International Adoption Clinics (IACs) were initially founded by a group of adoptive parents who were also physicians. We saw a huge gap in the health care given to our own internationally adopted children. Before IACs opened their doors we were trying to see international adoptees by squeezing them into the 15 minute or less appointment spot that most pediatricians are given with each patient in the middle of a busy day. This just wasn’t enough time to meet the needs of our children’s difficult medical needs and traumatic pasts.
Also, it was a lonely feeling being able to see so many needs and not having expertise in all areas that they needed… we needed the help of therapists, psychologists and nutritionists as well. We needed time to study these children, find out their specific needs and target those needs with effective strategies… but this takes money and time! Thus, IACs were born from university-based hospitals so that IAC doctors could earn their keep in the university in more lucrative areas of health care (rounding in the hospital, doing procedures, primary care clinics where high volumes of patients can be seen)… in order to do be freed up to do what they truly loved – caring for orphans.
In general, most IAC clinics just break even financially and are not very financially lucrative. I think this is always shocking to my patients because medical costs are extravagant these days. We are truly thankful for financial aids such as the Sparrow Fund and other donors that help families offset the costs of IAC expenses. This helps to support our research in adoption so that we can effectively provide good and continuous care to our children. Every time you visit your IAC, you are saying to the larger hospital system, “Our kids are worth special study and care!”
As you anticipate using your IAC, I’ve compiled a list of helpful ways to interact with your IAC:
1) Ask if your IAC has any educational seminars available to prepare you for adoption.
Some IACs have created seminars that are based on years of research and experience taking care of international adoptees.
2) Get your referral reviewed by an IAC familiar with Chinese medical reports.
Medical lingo can be confusing. Chinese medical lingo is a whole different ball game. However, it can usually be deciphered by an IAC doctor who has seen hundreds of Chinese medical reports. It is their job to see what words are normal in a Chinese file and what words are concerning, as well as to tell you if you are getting the same amount of information that is in a “typical” Chinese medical at the time of referral. If anything is missing, he/she should give you a list of questions to ask the orphanage in order for you to have the necessary information to make your decision. An IAC doctor will explain your child’s special need in layman’s terms. She can help you line up and prioritize the specialists that you are going to need after adoption. She can help you to know what questions to ask your insurance company so that you will be more financially prepared for your child’s medical interventions and therapies. An IAC doctor will also take your current family situation into account when advising you. While every kid deserves a family, every family may not be the right family for that child. IAC specialists have the benefit of observing adoptive families over many years’ time. They have a unique perspective on how certain special needs children fit in certain families over time.
3) Ask if your IAC offers prescription and on-call services.
Because they have reviewed your child’s file, IACs will feel comfortable calling in medicines that you may need for your child while overseas as well as provide you with a list of over the counter medicines to take with you. Many also offer on-call services while you travel to pick up your child. These on-call services are not just for medical needs (fevers, rashes, constipation, etc.), but also for emotional emergencies as well. I am convinced that many in-country disruptions could be prevented if more families used IACs for referral reviews and on- call services.
4) Go ahead and schedule your visit with your IAC before you travel.
As soon as you book your tickets, you can call to schedule your child’s post-adoption appointment so that you can be seen within 1-3 weeks after arriving home. They will let you know,based on your child’s special need, if any other subspecialty appointments should be made ahead of time as well (ex. cardiology is a common one that we will make ahead of time for severe heart defects).
5) Vaccines and lab tests.
If your child has had vaccinations while in China (most children have had many), be sure to bring the Chinese vaccination record to your IAC doctor. Your IAC doctor can check your child’s blood work for antibodies to each vaccine. These are called vaccine antibody titers. Your IAC will draw other lab work as well that is customized to your child’s medical needs and risks. Make sure you leave your first IAC appointment with stool vials to test for parasites!
6) Be sure the IAC doctor checks your child’s development initially, after 6 months and after 12 months.
We all expect most children to be delayed developmentally upon adoption and that they will have a fast rate of catch up initially. But did you know that this rate of catch up can be measured and predicted to make sure that it is an appropriate rate of catch up? An IAC doctor should be able to tell you if your child’s delay is an appropriate developmental delay for his or her history and, 6 months later, if your child has had an appropriate rate of catch-up. At the 6 month point, your doctor may identify areas that have been slower to catch up and may refer you to a therapist (occupational therapist, speech therapist, physical therapist) to target those areas so that the catch up rate increases between the 6 month and one year visit. Even if you think your child is advanced in development, this is an important evaluation because gifted children have their own set of attachment and emotional needs that need to be addressed.
