This "Medical and Developmental Issues in Adoption" handout (big download) comes from a talk that Dr. Bledsoe and I often give to parent groups, agency staff, and health care providers. More fun in person, but here it is for folks that can't make it to our travelling adoption medicine show.
Internationally adopted children tend to suffer more from micronutrient (vitamin and mineral) deficiencies and lack of attuned, stimulating care than from protein/calorie "macronutrient" malnutrition. Basically, most kids in orphanages get enough protein and calories to grow, but don't because of stress, neglect, and, perhaps, some micronutrient deficiencies. Iron and iodine deficiencies are well documented, as are vitamin A and D deficiencies.
The iron deficiencies (+/- anemia) may worsen during the catchup growth period, as children outstrip their limited iron supplies. This makes getting extra iron important for most internationally adopted children, for as long as they're having catchup growth. The constipation angle is overrated, in my experience, and I'd rather manage the constipation than see your child's brain development impaired by lack of adequate iron.
Vitamin and trace mineral deficiencies may also be implicated in the high rate of initial skin and hair symptoms. Zinc deficiency has been linked to stunting, poor healing, diarrhea, and cognitive delays in developing countries. I also wonder about essential fatty acid levels, and if we should be doing something to support the rapid brain growth we so often see. Many of the placing countries in international adoption also have environmental toxin issues (former Soviet Union, India, and China among others), but fortunately the lead issues we saw in years past are better these days.
In general, the research supports prevention and correction of deficiency, but not so much the trendy "giving more of a good thing" supplements industry for children not at risk for deficiency. A varied diet seems better for children at low risk of deficiency, although we still do recommend 600IU per day of supplemental Vitamin D for kids (Ddrops, Carlson D Drops, etc).
While vitamins and minerals are best absorbed from healthy food sources, it can be hard to meet the complete nutritional needs of a rapidly growing adopted child (who probably arrived with micronutrient deficiencies) through diet alone, especially if they're picky or have oral-motor delays and sensitivities. For that reason, we recommend as complete a multivitamin and multimineral supplement as you can find, at least for the initial 3-6 months of catchup growth.
The ideal supplement for internationally adopted children would contain plenty (100% RDA) of Vitamin's A and D, iodine, iron, zinc, selenium, and other vitamins and trace minerals. I've not yet found the ideal liquid/powder form, and would love to see suggestions in the comments below if you find a good one. Plenty of options in the chewable format, which can be crushed, but that's extra work, and not so dissolvable.
We also sometimes recommend essential fatty acid supplements like fish oils for new arrivals, as it seems plausible that children from malnourished pregnancies, who weren't breastfed, who were raised on diets poor in healthy omega-fatty-acids, and who are having rapid brain growth may benefit from supplementation in this area.
Essential-fatty-acid (EFA) supplementation has shown decidedly mixed results in ADHD, which is more common in IA children. DHA is a type of omega-3 fatty acid that seems important in early brain and vision development, and is a major structural building block in the brain. EPA is another omega-3 fatty acid that may be more helpful in later issues like attention (ADHD) and mental health. Flaxseed oil contains ALA, some of which is converted to DHA/EPA.
The optimum ratios of DHA and EPA have not been fully worked out, but I like to see more DHA early on for infants and toddlers, and more EPA for older children. Some fish oil products even include some healthy omega-6 and omega-9 fatty acids, for balance. Cod liver oil is a grandma favorite that usually contains natural vitamins A & D - check the labels to make sure you're not overdoing these vitamins, especially if they're in your other supplements and formula. It would be nice to get these healthy fats from diet alone, but sadly, our fish supply isn't safe enough in terms of mercury and PCBs to safely consume enough to meet our target intakes of DHA and EPA.
Some quality fish oils that are independently tested to have adequate potency and very low levels of contaminants include:
Another potentially helpful supplement would be probiotics, which are the good bacteria that live in your digestive tract, and that are found in yogurt. In fact, there's about 3 pounds of these bacteria in your body right now - isn't that a lovely thought? The Europeans have been big fans of probiotics for a while, and pediatricians are just starting to catch on. Probiotics seem to be a safe thing to try, especially for children with loose stools or those taking antibiotics. Since children from orphanages (where antibiotics are overused) are likely to have less-healthy "institutional strains" of these gut bacteria, it may be a reasonable thing to supplement for IA children. We've got lots more info and recommended formulations in our "Probiotics and Prebiotics" article.
What follows is a list of our typical recommendations at the initial post-placement evaluation. That first visit is a doozy, and much of what we say tends to get lost in the shuffle, so we'll recap many of our suggestions below. We like for folks to have a copy in hand when they leave our office, but you'll also find this article online at www.adoptmed.org/welcome, so that you can follow the links.
If you are lucky enough to live within driving distance of an international adoption specialist, we highly recommend an initial evaluation 1-2 weeks after homecoming with someone experienced in the unique growth, developmental, infectious disease, and parenting issues that our children tend to bring home with them. A full list of international adoption docs can be found here, and we describe our recommended evaluations in this article, as well as in our travel packet.
Unless you've adopted from Korea (shots trusted), Taiwan (also trusted), or Guatemala (we sometimes trust the shots there), we recommend that you either check titers (blood tests to confirm immunity) or start over on shots.
Hib and Prevnar (pneumococcal) immunizations are rarely performed in the typical sending countries, so we like to just start those at the first visit. Luckily, you only need 2 each of these if started >12mo, and you only need one Hib if given >15mo.
It's also rare to see an international adoptee with full immunity to measles, mumps, and rubella, so we'll often start MMR over as well, unless MMR immunization is well-documented at >1yo, in which case we could check titers.
Many IA children have received multiple DTP (diptheria, tetanus, and pertussis) and Polio immunizations, so those are ones we like to check with titers. However, titers done at less than 12-18mo may reflect transferred maternal antibody, so these may need to wait until the followup blood draw when children have been home ~6 months. If we have to wait to check titers, we will usually give 1-2 DTaP boosters, and perhaps one polio (IPV) booster, both to ensure coverage (lots of tetanus and whooping cough around, not so much polio in this hemisphere though) and to give the titers a good chance of proving immunity. Tdap (tetanus booster with added whooping cough protection) is a good choice for 11-18yo adoptees, and is now allowed earlier for those with uncertain immunization history.
Hepatitis A and Hepatitis B titers are routinely checked at arrival and 6 months later, so we hold off on those shots until we see what the labs say.
Varicella (chickenpox, 2 shots) can also be checked with titers, but the extra blood and expense may not be worth it given that we wouldn't save that many shots.
The oral rotavirus vaccine is not an option, as the first dose must be given at 6-12 wks old, with the last dose not given later than 32 wks old.
I tend to be a "lumper" rather than a "splitter" when it comes to shots. There is no reliable evidence that immunizations "overwhelm" the immune system, and I prefer to have fewer shot visits overall than drag things out by only doing 1-2 shots at a time.
The Vaccine Education Center at Children's Hospital of Philadelphia is my favorite online source for shot information from the generally pro-immunization perspective, as they link to relevant studies and also specifically address a lot of internet vaccine mythology.
A list of typically performed lab tests is listed here. Yes, that's a lot of tests, but it's the only way to know if many frequently encountered problems are present or not.
This is standard of care for internationally adopted children, although we get a bit creative in our office with children from Guatemala and Taiwan, and don't perform routine labs for children from Korea.
Our lab on the 1st floor downstairs, or the lab at Children's, is a good place to get these done. If the draw is not going well, you can certainly decide to try again in a few days.
It's going to require a lot of blood, typically drawn from the elbow or back of the hand, but your child will make more. Try to be calm, supportive, and resolute during the blood draw, model deep belly breaths, and try to put worries about attachment trauma and other anxieties out of mind, since your child will respond to your emotional state.
If your insurance company balks at coverage (tsk tsk), you and your pediatrician can adapt this insurance letter by Deb Borchers, MD. Refer them to the AAP Red Book, as well.
