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April 15, 2024

Where Every Family Matters

International Adoption: Helping Children Adapt

While developmental delays are not uncommon with internationally adopted children, they can result in unexpected challenges.

Middle Tennessee couple Elaine and Randy Meador adopted a little boy — Nicolas from an orphanage in Russia — and while it was wonderful, being adopted was a big change for Nicolas. It was also a learning experience for his new family, which includes the Meadors' 2-year-old daughter, Brooke. Russia is one of the top countries from which adults seek to adopt children internationally. First is China, second Ethiopia, according to the U.S. Department of State.

Families face the prospect of acclimating a child from another culture, but also a child with a set of issues often unknown. Support is necessary.

To help tackle the challenges, the Meadors turned to the Clinic for International Adoption at Vanderbilt Children's Hospital in Nashville. Founded in 2002, the clinic provides both pre-adoption and post-adoption consultation.

Services include evaluation of medical, developmental and nutritional issues that are of special concern to children adopted from foreign countries. The clinic's staff is comprised of three practicing pediatricians: Alice Rothman, M.D., who serves as the clinic director, as well as Greg Plemmons, M.D., and Chris Greeley, M.D. Occupational therapist Jennifer Pearson and child psychologist Linda Ashford, Ph.D., round out the staff.

Helping Parents Make Informed Decisions

This year alone, more than 21,000 children are expected to be adopted internationally and brought home to the United States, about 500 of them in Middle Tennessee. Unlike domestic adoption, the process of adopting a child internationally often means interpreting foreign medical records. It also includes determining the possible effects of life in an orphanage on a child's development.

For the Meadors, the journey to adopting Nicolas began with a pre-adoption visit to the Clinic for International Adoption after hearing about it from other parents. "People just raved about having a resource that could help read international medical records. That's not something that everybody can do," says Elaine. The clinic was a valuable resource to the Meadors when they received their first referral to a child with possible developmental issues.

While developmental delays are not uncommon with internationally adopted children, they can result in unexpected challenges. Rothman says the pre-adoption consultation service helps prospective parents understand what they may face. "Our role is not to make a decision for parents, because clearly the goal of adoption, whether it's domestic or international, is to find the right family for a child. That's a very personal decision," she says.

"But we try to give them as much information as possible so that they can anticipate if there are special needs that the child might have beyond the typical things we see in internationally adopted kids." Elaine describes this first referral as a "difficult situation," but she's grateful she had the clinic to turn to.

"We could call up Dr. Rothman and say 'Something doesn't look right. Tell us what you think.' And they're upfront with you and can tell you what you're looking at," says Elaine. "You have to decide what's going to be the best thing for that child." Preparing for international adoption, The Meadors soon received another referral for a boy named Nicolas. Once again, they consulted the clinic with the information they had about the child and found that all signs pointed to a healthy young toddler.

They were soon on their way to Russia to bring home their son. Rothman says that preparing prospective parents for the trip abroad includes basics such as what to take along. "We speak with the family and give them a list of over-the-counter medications that we recommend they bring with them – sort of as general supplies," she says. That supply kit also often includes a prescription antibiotic and a cream for scabies, a skin mite that can be contagious, just in case either one is needed.

While the Meadors had some information about Nicolas before their visit to Russia, not all parents are so fortunate. Depending on the country and even the orphanage, medical information may be unavailable to parents until they make their trip abroad. Rothman says that in those situations, the clinic tries to educate prospective parents. "What we try to do is give them some background information about how to gather medical information and what kinds of questions to ask. We'll review a growth chart, for example," she says.

"Basically we'll tell them what sorts of things to evaluate when they're looking at records and meeting the child, like what kinds of interactions to watch for." For extra peace of mind, the clinic can stay in touch with parents during their trip if needed. "When you're in a country that you're not familiar with, where no one speaks English, and you don't know the medical practices, you want something like that," says Elaine. "You never know what you're going to get into."

In many foreign orphanages, only basic life necessities are provided, and love and affection are in short supply. These deficiencies can lead to short-term treatable issues such as infections, nutritional problems and anemia, but some can have long-term effects on development and behavior.

During the post-adoption consultation, the clinic's team helps parents evaluate their children and determine any special needs. Most visits take place within a few weeks of the child's arrival in the United States. A session lasts about three hours and includes time with an occupational therapist, developmental psychologist and pediatrician. The Meadors arrived for their visit three weeks after bringing Nicolas home with the hope of getting "benchmarks" for their son, says Elaine.

Using educational games, Nicholas' motor and self-care skills were evaluated by Pearson, while Ashford gauged how he was adjusting to his new world and assessed his cognitive skills. The Meadors also answered questions about their observations of Nicolas since he joined their family. Ashford notes that for children adopted from orphanages, emotional issues often need special attention. "Parents have said that when they go in [to an orphanage] that it's the quietest place in the world. Nobody's crying," she says.

"Crying does not pay off for children in an orphanage. Why? Because nobody comes and helps them." She recommends that parents can help internationally adopted children "understand, recognize and control" their emotions. By using exaggerated facial expressions to recognize when something hurts, for example, she says that children can develop their emotions, which in turn helps them build healthy relationships throughout their lives.

The final component of the post-adoption visit is a medical evaluation by one of the clinic's pediatricians. The doctor focuses on medical issues commonly seen in internationally adopted children, such as growth. "Kids in orphanage environments can have what's called psychosocial short stature or growth deficiency," she says. "Not getting enough stimulation or positive interactions that can actually have an affect on growth, independent of getting enough nutrition."

She says that many kids will catch up post-adoption, especially in weight. The clinic's doctors work with the family's pediatrician to provide a smooth transition in the care of the child. "We always work in conjunction with the doctor. We do not replace a pediatrician," says Rothman. "We don't do vaccines or tend to talk about the routine well-child issues."

The post-adoption visit ends with a follow-up plan, including future visits with clinic staff to re-evaluate any problem areas, and some lab work required for children who have just arrived in the country.

A Happy Home

Today Nicolas is a happy, thriving young boy, and his health is excellent. "The clinic has helped us transition through the entire process," says Elaine.

"They helped us blend into a very happy home. I credit that to the support we received from the clinic. We have just been really blessed to have them here."


– Liz Cerami Taylor is a freelance writer residing in Middle Tennessee.

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