7) Use your IAC for finding the unique attachment techniques your child needs.
You’ve read all the books and prepared but now that you are home, you will need to narrow down your Attachment 101 To Do List. No one can or should use all the techniques given in the attachment books. Your IAC should be able to assess your child’s transition pattern (yes, there are particular patterns of transition depending on your child’s personality, your own history of child rearing and your child’s social history). They can then help you prioritize the strategies that will help your child attach the quickest by suggesting the attachment tools that best fit your situation. They can also help sort out the ever present, “is this adoption related or just normal childhood behavior” question. Attachment takes it’s own timeline with each child and is less predictable, but progress should be monitored and techniques adjusted if progress is halted. You do not have to figure this out on your own.
8) Ask for advice on catching up your child’s nutrition.
Most children adopted from China are going to have some degree of malnutrition. An IAC doctor can usually tell when something else is affecting growth other than just straight-forward malnutrition. Baseline measurements right after coming home, 6 months after coming home and at one year home are helpful to see if your child is following a typical catch-up growth trajectory. And, just like development, there is a predictable catch-up rate that is to be expected. If that catch up rate is not achieved, your child may need to be tested for other things such as lactose intolerance, parasites, genetic abnormalities, dietary adjustments, endocrine abnormalities, etc . At 6 months post-adoption, it is helpful to check some nutritional labs such as iron and vit D levels. These are nutritional areas that can be hard to catch up with just a good diet and a multivitamin with iron.
9) Use your IAC as a case manager.
The first 6 months home can be overwhelming in the way of doctors and therapist visits. Let your IAC do some of the thinking for you. You may have a list a mile long of things you need to do for your child medically, developmentally and emotionally. Because all specialists in an IAC are trauma trained, they can help you prioritize what the most important things are to do first. In our clinic, after every patient, we team the child amongst ourselves because trauma affects EVERY area of a child’s health and development. The doctor and therapists together will decide which interventions should come first and which ones can wait. They will be your advocate and help you find your voice in the medical system as an adoptive parent. They will also remind you of things that are easy to forget like getting your child’s vision, hearing and dental exams completed in the first 6-9 months home.
10) Your IAC can be a lifelong friend.
Everyone uses their IAC differently after that first year. Some people really want an assessment each year after adoption to make sure that attachment, development and medical issues are being monitored annually. Some people will come back to their IAC just before kindergarten or first grade for an evaluation to make sure all areas of their child’s development are ready for school entrance, some will come in second or third grade when school is getting more challenging and there are new areas of the brain that may be struggling, some will return when racial/adoption issues have now taken a front seat, others need extra help when their child is a teen and hormones have beautifully presented problems that they thought were already resolved in their child’s heart. You and your IAC doctor will make these decisions together of how often to come back for check-ups. You have never been home too long to go see your IAC doctor for the first or 20th time.
Bonus: Be sure to hug your IAC specialists.
Most of us IAC specialists are struggling just like you are at either being an adoptee themselves, raising our own adoptees or in just keeping a valuable resource open for future orphans to receive the care that they deserve. My village during all three of my adoptions included my staff AND patients. My staff, of course, supported me with their knowledge and love. My patients were so kind to ask how I was doing, give me hugs on hard days and just really care for me as a newly adoptive mom. (whew!….tears are flowing as I reflect on this). Thank you, sweet adoptive Mamas and Daddies for all of your love and support of this Village Doctor over the last 15 years.
Dr. Jennifer Chambers is a board certified general pediatrician with a faculty appointment at the University of Alabama at Birmingham in the division of General Pediatrics and Adolescent Medicine. Besides her clinical and teaching roles at UAB, she is also the founder of the UAB International Adoption Clinic. Dr. Chambers has had 15 years of experience evaluating and treating internationally adopted children. In addition, she regularly works on projects overseas in orphan care.
She and her husband adopted twin girls from China when they were infants and, most recently, a 12 year old also from China. This gives Dr. Chambers the unique personal and professional perspectives of international adoption.