In our office, you can expect a call or letter with all of the lab results in about 2-3 weeks, a bit longer if titers are perfomed. We'll call sooner with any concerning results.
If you haven't heard by 2-3 weeks, please give the nurses a call at 206-598-3030.
In 6 months or at 18 months-old, whichever comes later, we need to retest for HIV and hepatitis (to rule out exposures just prior to travel). This is a good time to check additional titers or follow up on earlier abnormal results, if we haven't already. We also retest for anemia and iron deficiency at the followup lab draw, since periods of significant catchup growth may cause children to outgrow their already limited iron stores. A TB followup test is also recommended.
You'll need to submit a total of 3 stool samples to check for giardia and other parasites (O&P x3 and 1 stool PCR panel or giardia antigen), collected every other day. This is important, regardless of symptoms - 15-20% of our IA children have a parasite like giardia.
Until you know the results, be scrupulous about handwashing (Purell and other alcohol-based gels are very handy).
Don't let your children bathe together until you know the stools are clear - baths are a great way to share giardia.
The lab will give you a bag with containers and instructions. Scoop a peanut-sized amount of stool into the preservative-containing vials, and on the day that you're dropping off the stools, submit a fresh (<4 hours old) sample in the screw-top plastic container as well.
Please make sure your samples are labeled with your child's name, and write in the date and time collected.
It's easiest for all concerned if you drop them off at our lab on the 1st floor, but you can also drop them off at a local lab, ideally a hospital lab that does this a lot. Have them fax us the results, and call us if you don't hear the results in 1 week.
It's not unusual for this initial evaluation to miss a parasite - we've had several cases of Ascaris (white roundworm) present several months later ... so have a low threshold to retest for parasites if unexplained abdominal symptoms persist.
If you have a positive result, we'll explain what to do, but please read our article on giardia and other stool parasites for more information.
We test for TB exposure with a skin test called a PPD, on arrival and again in 6 months after arrival. This followup test is crucial - we have a lot of kids who do have latent TB who have false-negative tests on arrival, due to stress/malnutrition.
This skin test will need to be read by a health care professional in 48-72 hours. Our nurses can do this without an appointment. Just drop in during business hours ... bring your poop samples and drop them off at the lab on your way up.
Children 2-5 years or older can have a blood test for TB (IGRA) instead; this is off-label but commonly done.
You may hear that this testing is unnecessary in children who received BCG, the TB vaccine performed in many of our placing countries. This is not true. A result of 10mm or greater is a positive result, regardless of BCG status. Our children tend to come from high risk backgrounds as far as TB exposure is concerned.
We like to see children for followup visits every 2-3 months after arrival until they've been home 6 months. Our front desk can schedule these for you on the way out.
We're happy to help you transfer care to a more local pediatrician at any point in the process. Many families stay with us until that 6-months-home visit, when labs, shots, and catchup growth and development are well underway.
We see significantly higher rates of visual, hearing, and dental problems in children adopted from orphanages. Prenatal exposures and malnutrition, untreated ear infections, lack of visual stimulation, lack of fluoride and minerals, and poor dental care all contribute. For that reason, we recommend:
Screening audiology evaluation by a pediatric audiologist in the first few months home. Most of our children are language-delayed on arrival, and audiology is extra important in that scenario. Parents and pediatricians miss significant hearing problems all the time, and ringing a bell next to a child's face is not an adequate test of hearing. We now have an otoacoustic emissions (OAE) gadget in our clinic for easy hearing screens, but it has a really low threshold to refer children to audiologists for further evaluation. If that happens, Children's Audiology (206-987-2000) is a good bet, since they're skilled in behavioral audiology techniques for young children.
Screening pediatric opthalmology evaluation in the 1st months home. We see significantly higher rates of strabismus (lazy eye) and other visual problems in IA children. The earlier this is detected, the better. David Epley (206-215-2020) and Werner Cadera (206-528-6000) are two good local pediatric ophthalmologists.
Early dental visit. Pediatric dentists like to see children as young as 1yo. See this article for more about early dental care. We don't have a current list of favorite dentists - check here, and ask other parents in your area.
If we recommend an early intervention evaluation, you can access the nearest center by calling WithinReach (WA state) at 1-800-322-2588 for a local referral.
For infants and small toddlers, we recommend an infant or toddler formula with iron and essential fatty acids for the first 2-3 months home, even past the "typical" wean to whole milk at 1yo. Formula is just more nutritionally dense than milk, juice, or water, and contains essential nutrients for rapidly growing children. When you do transition to whole milk (>1yo) or reduced-fat milk (>2yo if they've had good growth), try to limit it to under 18 ounces per day, since excess cow milk will fill up their bellies at the expense of other nutrition, and can cause anemia.
While vitamins and minerals are best absorbed from healthy food sources, it can be hard to meet the complete nutritional needs of a rapidly growing adopted child (who probably arrived with micronutrient deficiencies) through diet alone, especially if they're picky or have oral-motor delays and sensitivities. For that reason, we also recommend as complete a multivitamin and multimineral supplement as you can find, at least for the initial 3-6 months of catchup growth if not beyond. Other good sources of essential fatty acids for older adoptees include fish oils and flax seed oil. Probiotics are another supplement to consider. Please see our Nutritional Supplements in Adoption article for more information and specific recommendations.
For other nutrition ideas, you could read following resources on our site ...
But I have also been fortunate to collaborate with SPOON Foundation on the content for their most excellent AdoptionNutrition.org web resource. That's the place I'd start.
Our website is chock full of articles, links, and book recommendations on the topic of development in internationally adopted children:
This topic should probably be listed first, as I believe it's the most important intervention for newly adopted children. Kids who've experienced orphanage caregiving, multiple placements, neglect, abuse, and other trauma do have special needs in the area of parenting and attachment. What you'll read in typical parenting books, and what may have worked with "typical" children is not always the best idea for many of our children.
Please see these excellent resources:
Top Ten Attachment Tips for the First Year of Placement - great stuff, from Deborah Gray
Bonding Articles from Adoptive Families magazine
The following is an excerpt from Transforming the Difficult Child, by Howard Glasser and Jennifer Easley; reprinted with permission. I've posted this as a teaser, and because I really like the ideas in Chapter 2 (below) ... the actual techniques come later in the book.
As I've written elsewhere, this is my favorite book for parenting, and yes, transforming, children who are difficult to parent - intense, needy, having difficulty regulating their energy and behavior, "ADHD-ish", with negative self-image, acting out to get attention, and so on. Sound like any older adoptees you know and love? It's also a fabulous positive parenting approach for "easier" kids. Glasser's belief is that normal parenting and teaching methods are designed for the "average child", and that the harder normal methods are applied to difficult children, the worse the situation can get, despite the best of intentions.
There are many good resources on this topic, so I won't reinvent this particular wheel, but since it comes up so often in our office, let me share my favorite sensitive skin and eczema tips. As to why this this is SO COMMON in our adoptees, particularly those from China, I suppose it's a combination of ethnic predisposition, climate, harsh orphanage soaps and detergents, institutional disinfectants, malnutrition, chronic stress, poor skin care, and lack of appropriate treatment. While atopic dermatitis is a chronic tendency towards sensitive, dry, rash-prone skin, it tends to eventually improve when children come home, especially with the techniques below ...
Overview from the (British) National Eczema Society
Original list of terms by Jerri Jenista, MD; some drug definitions from Karen Hauff, Pharm.D; updates and intro by Julian Davies, MD
Big thanks to the original authors for their gracious permission to adapt and publish this list, for the pioneering work of Dr Jenista and the staff of the International Adoption Center, and the counsel of our colleagues in Russia and on the Adoptmed listserv of adoption medical professionals.
It should be noted that we are not Russian doctors, nor were we trained in the mysterious art of Russian neurology, so take this for what it is: a glossary of medical terms found in Russian (and Ukrainian, and Kazakh, and other former Soviet Union) medical charts based on the interpretations we've collected over the years. Other definitions for many of these terms exist, they are not always used consistently (or translated accurately), and the degree of concern over these diagnoses will vary based on other factors in a child's history.
