Adoption medicine: a new specialty

More and more parents consult experienced adoption doctors to evaluate their referral or to follow-up after adoption.by David Tuller

Two days after Ann and Stanley Reese brought home toddlers from Romania, Ann noticed that Ileana was limping. At the emergency room in Rye, New York, doctors told her that her daughter had advanced osteoporosis, a bone-thinning condition that primarily affects older people. Unnerved, Ann called Jane Aronson, D.O., an expert on the health problems of children adopted from abroad.

“Jane laughed and said, ‘It’s not osteoporosis. It’s rickets. They’ve just never seen a case of rickets in Rye,’” said Ms. Reese. Rickets, a treatable bone ailment caused by malnutrition and a lack of vitamin D, is common in developing countries.

A decade ago, only two or three doctors in the United States had extensive experience with the medical problems of children born abroad and adopted into U.S. families. Today, more than 100 physicians in the United States and Canada are considered specialists in the emerging field of adoption medicine. (Find a state-by-state listing at www.aap.org/sections/adoption.)

These doctors offer parents pre-adoption counseling and evaluation based on a child’s medical records, as well as post-adoption consultations. Often, the doctors provide the child’s primary care after adoption, as well. Pre-adoption, they focus on infections and ailments like hepatitis B and C, tuberculosis, intestinal parasites, scabies, and lice. They look for signs of fetal alcohol syndrome, which can cause cognitive and emotional problems, and malnutrition, which can impair growth and motor skills. They run tests to determine whether a child’s record of vaccinations, if one is available, is accurate.

Jerri Ann Jenista, M.D., a pioneer in the field, says that she evaluates as thoroughly as possible the medical conditions of a child that a family is thinking of adopting. She presents the results frankly but does not advise the prospective parents as to whether or not to adopt. Adoption medical specialists say that most medical problems they identify are treatable.

“In most cases, children catch up, and some show amazingly rapid growth,” says Jennifer Ladage, M.D., of the Foreign Adoption Clinic in St. Louis.

David Tuller reported on adoption medicine for The New York Times, from which this article is reprinted with permission.

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