Intercountry Adoption - physical health

adoption; adopt; international; overseas; physical; health; breastfeeding; thalassemia; thalassaemia. puberty; malnutrition;

Contents

• Medical checks
• Health conditions
• Development
• Growth
• Diet
• Toileting
• Adjustment process
• Resources
• References
• Acknowledgements

Children who have been adopted from overseas have been used to different physical conditions and different foods from the country they are adopted into. Some children may have health conditions that are not usual in their new country. The following information is specifically for adoption to Australia, but many of the health issues are similar for parents who are adopting children in other countries.

Medical checks

• Medical screening before adoption to Australia is as thorough as possible given the facilities in the country of origin, and illnesses of any importance are usually found before the children come to Australia.
• Some conditions may not be found either before or immediately after arrival in Australia.
• All newly adopted children need a medical check by a paediatrician soon after arrival in Australia - preferably one who has had experience with children who have been adopted from other countries.
• Medical checks should include a blood count for iron deficinecy anaemia and inherited blood diseases, faecal (poo) checks for parasites and other infections, and tests for TB, HIV and hepatitis B, even when they have been done in their country of origin.
• All children need vision and hearing checks. In South Australia this can be arranged by your Child and Family Health nurse.
• Most children will need to be fully immunised, even if they have had some immunisations in their country of origin.

Health conditions

• Many children have skin problems when they are first adopted.
  • Many children have dry skin. Use sorbolene and moisturisers as soap substitutes. Soap is drying to the skin.
  • Head lice are common.
  • They may have scarring from old infections.
  • Molluscum contageosum (viral infection of the skin) is also common.
  • Scabies is not so common now.
• Bowel infections and parasites (such as worms or Giardia) are also common, but can be easily treated.
• Children may have waxy ears due to poor hygiene - they may need medical attention.
• Dental care may have been minimal. A dental assessment should be done shortly after arrival. The school dental service provides an excellent and free service for school aged children (In South Australia phone 8222 8284.)
• Some children from Asia may have a type of Thalassemia (an inherited blood problem). Usually the child is a carrier, which causes no harm to the child. If the child later has a child with a partner who also is a Thalassemia carrier, their child may be affected. Thalassemia also occurs in some other groups, such as Middle Eastern, Greek and Maltese families.
• Some children adopted from South East Asia have been diagnosed with G6PD deficiency, which can cause anaemia and jaundice if the children eat certain foods. It is genetic but easily controlled by diet. It may or may not be found by medical checks before the child comes.
• Some children from India have sickle cell anaemia. This is a genetic change in the cell which gives some protection against malaria, but the anaemia can be a problem at times.
• A few girls from some parts of Africa may have undergone female genital mutilation. For more information about this, see the topic Female genital mutilation.
• Older overseas adopted girls may reach puberty early in response to a sudden improvement in their nutrition. While these girls will have grown quickly in the first year or so after arrival in Australia, if they go through puberty at a young age they are likely to end up very short as adults. If this seems to be happening, your paediatrician may refer you to an endocrinologist for hormone therapy to slow the pubertal changes.
• Some children of Asian, Hispanic, African and Native American background have birth marks called 'Mongolian blue spots' that can look like large bruises that do not go away. They are usually on the child's lower back or buttocks. They cause no health problems and usually fade as children get older. Because they may be thought to be bruises, you could have your doctor or child health nurse make a note for you of where they are on your child's body and their size. See the topic Birthmarks.

Development

• Some older children, particularly those from India, may have had a developmental assessment (eg. a Griffiths Developmental Assessment or a Bailey's Assessment). The results need to be interpreted with caution if the age of the child is not accurately known. Deprivation, malnutrition and emotional trauma may also affect the results.
• Accurate estimates of the age of the child are not always possible in the countries from which these children come. Births may not have been recorded, and neglect and poor nutrition will affect a child's growth, making it impossible to tell the age from appearance. X-rays to assess bone age and a dental check may provide additional information, although results have to be interpreted with caution. 
• Overseas adopted children often have quite uneven development. For example, they may have good self care skills (dressing, eating) but poor fine and gross motor skills because they have not been able to practice these skills, or they may have been ill.
• Language should be acquired quickly. Depending on their age, children who are able to talk in their first language should be able to express themselves well after 1 to 4 months. If they are not progressing, consider a hearing, speech and developmental assessment. (See your paediatrician, or Child and Family Health nurse in South Australia.)

