Assessing a Child's Health
There are roughly 30 adoption medical professionals around the U.S., who specialize in offering assessments of a child's health issues before and after adoption. One of these specialists is Dr. Mary Staat, adoptive mother of three, professor of pediatrics, and director of the International Adoption Center at Cincinnati's Children's Hospital Medical Center. We asked her a few questions on behalf of Choice Moms about the health issues of some children in international, domestic and foster care adoption programs, and how to assess and address them.
Q: With the limited access to medical information of many children being placed for adoption, and the limited resources/time of a single parent, many Choice-Moms-in-the-making who consider adoption are wary about whether they can cope with the possible special needs of a child. What is your advice to women fearful of taking this step?
A: It can be a scary step, whether you are single or married. Most children placed for adoption will have some issues, especially in those first six months at home, when you consider that all of them have to some extent had less than optimal conditions for the first weeks and months of their lives. The vast majority end up doing great. But it's important to understand what your gifts are, what you are capable of handling, what your resources are - emotionally, financially, physically - as well as the resources available in your community . Look at all the factors, give yourself an honest assessment, and decide what you're comfortable with before you start the process of choosing a country or a domestic program. Then let the social worker or attorney you are working with know your hopes and expectations. Their goal, just as yours is, is to make a good match. No one wants you to be adopting a child who has far more needs than you are able to care for. After you get a referral, review the information with an adoption medical professional to assess the possible long-term issues based on that child's growth parameters and how they are doing developmentally. They should be able to give you an idea of what challenges you might face in the future, and how to handle it.
So, the steps are to 1) be honest with yourself about what you can deal with, 2) talk it over with the person helping you get a placement, 3) review medical information with a professional.
Q: For the conscientious Choice Mom who wants to be mindful of the future life of her child, what are the types of things she should be aware that she could face in choosing adoption?
A: For an international adoption, there tend to be basic medical issues related to malnutrition and growth delays, which can be overcome. You will want to screen for infectious disease issues, which can be manageable with proper early detection. Most children will have some developmental delays, but they will generally catch up after being home with you for six months. The older the child, the more likely they will have delays that take longer to catch up. And of course some children will have been neglected and not stimulated for a long period of time, and they might not fully recover from those setbacks.
With foster care adoption, there will be some of the same issues of neglect and abuse. You'll need to have your eyes open to the fact that many of these kids, especially the older ones, will have suffered real hardships and traumas that you'll have to face together. Domestic adoption, too, will have some uncertainty of the in utero environment, whether there has been alcohol or drug use.
Any medical assessment will look for signs of fetal alcohol syndrome, learning how the infant did during delivery, growth parameters, whether they were premature or full-term, head size.
Psychologically, of course, there is a transition time for bonding and attachment. Some will have been more traumatized, especially if they are older, and will struggle longer with the transition.
Q: What is the healthiest way for a woman to prepare emotionally for adoption?
A: I always recommend that you remain objective and a bit detached initially after referral, because this may or may not be your child. It might be the right fit for your family, or it might not. Rather than send the picture of the child to everyone you know - which is a common reaction - consider that you need to explore first any issues that might not be the best for you. It's heart-wrenching to have to emotionally backtrack. Some of the families I work with send me the referral information to assess before they even look at the picture.
Q: For any single woman with limited resources, what can she do to become the best adoptive parent she can be?
A: I know so many single women who are offering an awesome family life for their child. You need to know how to use family, friends, community resources. It certainly can be harder to do without a partner, but make sure you line up your support before you bring your child home. You need to be able to ask for help. And get a rich support system that includes married couples, other single parents, adoptive families, even non-parents who can step in when you need them.
Also, look into your insurance plan. As a single person, with such a big life event change, you need to be sure you'll have the services you'll need especially in that first year with your child. Does your insurance cover speech therapy, which is a very common need? Or occupational therapy? Mental health for you or the child? You'll need a lot of screenings, evaluations, vaccinations that first year. Is it time to change your policy so you don't have such a high deductible?
Make sure your pediatrician has some familiarity with adoption issues. Or line up one of the adoption medical professionals to help you evaluate. Here in Ohio I do hundreds of pre-adoption reviews largely by mail. For post-adoption assessment, sometimes I get families here for two visits, coming from Michigan or as far away as Colorado. There are only about 15 adoption medical centers around the country.
Q: What are the benefits of early intervention?
A: We know so much now about the importance of early brain development and stimulating babies. When that doesn't happen, you need an early assessment to see where the child is so you can intervene and provide a rich environment to get them on target developmentally. Here at my center we're pretty aggressive about therapy. But if the child is only a little behind, we might send the family home with handouts to help get the kids off to a good start. If they end up with speech development issues and have trouble communicating, of course, that can end up leading to behavioral issues later on. So I can't emphasize enough the importance of getting them on target with early assessment.
