Health care of the internationally adopted child. Part 2: Chronic care long-term medical issues

International Adoption of Children Surviving the Haitian Earthquake

OBJECTIVE

To evaluate resilience and frequency of behavioral symptoms in Haitian children internationally adopted before and after the earthquake of January 12, 2010.

METHODS

We conducted a retrospective quantitative study in 40 Haitian children. Families were also asked to participate in a qualitative study (individual interview at 18-24 months after the earthquake) and to complete State-Trait Anxiety Inventory (STAI) and STAI for children (STAI-C) questionnaires.

RESULTS

Demographic and clinical characteristics were similar in the group who experienced the earthquake (n=22) and in the group who did not (n=18). The families of 30 adoptees were interviewed. There was no statistical difference between the two groups for the STAI (P=0.53) and STAI-C (P=0.75) or for the frequency of behavioral problems. Plenary adoption was pronounced for 84.6% and 33.3% of the children adopted in the pre- and post-earthquake group, respectively (P=0.02). Children rarely talked about the experience of the earthquake, which, by contrast, was a stressful experience for the adoptive families.

CONCLUSIONS

Haitian children adopted after the earthquake did not express more stress or behavioral problems than those adopted before it. However, the possibility of a resurgence of mental disorders after age 10 should be borne in mind. (Disaster Med Public Health Preparedness. 2018;12:450-454).

Acute care issues in internationally adopted children

Over the past decade there has been a dramatic increase in international adoptions in the United States. While most adopted children will have common illnesses, others may have unique medical issues as a result of the conditions in their birth country requiring a broadened differential diagnosis. Knowledge of these issues is essential in the management of these patients. This review will predominately focus on infectious disease issues commonly seen in international adoptees but will also discuss other medical conditions and some of the psychosocial issues which may be encountered by caregivers in the emergency department.

Evaluating acceptability and completeness of overseas immunization records of internationally adopted children

BACKGROUND

Increasing numbers of families in the United States are adopting children who were born in other countries. Appropriate immunization of internationally adopted children provides a challenge to pediatricians who must evaluate documentation of vaccines administered overseas and fulfill the recommended US childhood immunization schedule. The acceptability of vaccinations received outside the United States was addressed by the Advisory Committee on Immunization Practices in 1994, but few population-based studies assessing these vaccinations have been reported.

METHODS

We performed a retrospective cohort study of 504 children who were adopted from other countries and evaluated in 1997 and 1998. Our goal was to determine the acceptability of overseas vaccinations for meeting US immunization requirements. We assessed immunization records for both valid documentation of receipt of vaccine and comparability with the recommended US schedule. We also determined the number of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and measles-mumps-rubella vaccines under the US schedule.

RESULTS

The children's mean age at initial US evaluation was 19 months; 71% were girls, and most (88%) had resided in orphanages. They were adopted from 16 countries, most frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had overseas immunization records, 167 (94%) of which were considered valid. Most children with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US schedule.

CONCLUSION

The majority (65%) of internationally adopted children had no written records of overseas immunizations. Among the 178 children with documented overseas immunizations, 167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the US schedule. Additional research and more specific guidance in the most cost-effective approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side vaccination and to improve the health of these children and their communities.

Prevalence of infectious diseases among internationally adopted children

OBJECTIVE

Internationally adopted children are at increased risk of infections acquired in their country of origin. Ongoing surveillance of this unique population is needed to detect changing epidemiology and provide appropriate care.

METHODS

We performed a retrospective cohort study of 504 children adopted from abroad and evaluated from 1997 to 1998 to determine the prevalence of and factors associated with various infectious diseases.

RESULTS

The mean age of the study participants at medical evaluation was 1.6 years; 71% were girls, and they were adopted from 16 countries, including China (48%), Russia (31%), Southeast Asia (8%), Eastern Europe (8%), and Latin America (5%). Overall, 75 (19%) of 404 children tested had tuberculin skin tests >/=10 mm, but all had normal chest radiographs. BCG vaccination (odds ratio [OR]: 7.37; 95% confidence interval [CI]: 3.29, 17.16) and being Russian born (OR: 2.90; 95% CI: 1.68, 5.00) were risk factors for latent tuberculosis infection. Fourteen (2.8%) children had detectable hepatitis B surface antigen, but no child had active hepatitis C, human immunodeficiency virus, or syphilis. Giardia lamblia antigen was detected in 87 (19%) of 461 tested children, and such children were older (mean: 22 months vs 15.5 months) and more likely to have been born in Eastern Europe (OR: 2.82; 95% CI: 1.70, 4.68).

CONCLUSIONS

We demonstrated increased rates of latent tuberculosis infection and G lamblia infection than previously reported. Thus, ongoing surveillance of internationally adopted children, international trends in infectious diseases, and appropriate screening will ensure the long-term health of adopted children as well as their families.

Precocious puberty in immigrant children: indications for treatment

Immigration from developing countries to Europe has greatly increased during the last few years. Very little information is available on children who immigrated with their biological family, thus this paper deals only with children immigrating by adoption. In recent years some studies have shown an increased incidence of precocious puberty among adopted children, but information on this issue is scanty. Several hypotheses have been put forward to explain precocious puberty in adopted children, including nutritional, ethnic and/or emotional factors. Untreated precocious puberty is associated with short stature and has social and psychological consequences in addition to those related to adoption. Therefore, indications for therapy need to be carefully planned. In adopted children age estimation is a possible source of error in timing of puberty as date of birth is often missing or inaccurate. Thus each child must be carefully evaluated.

Maternal stress during hospitalization of the adopted child

PURPOSE

To identify and describe the experiences of mothers whose adopted children are hospitalized and to compare those experiences to those of mothers whose biological children are hospitalized.

DESIGN

Comparative descriptive design.

METHODS

Mothers of hospitalized children (n = 33 adopted; n = 19 biological) completed a slightly revised version of the Parental Stressor Scale: Pediatric Intensive Scale Unit (PSS:PICU). Adoptive mothers also completed a questionnaire related to their perceptions of the impact of their child's adoption on the hospitalization experience.

RESULTS

Adoptive mothers perceived statistically significantly higher levels of stress related to their child's behavioral/emotional response to hospitalization. Children who had been with the family for less time perceived the hospitalization as more stressful. When both groups of mothers were considered, mothers of younger children perceived a higher level of stress. A majority of adoptive mothers felt the adoption had an impact on the hospitalization experience, especially related to their limited information about their child's medical history, staff lack of knowledge about legal issues, and concern about attachment to the child.

CLINICAL IMPLICATIONS

Nurses need to be aware of adoptive mothers' concerns related to attachment issues, limited family medical history, and legal rights in order to provide sensitive and effective care. Inservice education programs could be designed to help teach all staff about these important issues.