We would urge you to discuss the specifics of a particular referral with an international adoption specialist who can incorporate these medical terms into the context of a child's growth, development, physical features, and signs of more familiar Western medical conditions.
Why so many neurologic diagnoses in Eastern European referrals? Some possible reasons:
Russian medicine tends to list issues that we might consider "risk factors" or "things to watch for" as diagnoses (thus, lack of prenatal care can become "risk for intrauterine infection")
many diagnoses are provided by specialists and hospitalists, notoriously the neurologists, many of whom seem to have "favorite diagnoses", and incentives to overdiagnose in general
a persistent Soviet-era pessimism about the birth process; even with a (to us) healthy delivery they are quite worried about interruptions of blood and oxygen to the baby's brain, kinking of the spinal cord, and so on ... their descriptions of the birth process (and occasional interpretations of newborn spinal xrays) can leave one marvelling that babies are born with their heads still attached
a tendency to interpret what to us are normal, immature newborn behaviors (startle reflex, trembling chin, mottled skin, belching, etc) as signs of neurologic damage
and a subsequent tendency to ascribe what we might call normal infant maturation to recovery from neurologic illness, thanks to massage, medications, supplements, and other typical treatments
when it comes to orphanage-raised children (who, admittedly, do come from higher-risk backgrounds), there may be a bit of cultural pessimism about outcomes
Or, on the 'flip' side:
"Sometimes they diagnose just to show they care ..."
"It's all just a big jobs program for Russian neurologists."
"This diagnosis, in Western terminology, means that the child was born in Russia."
"It's the 'shotgun' approach to diagnosis - if you label all the children with neurologic impairments, you can rest easy that you haven't missed any of the actual diagnoses."
An article just published in Lancet sheds some light on the practice of pediatrics in Russia, Kazakhstan, and Moldova in a systematic review of hospitals. Essentially, the pediatricians are found to be dedicated and proud of their work, but hampered by antiquated, unproven protocols that over-diagnose, over-test, and over-medicate young children, not to mention the outdated or missing diagnostic equipment and treatment supplies. Kids languish in hospitals far too long for minor illnesses, and in the case of orphans, typically receive very little stimulation (we've found that children often do worse in hospitals than orphanages). Children are routinely prescribed "large numbers of ineffective or dubiously effective treatments" (avg of 5 at a time in Kazakhstan) for vague indications, without adequate monitoring of potentially dangerous side effects.
Medical anthropology aside, orphanage doctors naturally have a good deal of experience with orphanage-raised children, and it can be very helpful to seek their opinion on how a child is doing. Sometimes they are stuck with diagnoses from other medical settings (see above) that they are not as concerned about, or can provide useful information on trends over time.
A brief note on cerebral palsy: It's remarkable how much time we spending talking and thinking about and trying to rule out CP in Russian referrals ... when in fact we haven't had more than a few Russian (and Kazakh and Ukrainian) children that arrived here in the past few years that turned out to have significant CP.
Not that we're going to stop asking followup questions about muscle tone trends, and rate of development, and if there are current concrete neurologic concerns, or flat-out "does this child have CP?" ... but I think it probably deserves much less anxiety than it gets. The Russian docs seem to do a good job recognizing cerebral palsy, or we do, or it's just not that common, compared to orphanage-related delays, transient dystonia (periods of higher or lower muscle tone in infancy that resolve), low tone and strength from lack of stimulation or mild rickets, and other issues that get better with time, stimulation, and nutrition.
Not that we don't see kids with neurologic and developmental issues ... but we see a lot more language delay, poor motor planning, sensory issues, fetal alcohol spectrum concerns, insecure attachments, learning problems, ADHD, etc than we do cerebral palsy. And CP can certainly be a milder disability than some of the above.
On that note, without further ado ... here it is, the evolving glossary of Eastern European medical terms and treatments:
Abnormal chordae (trabeculae): Extra muscle tissue in the wall of the heart, usually the left ventricle (lower chamber). Typically found by routine echocardiogram of the heart. This is an "incidental finding" - it does not cause symptoms or disease.
Abominum: Antispasmodic used in the treatment of gastritis and colitis.
Abstinence syndrome: Newborn withdrawal syndrome (or NAS), usually from narcotics.
Actovegin: Calf's blood extract used by Russian doctors and Tour de France cyclists to improve oxygen-carrying capacity.
Adiposogenital syndrome: Freohlich's syndrome, i.e., truncal obesity with hypogonadism and short stature in boys. Sometimes used (incorrectly) to describe obese boys with delayed sexual maturation.
Alcoholic fetopathy: Fetal alcohol syndrome.
Alienist: Psychiatrist.
Alimentary subnanism: Short stature due to malnutrition, illness or other medical problems past the first year of life. Also called hypostatura in younger children.
Alpha tirroxinum: Thyrotropinum, thyrotropin or TSH.
Aminalon (gamma aminobutyric acid): An antihypertensive medication to decrease pressure in the brain.
Ampiox: Antibiotic combination of ampicillin and oxacillin.
Anamnesis: Medical history.
Ankyloglossia: Tongue-tied.
ARVI: Acute respiratory viral illness (a "cold").
Asparkam: Potassium-magnesium combination used for cardiac arrhythmia.
ATP: Adenosine triphosphate, a coenzyme to improve muscle contraction.
Australia antigen: Also written as HbsAg. Hepatitis B surface antigen, marker for current infection.
Baclofen (Baclon): Drug used to treat spasticity such as that seen with cerebral palsy or spinal cord trauma.
Baktysutil (?): see Orobicin
Bendazol (dibasol or tiabendazole): A vasodilator.
Bilary dyskinesia: Functional problem with the motility of the biliary tract, often (over)diagnosed from ultrasound examinations.
BL: Test for the causative bacterium of diphtheria.
Brulamycin (tobramycin): Aminoglycoside antibiotic.
Calcium orotate (calcium salt of orotic acid): Used in the treatment of hyperuricemia and hypercholesterolemia; also used to treat liver disorders.
Cardiopathy: Any functional condition of the heart, e.g., rapid or slow or irregular heartbeat, heart murmur, poor heart function. Often transient and nonspecific.
Catarrhal otitis: Middle ear inflammation (redness only) without pus, accompanied by an upper respiratory tract infection. The condition American pediatricians call otitis media (redness of the ear drum with pus) is called "purulent otitis."
Cavinton (vinpocetine): Used to treat cerebrovascular and cognitive disorders.
Cefamezin (cefazolin): First-generation cephalosporin antibiotic.
Cefamid (cephradine): Semisynthetic cephalosporin antibiotic.
Cerebro-asthenic syndrome: Same as neurasthenic syndrome.
Cerebrolysin: Porcine brain extract used to treat nervous system disorders.
Cinnarizine (Sturgeron, Midronal): An antihistamine drug used to control vomiting by decreasing pressure in the brain, also to selectively dilate brain blood vessels.
Citral solution, citric acid solution: Used to relieve flatulence and pain; ingredient found in herbal remedies used for a variety of disorders.
COE: ESR - erythrocyte sedimentation rate (a marker for inflammation of infection).
Colpitis: Inflammation of the cervix or vagina.
Corvalol: Phenobarbital-containing OTC medication.
Complamin (xanthinol nicotinate): Used to treat hypercholesterolemia, peripheral arterial disorders; cerebral circulatory and metabolic disorders; retinal vascular disorders; Ménière’s disease and hearing disorders.
Coprogram: Stool examination.
D=S: Dexter=Sinister, that is, the right equals the left. Usually referring to muscle tone or reflexes in the extremities.
Diamox (diacarb, fonurit, acetazolamide): Diuretic drug (carbonic anhydrase inhibitor) used to decrease pressure in the brain, sometimes to help control seizures.
Diaphanosopy: Examination of any body part by transillumination (shining a light through or against it).
