- The Washington Times - Tuesday, March 19, 2002

Meggan and Dow Walker of South Riding, Va., brought home their 7-month-old adopted daughter from Kazakhstan a few weeks ago with very limited knowledge about the child's medical history.
The little girl could have infections, have developmental delays and lack immunizations conditions common among internationally adopted children of which the Walkers wouldn't necessarily be aware.
"It's typical for families to make their decision about adoption based on very little information," says Dr. Patrick Mason, medical director at the International Adoption Center at Inova Fairfax Hospital for Children, which opened last August.
The center is one of about a dozen of its kind nationally that focus on the medical needs of internationally adopted children. The next closest to Washington is at Johns Hopkins Hospital in Baltimore, says Janice Moore, spokeswoman for Inova Health Systems.
Dr. Mason works with his patients' pediaticians to help highlight the special needs and conditions of internationally adopted children.
"I am not here to replace your pediatrician," Dr. Mason says to the Walkers. "I want to work with your pediatrician."
Fortunately for the Walkers, their 7-month-old, with her chubby cheeks and deep brown eyes, seems to be in very good health, says Dr. Mason, a pediatric endocrinologist, after a 2-hour evaluation of the girl's health.
She is in the 95th percentile for height and weight for her age. Internationally adopted children often are underweight and short compared to American children.
"We definitely got some confirmation about her health and some peace of mind," Mrs. Walker says, holding her brown-eyed beauty, whose first name she does not want used.
However, Dr. Mason suggests that just to be on the safe side, the Walkers get their daughter a full round of immunizations, including re-administration of the few shots all of two that the little girl received in Kazakhstan, a former Soviet republic north of Afghanistan.
He also suggests blood and stool analyses to check for possible infections, such as hepatitis and parasites.
"Parasites, such as giardia, are the most common medical problem we see in internationally adopted children," says Christine Narad, a nurse who helps Dr. Mason with the evaluations at the center.
The medical issues are usually dealt with easily and quickly, with antibiotics or vaccinations, once they have been diagnosed correctly, Dr. Mason says.
Two-year old Alexander Schmidt of Jessup, for example, was seen at the center a few months ago and is being treated for parasites and exposure to tuberculosis, says his adoptive mother, Debbie Schmidt.
"When we came back from Russia in December, we just wanted the medical issues to be covered, so we went to the International Adoption Center," says Mrs. Schmidt, who found out about the center from a pediatrician.

With the medical issues behind them, Mrs. Schmidt and her husband, Scott, along with many other adoptive parents, are more concerned with the developmental and psychological issues facing their children.
While Alexander and his sister, 1-year-old Yelena, who also was adopted from an orphanage in Russia, have made "tremendous progress in the past few months," they are behind developmentally, Mrs. Schmidt says.
"We may not be able to fix everything, but the medical issues are usually minor, and we can treat them easily," Dr. Mason says. "It's the developmental issues and disorders such as attachment disorders that are more problematic."
An attachment disorder means that the child is not attaching, or bonding, to his or her parent or primary guardian in the right way. The child may not make a distinction between an adoptive parent and a grandparent or teacher, treating everyone with the same attention and interest.
A child's level of development is judged on three levels: gross motor skills, such as crawling and sitting; fine motor skills, such as grasping or gripping; and language.
"It's typical for adopted kids to be about three months behind developmentally," Ms. Narad says.
During this first-time visit, Ms. Narad spends about an hour with the Walkers' 7-month old. While sitting down on a pastel-colored mat covered with the letters of the alphabet, she considers the child's ability to "talk," or babble, her ability to crawl and her ability to grab objects between her index finger and thumb.
"Her fine motor skills are more like a 5-month-old's, but she's doing really good," Ms. Narad says.
During her evaluation, Ms. Narad tells the Walkers of ways they can help the little girl catch up.
"You can encourage her speech by saying, 'This is your cup,' as you give it to her, and repeat back to her what she says," even if it's just babble, Ms. Narad says.
She also shows the Walkers how they can help their daughter sit up which she is close to mastering by spreading the little girl's legs farther apart.

As far as psychological issues go, the 7-month-old needs to bond with her new parents as much and as quickly as possible, Ms. Narad says. This means limiting the girl's exposure to other people, even other relatives, such as grandparents.
"You need to do all the feeding; you need to be putting her to bed," she says.
"Think of her as 6 days old instead of [more than] 6 months old," Ms. Narad says. "You wouldn't be asking other people to hold your 6-day-old daughter."
After the developmental evaluation, Ms. Narad asks if the Walkers have any concerns.
"I guess we wanted to find out what questions we should be asking the pediatrician and what we should be looking out for developmentally," Mrs. Walker says.
This is exactly how Dr. Mason and Ms. Narad see their roles they are international adoption specialists who can give the new parents guidelines about what they need to be looking for in their youngsters and what specialists they might need to seek out for specific problems.
They also can help analyze terms and language used in medical records from such countries as Russia and China among the most common adoption countries right now which a regular pediatrician may not be able to do, Dr. Mason says.
For example, he says, when Russian doctors talk about a risk for neurological damage in a Russian child, it can mean that the mother had abortions before giving birth to the child. Normally, this isn't considered a risk for neurological damage in the United States, Dr. Mason says.
He tries to help the new parents distinguish between what is a real risk and what isn't.
Though international adoption is starting to be recognized as a subspecialty in pediatrics, insurance does not always pay for a visit to the center, Dr. Mason says.
A visit costs between $150 and $500 in out-of-pocket expenses, which may or may not be reimbursed by health insurance, he says.

After the 2-hour evaluation, Mrs. Walker says she's pleased with the attention, time and information Dr. Mason and Ms. Narad gave her.
"We learned a lot," Mrs. Walker says. "We found out what we can do to help her along, helping her to sit by spreading her legs and helping her crawl," she says. "We found out stuff that your typical pediatrician may not know to look for."
The Walkers and the Schmidts both families go to pediatricians, too are planning to revisit the International Adoption Center in a couple of months in order to monitor the developmental progress of their children.
The Walkers say that when they go back to Kazakhstan for a second adoption a year or two from now, they plan to have the International Adoption Center review their prospective child's medical records and other information.
At its outset back in August, the center saw only one or two children a week, Dr. Mason says, but as word has gotten out about its existence, more and more families, up to a dozen a week, have begun to come to see him with their concerns. The children's ages range from 2 months to teen-age.
"For a metropolitan area, this is one of the most heavy on international adoptions," Dr. Mason says. "I moved up here [from Atlanta] and saw that there were a lot of pediatric practices that saw adopted kids, but there was no clinic devoted to adoptions. I saw a need to open one," Dr. Mason says.
"We understand them and know where they are coming from. That's what we bring to the table," he adds.

The International Adoption Center, Inova Fairfax Hospital for Children
8505 Arlington Blvd., Suite 100, Merrifield
The International Adoption Clinic, The Kennedy Krieger Institute and the Johns Hopkins Children's Center
:700 N. Broadway, Baltimore
: 443/923-9402

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