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The Handbook of International Adoption Medicine

by Laurie C. Miller, M.D.Oxford University Press; $45



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If youíve found that most medical reference books are boring tomes that you must grit your teeth to slog through, youíre not alone. You can usually forget about intriguing anecdotes and generous helpings of practical advice from these manuals. But now thereís something entirely different, The Handbook of International Adoption Medicine by Laurie C. Miller, M.D., associate professor of pediatrics at Tufts University School of Medicine and director of an international adoption clinic in Boston. A physician with numerous medical journal articles to her name, Miller has combined her medical knowledge on internationally adopted children with an enormous amount of research to create an excellent book.

The book is divided into seven major parts. The first part includes chapters about what happens before children are adopted, and discusses the effects of institutionalization and the evaluation process of children referred for adoption. There is specific information about children adopted from Korea, China, Romania, Guatemala, and the Ukraine. The second part covers prenatal exposures to alcohol, drugs, and smoking. Another part concentrates on travel to other countries, and advises which potentially scarce items to bring your child (alcohol wipes, antibiotic ointment, and diaper-rash cream, among them).

Included are information-packed chapters on growth and development (vitamin and mineral deficiencies, developmental delays); medical conditions (precocious puberty, lactose intolerance); and infectious diseases (hepatitis, tuberculosis, intestinal parasites, HIV). The final section covers attachment, behavioral and mental disorders, language competence, school problems and other key topics.

I was impressed with the many photographs, especially the one of a tightly swaddled Russian child. Miller says swaddling is common in orphanages, but that it allows children to have "little opportunity to practice gross or fine motor skills." Another photograph shows an orphanage caregiver wearing a surgical mask that covers nearly her entire face. Miller notes the deprivation children experience in not seeing human faces.

In many sidebars, Miller describes individual children and their outcomes, such as Randy, 4, adopted from Romania. Miller states, "He made poor eye contact, refused to offer affection, and made few vocalizations." Relatives worried that Randy was autistic. Writes Miller, "Within a month, ritualistic behavior diminished significantly. Excellent social and cognitive skills emerged, and Randy became a source of delight to his family."

Miller is also unfailingly sensitive to adoptive parents. For example: "The moment the adopted child is placed with his or her new parents is an unforgettable emotional event for families. As in the delivery room, a scene familiar to pediatricians, the addition of a child to a family is one of the peak experiences of human life."

I strongly recommend this book to adoptive parents, adoption agencies, physicians, and anyone interested in the health and well-being of children adopted from other countries.


Reviewed by Christine Adamec, author of The Complete Idiotís Guide to Adoption (Second Edition).

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