Dibasol (bendazol): Vasodilating drug.
Dropsy of the testicles: One of my favorite "lost in translation" diagnoses. It means hydrocele, which is a benign fluid collection in the scrotum that resolves with time.
Dysbacteriosis: Loose or diarrheal stool following lack of breast-feeding, illness or a course of antibiotics. Due to changes in the normal bacterial flora of the intestine. Treated first with an antibiotic to decontaminate the gastrointestinal tract and then with "ferments and enzymes," similar to our treatment with lactase (milk sugar enzyme) or probiotics (live cultures found in yogurt).
Dysmetabolic nephropathy: Secondary impairment of kidney function following a insult such as malnutrition. There is no structural damage to the kidney. Most cases are reversible once the underlying disease is taken care of.
Electrophoresis: Method of giving medication. Substance is applied to the skin, usually over the affected part, and then a mild electric current is run through is.
Encephabol (pyritinol): Used to treat rheumatoid arthritis, cerebral insufficiency, organic brain disorders, migraine and trigeminal neuralgia.
Epicrisis: The word means "time period." It is used in two different ways.
*When a patient is admitted to the hospital. Written summaries of the condition and progress are made at admission, at about 10 days and at discharge. These are referred to as epicrisis.
*Developmental progress is codified by the skills which are typically achieved in a certain time period or epicrisis. In the first year of life there are well child check-ups at 1, 2, 3, 6, 9 and 12 months of age. Each visit encompasses an epicrisis from the previous point. As the child gets older, the epicrisis periods are longer usually 6-month intervals. Thus a 9 month old who is "delayed 1 epicrisis" has the expected development of a 6 month old.
Euphyllin (aminophylline): Bronchodilator, for wheezing or asthma.
Exudative diathesis: Skin rash usually attributed to feeding problem, especially food allergy, or a drug reaction. The skin is usually red and dry; the child may scratch until it oozes or bleeds. If the rash persists for months or is very severe, it may be considered eczema.
Ferrimed (vitamin B substances, iron polymaltose, folic acid): Used in the treatment of iron-deficiency anemia.
Furagin (furazidin): An anti-infective agent.
Furanthril or Furantral (furosemide): Loop diuretic.
Gestosis: Morning sickness. Sometimes the term is used (incorrectly) to refer to toxemia or pre-eclampsia manifest in the mother during pregnancy by protein in the urine, edema (swelling), high blood pressure and, rarely, other neurologic problems.
Glutamic acid: A dietary supplement.
Grefe symptom: "Sundowning" of the eyes (sclera is visible above the iris when the eye is open but relaxed) sometimes indicating hydrocephalus.
Growth: Classified by percentile as on North American growth charts. Average or normal growth is considered to be between the 25th and 75th percentiles for age and sex. Growth patterns:
Harmonic: Height, weight and chest circumference are all at or near the same percentile.
Dismarmonic: One of height, weight or chest circumference is markedly different in percentile from the other parameters.
Mesosomatic: Height, weight and chest circumference are all average.
Microsomatic: Height, weight and chest circumference are all low.
Macrosomatic: Height, weight and chest circumference are all high.
Gypotrophy: Same as hypotrophy.
Health group : Classification of children's health condition. Groups I-III are considered basically healthy children, although treatment may be necessary. Sometimes an A or B is appended; certain diseases belong to these A or B subgroups. These health groups are pretty vague and inconsistent, in our experience.
Group I: Absolutely healthy (unusual to see on orphans records or any records, for that matter)
Group II: Minor problems such as enlarged tonsils or a mild chronic condition such as gastritis with no symptoms.
Group III: A chronic condition with frequent exacerbation, for example, asthma under poor control.
Group IV: Severe health condition with some degree of disability.
Group V: Physical handicap such as a missing extremity
Hyalase, Wydase (hyaluronidase): Adjuvant to increase the absorption and dispersion of other injected drugs or for hypodermoclysis.
Hyperexcitability (neuroexcitablity, neuro-reflex irritability) syndrome: Similar to muscular dystonia but diagnosed within the first 3 months of life. Noted when the infant has marked reactions to stimuli (such as being moved or disturbed), especially if tremor, increased newborn reflexes, trembling chin or frequent belching is present. It may result in "movement disorder" at an older age.
Hypermetropia: Far-sighted.
Hypertension syndrome: Same as hypertension-hydrocephalic syndrome.
Hypertension-hydrocephalic syndrome: Clinical diagnosis based on one or more criteria alone or in combination:
Seizures
Increased muscle tone
Brisk reflexes
Firm or tense fontanel (soft spot)
Pulsation of the fontanel Tremor
Jitteriness
Large head circumference
Dilated blood vessels over the scalp
Prominent or bulging eyes
"Sundowning" of the eyes
Bluish discoloration over the bridge of the nose.
May be "confirmed" by ultrasound of the brain looking for dilation of the ventricles (fluid-filled spaces in the brain) or changes in the blood flow pattern. Considered in most children to be a transient condition secondary to the birth process. Treated with certain vitamins, diuretics, and/or other drugs to improve blood flow to the brain. Surgical shunting is very rare. It is not equivalent to the Western term "obstructive hydrocephalus".
The condition is considered to be "subcompensated" when the child still has some minor signs or symptoms but is doing okay. It is "compensated" when there are no clinical signs except perhaps for a head slightly out of proportion with the rest of the body: at this point, the child expected to be normal.
Hypometropia: Myopia, near-sighted.
Hypostatura: Short stature due to malnutrition, illness or other medical problems. Past the first year of life, it is called alimentary subnanism.
Hypothyrosis: Hypothyroidism, treated with oral thyroid replacement. Screening for hypothyroidism is usually carried out at the first well-child check-up at one month of age.
Hypoplasia: Short stature with no other problems, usually genetic or "constitutional". Also used to refer to under-development of any organ such as a limb, the testis, an eye, etc.
Hypotrophy: Weight lower than expected for age. May be further described as mesosomatic or microsomatic, harmonious or disharmonious, depending on changes from previous growth and the relationship to the height and chest circumference.
Hypoxia of the newborn: Lack of oxygen at or before delivery, usually diagnosed if it was a difficult pregnancy, labor or delivery, if the baby needed a lot of resuscitation at birth or if specific abnormalities are noted in the placenta (afterbirth). When severe oxygen deprivation was felt to occur, the word "asphyxia" is used, although this seems to have a loose definition over there. "Prenatal hypoxia"" is a vague term, sometimes used with the wording "non-specific intrauterine infection" to explain away low weight or asymmetric reflexes or tone in a full-term baby.
Hypoxic (metabolic) cardiopathy: A clinical diagnosis, sometimes confirmed by "metabolic changes in the EKG." This refers to any number of mild changes in circulation such as perioral cyanosis (blueness around the lips and nose), irregular heartbeat, mottled skin, anemia or rickets. This is a transient condition, which resolves when the underlying condition is treated. Term may be also used for more serious conditions such as myocarditis.
Increased seizure readiness syndrome: When a child has an evaluation for suspected seizures or some other problem, an EEG of the brain may be done. The term is used to describe the finding of an abnormal focus on the EEG or when a child has increased muscle tone not related to cerebral palsy. Usually no treatment is given.
Intrauterine pneumonia: Applied broadly when a newborn has respiratory distress or "rule-out sepsis" (signs of infection).
Ischemia of the newborn: Usually referring to lack of blood flow to the brain, used in the same way or as a synonym to "hypoxia of the newborn."
Lambliosis (lambliasis): Giardia infection.
Lidaza: A very popular enzyme drug, bovine hialuronidase extracted from testicles. Given by injection or electrophoresis to decrease scarring form chronic inflammation, for example, after abdominal surgery.
Limonal: Light magnesium carbonate used to treat constipation.
Little's disease: Cerebral palsy.
Logopedist: Speech therapist.
Lues, Luis: Syphilis.
Luminal (phenobarbital): An anticonvulsant, unfortunately used in many children who do not have epilepsy.
