Q:“We’re adopting internationally. When should we begin working with a pediatrician? Is a specialist our best bet?”
A: Choosing your child’s health care provider is one of the most vital decisions you’ll make as a parent. Adoption and foster care impact countless families, yet most pediatric and family practice residency programs have little or no training on the issues specific to our children. Take your time in finding a doctor who will work with you–answering questions, addressing concerns, providing information–as you go forward in your journey.
Essential First Steps
Even as you prepare your paperwork, a physician can be helpful. There is often information in a child’s prenatal and early medical and social history that indicates special needs. A doctor can review the “Special-Needs Checklist” in your paperwork and help you determine which needs you are best prepared to meet.
A child in long-term orphanage care may be sick at the time of placement. If you’re traveling to meet your child, make sure you can contact the pediatrician while you are abroad, if necessary. Some doctors are willing to give you medications to take on the trip–see if this is possible. If not, ask your doctor to provide you with a list of places where you can get appropriate medical care or obtain medications prescribed by a physician in your child’s country of birth. If you are adopting overseas, see your physician to get any immunizations necessary before you travel. Many vaccines are scheduled to be given over a six-month period, so an early start is important.
If your physician is unfamiliar with travel medicine, find a travel medicine specialist or visit the Centers for Disease Control and Prevention. Sign up for health alerts specific to the country you will be visiting, and read up on proper hygiene practices there. Print out articles you’ve read about health care abroad or about adoption travel medicine–and take them with you to your doctor’s office. Remember, a physician might not be adoption-savvy, but the right one will support your family and help you resolve problems.
Next Steps and Transitions
Once your child is home, see your pediatrician for a comprehensive evaluation. (This appointment should be made as soon as you have your travel dates.) Many families prefer to work with a doctor who is knowledgeable about adoption. This may be a specialist at a children’s hospital or university, or a primary care physician with adoption expertise. Find a list at the American Academy of Pediatrics Section on Adoption and Foster Care.
Whether you choose a hospital-based specialist or a primary care physician for the initial evaluation, make sure your doctor fits your needs. (It is not necessary for you to see both a specialist and a primary care physician, as the exams will likely duplicate each other.) A specialist should communicate promptly with your primary care doctor about your child’s needs and a recommended vaccine schedule. How and when you transition to the primary care physician will depend on the specialist and on your familiarity with him or her. Some families visit the specialist just once, for a post-adoption evaluation. Others see the specialist for a year or two after their child comes home.
Base your decision to see an adoption specialist on on-call availability, convenient office hours, her ability to partner with you, and whether the specialist resides in your area. If you are unable to find a specialist, ask your social worker and other families to recommend local health care providers with an interest in adoption. Schedule meetings with them, and take along any resources or articles you’ve gathered. (The American Academy of Pediatrics offers a brochure for new adoptive parents to bring to the first check-up.) Most important, choose a physician who recognizes that adoptees have special needs and require a comprehensive evaluation. If a doctor doesn’t believe referrals or testing is needed, look for another doctor.
Whether your child has special needs, or seems to be developing as predicted by the baby books, monitor your family/doctor relationship as your child ages. With the right physician, you can work together to address any of your child’s health issues–and ensure that she thrives as she grows!