Growth

Children who are adopted may not have had good nutrition for all of their lives, or they may have had some serious illnesses and emotional deprivation. Many are smaller than other children in their own country, and they may be a lot smaller than Australian-born children.

If they have not been well nourished, they will often have a very large growth spurt in the first year after arrival in Australia, but after that their growth rate will return to a more normal pattern.

Growth Charts (Australian or Asian) can be useful to plot how they are growing - but the children may start well below the lowest line. What is important is not so much where they are on the chart, but that they are growing and developing.

Diet

• Don't try to force children to eat. They do best if they eat only as much as they want. Offer food that is as close to their original diet as possible.
• Some children take a long time to learn to chew solid food.
• Some children will overeat, either as a response to previous malnutrition or as a way of finding comfort in a stressful situation.
• Signs of malnutrition include failure to grow, tiredness, being very pale, being irritable, lots of infections, slow development, lack of appetite, loss of muscle tone, skin problems (such as dermatitis), thin hair and diarrhoea.
• Some children may be anaemic because they have not had enough iron in their diets, or have internal parasites. Anaemia causes a lack of energy and may slow development. Your paediatrician will have your child's blood checked.
• Some children have had watered-down formula, and a sudden change to full strength can cause diarrhoea. Others will have been given full strength cow's milk.
• Lactose intolerance is more common in Asian children. Young children can have diarrhoea that does not clear up. (See the topics Reactions to foods and Lactose intolerance in babies.) Older children may complain of recurring abdominal pain as well as diarrhoea.
• Talk to a dietitian if you are worried about what your child eats or needs.

Toileting

• It is useful to find out how to say the word for toilet in your child's language so that he can let you know of his needs before he learns English.
• Sometimes children who are toilet trained will go back to needing nappies for a while when they are under stress.
  • If this happens, accept it as normal, and concentrate on helping your child adjust to the big changes that have happened.
  • When he feels comfortable again, his skills will come back.
• Some children may have been trained to use the toilet by always being taken to the toilet at a particular time. If this is the case, be prepared for mishaps and do not make an issue about it.
• It is possible that a foster parent or carer will tell you that the child is toilet trained when this is not so, because they are trying to please you.
• A changed diet often causes changes in bowel actions.
  • Your child may develop diarrhoea or constipation. This will probably settle down quite quickly, but if diarrhoea persists, get this checked out when you return home.
  • If your child is constipated, see the topic 'Constipation' for ideas about how to manage this.
  • The colour of the bowel action may also change, especially if you change a baby's formula. This is normal.
• If there is blood or mucus in the bowel action, you need to get this checked as soon as you get home.
• Bowel actions may be also be affected by worms.

The stress of all the changes means that it would be better to leave any attempt to toilet train a child for several weeks. See the topic 'Toilet training' for more information about recognising when your child is ready to try.

Adjustment process

See the topic 'Intercountry adoption - emotional health'.

Resources

South Australia

Adoption and Family Information Service (AFIS) of South Australia - phone 8207 0060
http://www.adoptions.sa.gov.au/

References

Focus groups with parents from the Australian Aiding Children Adoption Agency (AACAA)

Johnson D, 'International Adoption Medical Program', University of Minnesota
http://www.peds.umn.edu/iac/ 

Acknowledgements

CYH would like to acknowledge the contribution of the Australian Aiding Children Adoption Agency (AACAA), Dr Michael Rice (CYWHS) and Dr Chris Poole (CYWHS Medical Officer) to the preparation of this topic.

The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.