Midronal: Same as cinnarizine.
Minimal brain dysfunction: Used variably to describe transient neurology signs such as hyperactivity or short attention span, or as a followup diagnosis to "perinatal encephalopathy".
Mixed genesis: A health condition with more than one contributing or underlying causes.
Movement (motor) disorder: This is one result of delayed motor skills. For example, a 10 month old who cannot crawl has a movement disorder. This is not considered a serious diagnosis in contrast to more pronounced forms, like spastic tetraparesis. It is sometimes used when a child is not "perfect" but no other diagnosis can be made.
Mucoviscidosis: Cystic fibrosis.
Muscular dystonia: Muscle tone is considered to be dependent on the emotional condition of the baby. A normal child should be calm with appropriate relaxed tone. Muscular dystonia is present when the tone is very high (jittery or irritable) or is labile (changes rapidly). This is not a permanent condition but changes over brief time periods (an hour) as the baby's state changes (from sleepy to alert, etc.)
Myodocalm (tolperisone or mydeton): Centrally acting muscle relaxant.
Myotonic syndrome: Vague terminology used to describe changes in muscle tone, especially low tone (hypotonia).
Narcomania: Drug addiction.
Natal trauma of the spinal cord: Diagnosis made at the time of delivery based on the process of the delivery itself and the state of the newborn. Risk of this condition is considered to be present if the delivery was difficult, i.e. the baby had to be rotated, the head turned, etc. or if the baby has certain signs such as abnormal tone, tremor, irritability, mottled discoloration of the skin, pallor or sweating. This is a functional condition; that is, it will resolve with treatment (massage, application of mild electrical current to the skin over the affected part, etc.) Even when the condition has resolved, the diagnosis is often kept until the age of 1 year. It is frequently used as a contraindication to giving immunizations, with the thought that vaccinations may exhaust the immune system and prevent complete resolution of the spinal trauma. May be accompanied by xray "findings" of "subluxation of C1-C3 vertebrae." Scarier-sounding than it typically turns out.
Nephropathy: Generalized term used to describe any past or present abnormality in kidney function, usually used for conditions thought to be transient.
Neurasthenic syndrome: Condition when a child gets tired very easily or irritated for little or no reason. Manifests in many ways, e.g., irregular or fast heart beat, poor sleeping habits, becoming very red or very pale with vegetative functions (feeding, burping, passing stool) in infants.
Nicospan (nicotinic acid): B-complex vitamin.
Nootropyl (nootrops, piracetam): Drugs used to treat strokes, vertigo, learning disability and other brain disorders. Occasionally used in Down's Syndrome and sometimes in difficult births.
Obstructive bronchitis: A viral respiratory infection with wheezing. This can be wheezing from the inflammation and airway mucous of viral bronchiolitis, or a wheezing tendency that may evolve into asthma. Roughly speakly, 1/3 of infants and toddlers who wheeze for the 1st time won't wheeze again, 1/3 will have wheezing with colds and such but outgrow it by school-age, and 1/3 will continue to have asthma symptoms into later childhood and beyond.
Oligophrenia: Functional mental impairment, meaning the person is not operating at the expected level, usually not diagnosed until older than 4 years. Vague and frustrating "diagnosis" for us, that may be caused by any number of inheritable or environmental influences such as genetic syndromes, learning disabilities or mental retardation of unknown cause, fetal alcohol spectrum issues, head trauma, infection, orphanage care, social chaos, poor schooling, and other adverse experiences, etc ...
Could refer to an adult that would be cognitively "normal" if tested but has had a hard-knock life and is seeking disability pension, or an orphan unfairly labeled as "debil" by a cursory examination at 3-4yo, or a person with mild mental delay, or severe mental retardation. Not unusual to hear that a birth parent has this label, very hard to know whether this is an inheritable condition in any given case. It does not refer to schizophrenia, although it is useful to ask about mental health concerns. Nor does it refer to a rock opera by the Who.
Onanism: Masturbation.
Open oval window: Patent foramen ovale, the normal embryological connection between the two upper chambers (atria) of the heart, typically detected on routine newborn heart ultrasound. Is not considered a heart defect, and usually closes on its own. Not the same as an atrial septal defect (ASD).
Panagin (aspartic acid): A dietary supplement.
Panangin: Hungarian-made equivalent of Asparkam.
Pancreatin: Pancreatic enzymes with protease, amylase and lipase activity used to treat pancreatic insufficiency associated with CF and pancreatitis.
Pantogen (calcium pantothenate): A component of coenzyme A which is essential for the metabolism of carbohydrate, fat and protein; B complex vitamin.
Pantogar (calcium pantothenate; thiamin nitrate; medicinal yeast; cystine; keratin; aminobenzoic acid): Used to treat disorders of the hair and nails.
Pantotene: Vitamin B5.
Papaverine: Synthetic analog of an antispasmodic substance found in the opium poppy. Used to relax involuntary muscles (blood vessels, intestine, etc.)
Pentagin: Pentazocine, narcotic analgesic.
Perinatal (prenatal) encephalopathy : Variably translated as "perinatal lesion or affectation of the central nervous system," "encephalopathia," and many others. One or more risk factors present in the history of the mother or the baby, which may allow, or not, for a poor neurological outcome (see table that follows). Some variation of this on >90% of Russian referrals, thus has very little, if any, predictive value for any particular child. Best to look for more concrete information in the referral.
Maternal Factors
Lack of known medical history
Drug, alcohol or cigarette use
No prenatal care
Anemia
Past miscarriages, abortions or premature deliveries
Young or old maternal age
High number pregnancy
Chronic health problems
Infections
Poor social situation
Difficult or complicated delivery
Abnormal placenta
And many others
Infant Factors
Low Apgar scores
Abnormal muscle tone or reflexes
Jaundice
Seizures
Irritability or depression
Tremor
Poor suck, feeding problems
Abnormal ultrasound of brain or other parts of body
Intrauterine or perinatal infections
Prematurity
Abnormal prenatal growth
Abnormal laboratory tests
And many others
Perinatal trauma (affectation) of the CNS (central nervous system): Synonym for perinatal encephalopathy. Also called perinatal lesion, cranio-cerebral trauma of the newborn and other variations.
Phthisiologist: Specialist in the management of tuberculosis.
Piloecstacy of the kidneys: Dilatation of the collecting system just next to the kidneys, considered to be "pre-hydronephrosis."
Piracetam: see Nootropyl
Positive dynamics: Continuous improvement or in the recovery phase in any condition, but especially in growth and development. A child with positive dynamics is expected to be normal.
Prematurity: Determined by maternal history, birth weight, and/or a scoring system such as the Dubowitz (same as used in North America). Described as stage or degree (terms not used in US), see table below.
Stage or Degree
Gestational Age
Weight
1
36-37 weeks
2001-2500 grams
2
32-35 weeks
1501-2000 grams
3
28-31 weeks
1000-1500 grams
4
<28 weeks
<1000 grams
Psycho-affective respiratory attack: Breath-holding spells.
Pyramidal insufficiency: Infant considered to be at risk of cerebral palsy because of adverse perinatal history (e.g., extreme prematurity or low birth weight) and/or because of abnormal physical examination (e.g., increased tone or reflexes, asymmetry of reflexes, delayed development). Usually cannot be confirmed as cerebral palsy until after 12 months of age as most children will improve before then. Usually is apparent by 6 months of age and, if it is going to resolve, disappears by 1 year. This is a commonly encountered diagnosis.
Pyridoxine (pyridoxal phosphate): Vitamin B6, often used with other B vitamins to treat brain disorders.
Rachitis: Rickets, bone disease due to lack of vitamin D (see table below).
Stage or Degree
Time to develop
Clinical signs
1
Weeks
Minimal or nothing at all.
2
2-3 months
Delayed development due to bone pain and weakness.
3
Many months
Marked developmental delay, bone deformation (bowed legs), abnormal skull shape or size (boxy forehead), poor muscle tone and strength.
