Thoughts on the tricky business of understanding medical reports for children available for adoption, particularly from other countries.
Dr Julia Bledsoe could be described as a medical detective—she knows when something doesn’t sound or look right, what questions to ask, and how to find the answers.
A pediatrician at the Centre for Adoption Medicine at the University of Washington, Dr Bledsoe provides either pre- or post-adoption medical assessments for people who have received a proposal for a child from abroad or from the US. Information provided by Dr Bledsoe helps parents make the decision whether to adopt a particular child and prepares them for what to expect if they do go ahead.
At an AFABC presentation on medical issues and intercountry adoption, Dr Bledsoe, an adoptive parent herself, was enthusiastic yet cautionary. Her strongest message was that no child comes with a health guarantee and that adoptive parents need to be prepared for surprises at the time of referral and after a child has come home. She also points out that pre- and post-adoption medical testing can reveal a great deal of hidden information about a child’s health, but parents should be aware that some issues do not become apparent until a child is older.
Dr Bledsoe explained the term “orphanage slide”— for every three months spent in an orphanage, we can expect about one month in developmental delays. However, she also emphasized the dramatic improvements in the health of many children after they have settled into their new home. She also made it clear that while we can make some generalizations about particular countries—drinking rates during pregnancy are high in Russia, for example—we can not make assumptions on the health of a child on the basis of country of origin.
Dr Bledsoe also cautions that the only constant is change. She pointed out that Korean adoption has been popular partly because of the very low drinking rates amongst Korean women; but, recent research suggests drinking rates are now increasing amongst younger Korean women.
Dr Bledsoe suggests that all medical information should be taken seriously, but that it is also all suspect. To illustrate this, she explained that Russian medical terminology can be quite different to that used in Canada and that some terms Russian doctors use can sound alarming but are not a cause for concern.
Dr Bledsoe has come across children that are described as in good health yet, after examining medical information, photographs or videos sent to her by prospective adoptive parents, she finds quite the opposite. Photographs or videos can indicate Fetal Alcohol Syndrome, Cerebral Palsy and other disabilities, which have not been mentioned in medical reports.
Equally, Dr Bledsoe has encountered situations where a child is described as having an issue for which there is no evidence. In one case, a child was described as having only one kidney—an ultrasound revealed that both kidneys were in excellent condition! She even had a case where a child was incorrectly diagnosed with spina bifida. Dr Bledsoe showed a slide of a child adopted from Russia who had what she described as “16 funky medical terms” on her medical report, yet she is now doing very well.
As well as birth family history (Dr Bledsoe finds that if she probes she can discover more about birth family than was at first available) a preadoption medical review will consider any medical information available: prematurity, the child’s growth rate (height, weight and head size) and whether a child has reached key developmental milestones. Dr Bledsoe also reviews any photographs and videos that are available. She explained that head growth is very predictive of some developmental problems, and if head size is not provided then it should be requested.
Once a child comes home to Canada, a post-adoption medical assessment is just as important. Taking into consideration the country of origin of the child, it would include a medical and developmental assessment, vision and hearing testing, blood and urine testing, testing for certain viruses, parasites, and skin problems, and an immunization check.