in cases with both giardiasis chronic gastritis (50) than in cases with giardiasis alone (5%) but with statistically insignificant difference (P>0.05). None of the cases with chronic gastritis alone (without giardiasis) was positive for gastric giardiasis. Dyspepsia was the main presenting symptom in cases with gastric giardiasis (P
This article reports the findings of a research project conducted in 1995-96 on infant abandonment and adoption in China. These two practices were found to be closely linked. Restrictive birth planning policies combined with parents' perceived need for a son produce patterns of abandonment that primarily affect higher-parity daughters in sonless families. A lesser, but nonetheless strong desire for daughters among daughterless families leads to adoption as a means to remedy this situation as well as a means to overcome childlessness. These aspects of contemporary Chinese culture-the desire for daughters and the willingness to adopt unrelated children as a method of family construction-have helped alleviate the ill effects of increased infant abandonment in the 1980s and 1990s by leading many families to adopt foundlings. Because government laws and regulations discriminate in various ways against foundlings and over-quota children, and punish the parents who raise them, much of this popular solution to a difficult social problem has taken place outside of official channels and institutions. There is hope that legal changes may soon alter this situation.
Aportar la experiencia en los problemas que generanlas adopciones transnacionales de niños, los planteamientosy su manejo.Material y métodoRevisión de casos asistidos en el servicio de pediatría yrevisión de la bibliografía.ConclusionesLa adopción de niños procedentes de otros países estáaumentando en el nuestro. Los problemas que planteanlos niños adoptados incluyen enfermedades infecciosas,nutricionales y psicoemocionales. Además, debentenerse en cuenta condicionantes de índole éticaque el pediatra debe conocer y comentar con los padresadoptantes.
Infants living in an orphanage (n = 22) in Romania were assessed on the Test of Sensory Functions in Infants (TSFI). Testing of the institutionalized infants was done before and 6 months after an enriched caregiver intervention program. Results showed significant changes in areas of reactivity to tactile deep pressure, visual-tactile integration, oculomotor control, reactivity to vestibular stimulation and total test responses. No significant changes occurred in the area of adaptive motor functions. Effects of sensory deprivation resulting from institutional settings and changes that can occur from enriched caregiver environments are discussed.
The object of the following paper is to present the result of a number of observations touching certain aspects of the question of habitual inebriety, notably the rôle of maternal alcoholism as an agent in race degeneracy.
Observational studies of 85 children aged 2-5 years were made in 13 residential nursery groups. The aim was to relate the language development of the children to the amount and quality of adult talk directed at them, and both these factors to the way in which the nursery was organized. No "institutional retardation" was found, and the mean test scores on both verbal and nonverbal tests were average. Significant correlations were obtained between the language comprehension scores of the children and both the quality of the talk directed to them and the way in which the nursery was organized.
Objective:
To investigate associations between lead exposure and early motor development.
Study design:
We conducted standardized assessments of motor function (Bruininks-Oseretsky Test of Motor Proficiency and Beery Developmental Test of Visual-Motor Integration) at age 54 months in 283 children whose mothers were recruited in pregnancy from a smelter town and a non-lead-exposed town in Yugoslavia and who have been monitored twice yearly since birth. Blood lead concentration (BPb) was summarized in a measure reflecting the average of the child's semiannual serial log BPbs through 54 months.
Results:
Multiple regression showed that taken together, anthropometric measures (birth weight, body mass index) and markers of a stimulating and organized home life (HOME scale, parental education and intelligence, availability of siblings) explained a significant 10% to 18% of the variance in motor functioning. Beyond these contributions, BPb was significantly associated with poorer fine motor and visual motor function but was unrelated to gross motor coordination.
Conclusions:
Modest associations between early lead exposure and fine motor and visual motor functioning appear even after statistical adjustment is done for other contributors to motor development. Associations with BPb are specific to these areas of motor skill; gross motor development was unaffected.
The etiology of acute lower respiratory tract infection (ALRI) was identified in 235 (43.807o) of 537 hospitalized children <5 years of age. Clinical evidence of measles was found in 258 (48.0%o) patients, of whom 59 had a second viral infection. A viral agent was identified in an additional 121 patients, so that a total of 379 (70.6!7o) had viral infections. After measles, respiratory syncytial virus was the most common respiratory virus. Bacteremia was noted in 72 children (13.4%o), occurring as frequently in children with measles (14.807o) as in those without (12.1l7o); Haemophilus influenzae and Salmonella typhi were predominant in the former, and H. influenzae, Staphylococcus aureus, and Streptococcus pneumoniae were prominent in the latter. The presence of bacterial antigen in urine was not helpful in identifying bacterial infection. Extrapulmonary and intrapleural complications, concomitant measles, complicated ALRI, female gender, and malnutrition were associated with increased mortality among children with ALRI. The importance of measles immunization, vitamin A supplementation for alleviation of defects associated with malnutrition, and timely antimicrobial therapy is emphasized. The mortality due to acute respiratory tract infection (ARI) in children is exceedingly high in developing countries compared with the rate in developed countries; this difference has been attributed to the higher prevalence of bacterial infections in the