Relanium (diazepam): Long-acting benzodiazepine used as a sedative, anxiolytic and anticonvulsant.
Retrobolin (nandrolone): Anabolic agent.
RIF: "Immuno-fermentation reaction" - a test for syphilis.
RIT (or RIBT): "Immobilization Treponema Pallidum Reaction" - another syphilis test.
Rudotel (medazepam): Long-acting benzodiazepine with uses similar to diazepam, such as anxiolytic, sedative, anticonvulsant, etc.
Sana-Sol: Multivitamin and mineral supplement.
Seduxen (diazepam): Long-acting benzodiazepine used as a sedative, anxiolytic and anticonvulsant.
Sexual crisis: Bloody discharge from the vagina of the newborn or breast swelling, with or without milk discharge. Normal finding, noted in the first two weeks of life, due to withdrawal of maternal hormones.
Sonne Dysentery: Lower intestinal infection with Shigella bacteria, causing loose/watery to bloody/mucoid stools, occasional neurologic symptoms like seizures and lethargy, treated with antibiotics and fluids.
Spastic tetraparesis: This is a potentially more serious form of movement disorder in children less than 12 months of age, graded from mild to severe, involving all 4 limbs. In the worst case, the child barely moves at all. If treatment (massage and physical therapy) is started early, this is usually easily correctable but some children have persistent neurological findings. When we see this diagnosis, we make sure to ask about trends of muscle tone and development over time, and if the child is felt to be showing signs of cerebral palsy.
Specialized Schools: Courtesy of Dr Gordina, here's a list of Russian specialized ("correctional") schools:
Type 2 - For children with hearing problems
Type 3 - For children with significant vision problems (legally blind)
Type 4 - For children with poor vision
Type 5 - For children with significant speech/language delays
Type 6 - For children with motor and orthopedic problems (mostly CP)
Type 7 - For developmentally delayed children
Type 8 - For children with intellectual disabilities (mental retardation)
Squint: Crossed eye.
Stage of condition: The progression of a disease:
Recuperation or rehabilitation - Improving but still requiring treatment.
Subcompensated - Abnormal, clinically unstable may deteriorate.
Compensated - Abnormal but stable.
Recovery - Condition or illness completely resolved.
Stigma: Any one or more minor congenital abnormalities such as low set or posteriorly rotated ears, high arched palate, epicanthal folds, broad thumb, etc... When no particular syndrome is identified, North American physicians sometimes refer to such as child as a "funny looking kid," or to use a more technical term, "mildly dysmorphic". A child with 3 or more minor congenital anomalies is at increased risk for a broader syndrome.
Stomatologist: Dentist.
Sugeron: Same as cinnarizine.
Sumamed: Azthromycin (Zithromax), a macrolide antibiotic.
Thymomegaly: Enlarged thymus, "diagnosed" from the normal thymic shabow on infant xrays, and of no clinical significance.
Toxicosis: The same as gestosis when used for pregnant woman. Also used in any severe acute disease, usually an infection, to describe a very ill looking patient (same as North American description "toxic-appearing.")
Trental (pentoxifylline): Used in the treatment of intermittent claudication associated with peripheral vascular disease.
Triampur: Combination diuretic containing triamterene and hydrochlorthiazide.
Umbilical hernia: We use the same term ... for some reason seems more common over there. Benign protrusion of the bellybutton caused by lax umbilical fibrous ring. Can look impressive, but is common, painless, easily reducible, and the majority resolve without intervention in a few years. Large, "elephant trunk" hernias are less likely to close on their own, but it's an easy day-surgery to fix. Does not need taping or any other "treatments".
Valerian: Dried rhizome and roots of valeriana officinalis, which is used as a sedative.
Vegeto-vascular syndrome: Symptoms thought to be associated with blood flow to internal organs, for example, frequent headaches or migraines in an older child or mottled skin in the infant.
Verospiron (spironolactone): Diuretic, aldosterone antagonist.
Vertizine (meclozine): Used in the prevention and treatment of nausea, vomiting and vertigo associated with motion sickness.
Vicasol: Synthetic vitamin K.
Viferon: Anti-viral, immunomodulating medication containing interferon and vitamins.
Wassermann test: Also written as RW. Screening test for syphilis.
Wydase: see Hyalase
The topic of what formula to use when breast milk is not an option generates a lot of smoke and heat, and is one of our more frequently-asked-questions ... so here it comes, folks, 2 level scoops of science mixed with 4 ounces of opinion.
I usually recommend a cow-milk-based formula at first. "But aren't all (insert-ethnicity-here) children lactose intolerant?" Actually, inborn lactose intolerance is extremely rare. Since lactose is the main sugar in breast milk, infants are born with the enzymes to digest it. While lactose intolerance may show up earlier in non-Caucasian children, you probably have at least 1-2 years of good ability to digest lactose. Also, an internationally adopted child has most likely already been receiving a cow-milk-based product, quite possibly sweeter, more dilute, and less nutritious than Western formulas. If you really really want to avoid lactose, and stay with a cow milk formula, there are lactose-free formulas, but they swap in corn syrup for the lactose.
Soy formulas are also an option, but in my mind you should have a compelling reason to switch. The long-term effects of a mostly soy-formula diet are not well-described; in the decades they've been in use, we've not seen obvious hormonal impacts from soy's phytoestrogens, and one retrospective study seemed reassuring, but we can't know that there aren't subtle effects. Also, certain minerals may not be as well absorbed from soy products, and children can get constipated on soy formula, neither of which is what you want in the first few weeks. I'm not that anti-soy, and do feel that cow milk itself is a bit overrated as a nutritional source ... but for infants I need a good reason to go with soy. For toddlers, where the soy is just part of a healthy diet, and lactose intolerance is a more real possibility, a soy formula could be fine if they don't tolerate dairy.
You won't see goat milk on my list of recommended formulas. Goat milk is well and good as a substitute for cow milk, but I've just seen a few too many infants starving on goat milk formulas. Perhaps it's that "make-your-own-formula" isn't the safest way to go, perhaps it's that people don't realize that truly cow-milk-allergic infants are also likely to be allergic to goat milk (and soy) ...
I also never recommend a low-iron formula, but luckily they're hard to find. Adequate iron is essential for cognitive development, and international adoptees are frequently iron-deficient.
As for DHA/ARA, which are omega fatty acids present at varying levels in breast milk that are felt to help brain and eye development, I will say that they make good theoretical sense, but the research outcomes have been more mixed than the advertising would have you believe. For international adoptees, there is no research on this topic, but it would make sense that they'd be deficient in essential fatty acids, so I do have a preference for formulas with DHA/ARA.
You'll be seeing more about probiotic formulas, now that Nestle has introduced an infant formula with probiotic cultures to the US market. I can't say that the verdict is in on probiotics and infants, particularly when it comes to which strains and doses to use, but there is mounting preliminary evidence that this may be a good thing. I don't think everyone should jump on this bandwagon just yet, but something to think about for adventurous early-adopter "natural" medicine type folk. Our article on probiotics has more, including some brands to consider, if you'd like to add your own.
I do recommend that newly adopted infants and young toddlers stay with formula as their drink of choice for about 2-3 months post adoption, and certainly to at least 1 year of age. It's just much more nutritionally dense than milk, juice, etc. Since many adoptees have micronutrient deficiencies (vitamins, mineral, iron), the formula can help. As for "toddler formulas", it's a trade-off: on the good side, they've got more calcium and phosphorus, on the bad side, the sugars are typically from corn syrup (unless you're convinced your child is lactose intolerant, then it's good). Confused yet?
Many parents choose to continue using the familiar local formula when travelling, which makes sense in terms of minimizing transitions. You can gradually switch to a US formula when you get home. However, I do think it's a good idea to bring some US formula too, in case you run out, or for children who don't seem too picky about such things. And for those adopting from China, I would switch promptly to US formula, even though it's likely that melamine is no longer in Chinese formula as of 8/08. For children getting rice cereal in their bottle, I would wean that too when you get home. Rice cereal is for eating, not drinking, and it won't "fill them up for sleep" (sadly).
If you child is refusing formula during your travels, please see our topic on Transitional Feeding Difficulties for some ideas. We also have an article on Nutritional Supplements in Adoption with more advice on vitamins, minerals, and essential fatty acids.
When it comes to specific brands, it's more about your philosophy and pocketbook, and your child's digestion, and less about science.
One last thing: use bottled water to reconstitute formula in developing countries, and consider doing the same in the US, at least for infants. It doesn't need to be designer water from artesian alpine watersheds, those cheaper jugs will do. Not that our water supply isn't the envy of many countries ... it's just that now the ADA has stated that using fluoridated water for infant formulas may overdo the fluoride. For toddlers, for whom formula is not the mainstay of their diet, I'm not as fussed about the fluoride issue, so filtered or tap water is probably fine. Brita and Pur-type filters remove a bit of the fluoride, but do leave enough for the water to be considered fluoridated.
Updated: 11/2017
What about the facial features? An overly long list of features associated with FAS has piled up over the years, but there are only three features that really count – a thin upper lip, a smooth or absent philtrum (vertical groove between the nose and lip), and small eyes. The face of FAS requires all three of these to be abnormal, and the diagnosis of full-blown FAS requires the face. Unfortunately, since that face gets “created” on only 2-3 days in early pregnancy, there are moms who drink heavily whose kids can be quite alcohol-affected but don’t have the face of FAS. Not having “the face” does not rule out alcohol exposure and effects. But having “the face” dramatically increases your risk for FAS and its associated disabilities.
The other things you’ll hear about - big cupped ears, “clown eyebrows”, wide-spaced eyes, epicanthal folds (“asian” eye appearance), flat nasal bridge, short upturned nose, flat midface, small chin, etc - are not necessarily caused by alcohol exposure. They can be developmental (most babies have short upturned noses), ethnic, or just minor anomalies unrelated to alcohol. We do see them more often in alcohol-affected kids but the thin lip, smooth philtrum, and small eyes combination is much more reliable and specific for alcohol damage.
We can often get a decent look at the lip and philtrum from referral photos and videos. That’s two of the three features, and if both are abnormal then we get concerned. If you have a thin lip and smooth philtrum, plus microcephaly (small head), and strong suspicion of alcohol exposure then I’m usually quite worried about damage from alcohol. If we've been relatively happy with the lip and philtrum but have asked to see some trip photos, you might be able to skip the sticker part, but the following photo tips will still be helpful.
In more borderline situations we might need eye measurements. The size of the eyes (measured from the inside to the outside of the visible part of each eye) can only be accurately measured with a specialized photograph, one that you can take on your trip and email to us for computer analysis. Here’s how to take that photo …
The key here is an internal measure of scale – you’ll need a small round sticker 1/2 to 3/4 inches in size, which you can get from an office supply store. Homemade stickers or pieces of tape are not helpful, as they are of variable width. Mark the width in magic marker on the sticker - this is important, as we must know the width of the sticker. Place it on the child’s forehead between the eyebrows … yes, they will look at you funny in the orphanage when you do this, and you want to be sensitive to staff and older children’s feelings. Put some stickers on your own face if you want to goof off, give out extra stickers, and if you can, print/send/bring a nicer smiling photo to the child as a memento. Again, we only need the sticker if the lip or philtrum is worrisome.
Use a digital or 35mm camera – polaroids aren’t good enough. Take a closeup facial portrait photograph so that the head fills the entire frame (but watch the focus). When looking at the face in the viewfinder you should be able to draw an imaginary line from the ear canals through the bony ridge below each eye (lower orbital rim). That makes sure the child isn’t looking up or down. There also should be no left-to-right rotation – make sure both ears are equally visible.
The facial expression is important – smiles or frowns can really distort the features and make a nice thick upper lip and deep philtrum disappear. No smiling! We need a relaxed facial expression with lips gently closed, eyes wide open, and no eyeglasses. For older children, ask them to look at your nose, and breathe through their nose - this often relaxes their expression.
Asking the child to look up with their eyes (“what’s on the ceiling?”) without tilting their head up will help the eyes be wide open; for younger children ask someone to wave something just above your head. It may well be that one photo gives a good look at lip and philtrum, and another one gives us eyes wide open, so keep trying. Please review your photos on the camera screen before packing up, as we get a lot of out-of-focus or otherwise less than useful photos.
A “3/4 view” halfway between frontal and side view is also helpful, especially if you have a centrally mounted flash that can wash out the philtrum in frontal photos. A profile view may also help. One last tip is to use your digital camera’s “video clip” function to capture a brief, very upclose view of the face as it moves through different angles – we can pull frames from this video clip that may capture the true lip/philtrum better than a still photo. If you want more information about the photographic analysis, visit our FAS clinic's website. You can also print out instructions for taking screening "sticker" photos for FAS, and view a video animation of proper camera alignment.
Sounds complicated ... but we do this routinely in our clinic, and have a lot of success even with older infants and toddlers. We've found that parents really are able to do this themselves, especially if they practice a bit in the hotel room. Have fun, and good luck!
This is a handy list of medical resources in China for travelling families, graciously shared by Todd Ochs, MD. Please note that this list originated in the mid-00s, so many items here may be out of date.
Guiyang - The Affiliated Hospital, Guiyang Medical College
28 Guiyi Street
0851- 6855119
Haikou - Hainan People’s Hospital
#8 Longhua Road 570001
0898-6864-2660, 6622-3287 (outpatient)
Emergency hotline 0898-6622-5866/6666/2423
Guo Zhiliang, MD
Affiliated Hospital of Handan Medical School,
Department of Pediatrics
056002 (86310)3092829
Shi Jia Zhuang
Hebei Number One People’s Hospital
348 West Heping Xi Lu
0311-7046996
Harbin - Harbin Medical University #1 Hospital
#5 Youzheng Street, Nangnang District 150086
0451-3641918, 3607924, 3641563
Harbin #1 Hospital
English-speaking contacts: Dr. Sun Wei Fu
468-3733 X5012, Dr. Chen Mi Bin
(Ultrasound Room)
151 Diduan Street, Daoli District 150010
0451-4683864, 4614606, 4614636
Sheng Guangyao, MD
First Hospital of Henan Medical Hospital,
Department of Pediatrics
40053, Henan (86371)6913382
Zhengzhou - Professor Sheng Guanyao
President, First Hospital of Henan Medical University
Henan Provincial People’s Hospital
No. 7 Wei Wu Road, Jin Shui District 450003
0351-595-1056/2183, 588-0011
Hong Kong- International SOS Clinic
16/F World Trade Center
280 Gloucester Road
Causeway Bay
852-25289900 (alarm)
Hong Kong Adventist Hospital
40 Stubbs Road
852-2574-6211
Shenyanag - Liaoning Province People’s Hospital
#33 Wenyi Road, Shenhe District 110015
Emergency hotline 024-24810136, 24147900
English-speaking contact:
Dr. Zheng Zhong Xin at X8479, or mobile 13002490807.
Hospital designed for foreigners, with English-speaking MD’s.
#2 Hospital of China Medical University
26 Wenhua Road, Heping District, 110003
024-2389-3501
Dr. Xie Hui Fang speaks English, ext. 6640
Mon & Fri., 6540/6549 Tues- Thurs.
024-2389-1476 (home)
Mobile 13609827551
American Medical Cernter (Global Doctor)
54Pangjiang Road, Dadong District
024-2433-06778/ 2342-6409
Emergency 024-2432-6409
Yinchuan - Yinchuan No. 1 Renmin Hospital
No. 2 Li Qun West Street
0591-6192067, 6192235
Ningxia Hui Autonomous Region People’s Hospital
Huai Yuan Lu, Xin Shi District 750021
0951-202-1154/1491 X335/361
Xining - Qinghai Province People’s Hospital
2 Gong He Lu 810007
097-817-7911 X215
Taiyuan - Shanxi Medical University #1 Hospital
85 Jie Fang Nan Lu 030001
0351—404-4648, 404-4111 X25463/26706
Xi’an - Xi Jing Hospital,
affiliated with People’s Liberation Army Number Four Medical University
No. 17 West Changle Road
029-3375548 (foreigner service section)
029-3374114 (operator)
Shaanxi Provincial People’s Hospital
You Li Lu
029-525-1331 X2079 (pediatrics)
Jiao Fu Yong, MD (head of pediatrics dept.)
Jinan - Shangdong Province Qianfoshan Hospital
66 Jing Shi Lu, 250014
0531-296-8900/ 3647 x2224/2082
Jinan - Wang Yi, MD
Depatment of Pediatric Cardiology
Shangdong Provincial Qianfoshan Hospital
66Jing Shi Lu, Jinan 250014
0531-296-8900/3647 X2224/2082
Wang Yali, MD,
The Affiliated Hospital of the Weifang Medical College,
Department of Pediatrics
Shanghai - Shen Xiaoming, MD
Shanghai Children’s Medical Centre
1678 Dongfang Road, Pudong District 200092
(021)58732020
Shanghai United Family Hospital and Clinics
#1139 Xian Xia Lu,
Changing District, 200336
021-6291 0917
Chengdu - Jinka Hospital
affiliated with Huaxi Medical University
No. 37 Guo Xue Xiang
028-5422408
Sichuan International Medical Center & Foreigners Clinic
028-524-2408 (M-F 0830- 1730), 542-2777
(M-F nights and weekends)
Chengdu Children’s Hospital
137 Taishengnai Road
Emergency hotline 028-662-4791
Tianjin - General Hospital of Tianjin Medical University
154 An Shan Da, He Ping District, Tianjin 300450
022-2781-3159
Lhasa - Tibet Autonomous Region #1 People’s Hospital
Emergency Medical Facility
#18 North Lin Kuo Road 85000
Emergancy hotline 0891-120
English-speaking contact: 0891-632-2200
Urumqi - Xinjiang Uigur Autonomous Region
People’s Hospital
91 Tian Chi Lu 830001
0991-282-2927 X3120/2209
Kunming - First attached Hospital of Kunming Medical University
153 Xichang Road, Kunming
0871-532-4888
Emergency hotline 0871-532-4590
Yunnan Provincial Maternal and Child Hospital
#20 Gu Lou Road, Kunming 650051
871-517-7000
Hangzhou - Sir, Run Run Show Hospital
#3 Qing Chun Dong Road, Hangzhou City
0571-8609-0073
Du Lizhong, MD
Children’s Hospital of Zhejiang Medical University,
310003, Hangzhou
Jian Chen, Holt International
Du Junbao, MD, Beijing
Aina Ling, MAPS
Snow Wu, Great Wall Adoptions
U.S. Embassy, Beijing (hospital listing)
Adoptive parents
For additions or subtractions, contact Todd J. Ochs, MD in Chicago, and please let us know as well.
It's hard to be "ethnically correct" when assessing growth in international adoption. Many of the available country-specific growth charts are out-of-date, from a small sample size, drawn from ethnic groups that may not represent your child's ethnicity, based on malnourished populations, or all of the above. US growth charts aren't perfect either, but they are drawn from large population surveys, and were recently revised to better reflect the racial-ethnic diversity and combination of breast- and formula-feeding in the US.
In 2006, the WHO (World Health Organization) released new international birth-5yo charts based on 8,500 children from Brazil, Ghana, India, Norway, Oman and the USA. Their unique approach was to select children whose care meets recommended health promotion standards (breastfeeding, standard pediatric care, anti-smoking, etc) so that the charts would represent how children should grow, not necessarily how they are growing. Their big finding was that "child populations grow similarly across the world’s major regions when their needs for health and care are met."
However, most international adoptees are bottle-fed and often do not receive ideal or even adequate care. Our default charts are still the revised CDC/NCHS (US) growth charts published in 2000, if only because we by now have years of experience following ethnically diverse children pre- and post-adoption on these charts. Still, it can be interesting to plot children on country-specific growth charts, so here's a smörgåsbord of US, premature, and country growth charts.
For more information, see our articles on Evaluating Growth in Adoptees and Head Circumference Issues ...
START HERE - CDC growth charts for boys and girls, birth to 20 years
Nellhaus male and female head circumference charts for children over 3 years old (I don't love these charts, as the pooled data is from 1948-1965, and is not as "interracial" as advertised, but we don't have many other options for older children).
These 2010 United States head circumference growth reference charts: birth to 21 years, by Rollins et al., look better than Nellhaus for plotting head size in kids older than 2-3yo.
26wks to 1year chart, for boys and girls
Fetal-infant growth chart for 22wk-2mo preterm infants from a meta-analysis of published reference studies
Charts based on birthweight categories (for when gestational age is unclear). LBW (low birthweight) is for birthweights from 1500g to 2500g. VLBW (very low birthweight) is 1000g to 1500g at birth.
The widely available China growth charts are from a sample of Southern Chinese children in Hong Kong in the 1960s, and thus quite out of date and not necessarily ethnically appropriate. These can be found on the Families with Children from China (FCC) site.
Also available online are Hong Kong boy and girl growth charts, which do include weight, height, and head circumference. More information about these charts is here.
Another useful reference could be "Infant feeding and growth of Chinese infants: birth to 2 years", which tracked growth in healthy, fullterm, formula-fed infants in 1985 Hong Kong and found that at 2 years old, infants were -0.6 standard deviations (SDs) lighter and -0.4 SDs shorter than US growth data, even with similar protein/calorie intake to Caucasian infants.
An article called "Updated gestational age specific birth weight, crown-heel length, and head circumference of Chinese newborns" based on preterm and term births in Hong Kong has weight, height, and head circumference charts.
Note - these are unofficial charts based on his personal experience
Guatemala - Head circumference graph for infant girls, ages 0-9mo
Guatemala - Head circumference graph for infant boys, ages 0-9mo
The Indian Academy of Pediatrics has recently published new recommendations for growth monitoring of children from India, including growth charts based on "affluent urban children from all major zones of India measured between 1989-91"; this is actually an advantage, as they are more likely to reflect how Indian children can and should be growing:
These historical charts are from the International Adoption Clinic at UMN.
These 2017 Korean National Growth Charts look higher quality.
An article with weight, height, and head circumference data for relatively healthy, higher socioeconomic status Kathmandu term infants:
Nepal - Article describing growth in Nepalese Infants, Birth-1yo
Nepal - Infant Growth Charts, which I adapted from the article above
From Dr. Tsepkova, via Karen's Adoption Links. Of unknown sample size and quality ... we prefer the CDC growth charts for Russian children.
Russian Girl Growth Charts, 0-17yo
Russian Boy Growth Charts, 0-17yo
From a parent who lives in Taiwan. These are the growth charts that seem to be a part of children's shot records. The less-than-smooth percentile lines does make me wonder whether the sample size or statistical techniques were adequate. I'm told they were in use from 1999-2009, when they switched to the WHO charts above.
The 1st page top left has head size in centimeters, by age in months. The rest of the 1st page is weight in kg by months and then by year. The 2nd page is height in cm by age. Percentile lines are in the legend.
Adopt Vietnam has links to a few Vietnamese growth charts; however, they are not easy to interpret and are of unknown date and sample size.
Our center has 3 pediatricians that specialize in adoption medicine: Julia Bledsoe, MD, Julian Davies, MD, and Cynthia Kertesz, MD. We have over a decade of experience in international adoption and foster care.
Our center has two pediatricians that specialize in adoption medicine: Julia Bledsoe, MD and Julian Davies, MD.
We perform pre-adoption consultations by telephone for families adopting from abroad or domestically. We also provide post-placement evaluations and ongoing pediatric care at our Seattle clinic.
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