The Health and Development of Adopted Children

April 18, 2006 - Tuesday
7:48 PM to (EST)
Guest Speakers: Michael Traister, MD
NYU Children's Health Center

Categories
Adoption • International Adoption

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Traister	Deb?
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Traister	deb?
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luly	Deb - will this session be taking place tonight?
deb_capone	Sorry guys...
deb_capone	Dr. Traister, can you give us a short primer on what we should ask, look for and expect as we look at international adoption.
Traister	Thanks,Having a child always involves risks....what i would like to do tonite is help you guys assess the special risks that are involved international adoptions.
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deb_capone	Good evening Shelia. Thanks for joining us.
Traister	The first step after people decide on adopting ffrom other countries is deciding from what area.
deb_capone	How does one decide that?
deb_capone	Are any areas 'healthier' than others?
Traister	basically, there are 3 general regions: Asia, eastern europe and russia and central/south america
luly	Or are there areas that are in need more than others?
Traister	Each one is different. And trhe rules change
Traister	Luly, waht do you mean by :need"
luly	Is there an abundance of children in any certain area that are up for adoption?
Traister	There are children in all areas.
Traister	Actually, teh local politics play a role...for example, Korea has age restrictions on adopting parents
Traister	I think Japan, will only allow, Japanese americans to adopt, etc
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luly	Is there a location such as a webpage that helps us understand the regulations each country has as well as what the pro's and con's of each area are?
deb_capone	As an FYI to everyone, we seem to be riddled with technical problems tonight. If you get disconnected, it is not you! Just get back on as soon as you can!
Traister	The children from eastern europe tend to be blond and blue-eyed...the girls from china boviously stand out if the adopting parents are "anglo"
Traister	Yes, Luly...i don't have the eact web site but the US state department actaully has a nice web site which can help sort thins out
Traister	The other reference is the web site from Families with Children from China...they have great links and the people are very willing to share their experiences
Traister	Whichever region, you have to understant the risks
luly	Does this US State Dept also talk about the health concerns associated with each area?
Traister	No, they do not!
Traister	i encourage families to review with their pediatricains all referral information
luly	In your opinion, what can we expect health wise from each area?
deb_capone	Luly, there are support groups like Families with Children from China for most of countries that US families look to to form their families.
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Traister	Aslo, try to push the agemcies, to get photos, recent height weights, etc to assess development, etc
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deb_capone	Good evening Kconnaghan. We are talking with Dr. Michael Traister about the health and development of kids adopted internationally.
Traister	From Guatemala, for example, the children are indentified early - at birth...we get, monthly reports from the pediatrcians there
deb_capone	Dr. Traister, can you give us a brief synopsis of the 'risks' that a pediatirican looks for in kids adopted internationally...and does it change country to country
luly	I know that newborn adoption is possible in the US. Is that also a possibilty overseas?
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Traister	I can then establish a chart, and watch the infant grow just like we would do if the child was in the US - Vaccines from Guatemala can be trusted - they are the same as here
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Traister	Luly, basically from guatemala, you know the child from birth
Traister	I have many families who go down to visit - the child is kept in foster care
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Traister	The newborn from Guatemale, though, frequently are small, and it si unclear what, if any pre-natal care they have had.
denise	what are the most common health issues that children adopted from china experience from birth on...
Traister	Denise, the main risk from China is hepatitis B
Traister	Hepatitis B is endemic in china - about 25 % of the population as been exposed to hep B with about 8% are chronic carriers
Traister	In the act of childbirth, the infants are exposed to the virus
Traister	Many become chronic carriers
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luly	What are the most common health issues for Russian children?
Traister	From china, you do get lab work with the referrals - but in my experience, it is not 100% reliable.
deb_capone	As a general FYI to Luly and others who are wondering about the age of the child...the answer is: it depends on the country. Each country has its own rules about the age of the child and the age of the parents. For example, in China, if the average age of the parents is under 50 they 'qualify' for a child under 12 months old. In Korea, only married couples deemed 'healthy' by the Korean government can adopt and young children i.e. under 12 months old are available for adoption. The best way to sort it out is to work with a reputable agency.
tenayagirl2	i'm sure no matter how i ask this question, it could come out wrong...but i will go ahead and ask..are their certain countries generally known for children with diminished (or higher-than average) intelligence as a group (perhaps b/c of lack of prental care, for example?)
Traister	From Russia, fetal alcohol syndrome and effects
Traister	Yes, tenayagirl2...Korea has the best "reputation"
tenayagirl2	sounds like the babies there get the best prenatal care? what would be the 2nd-best?
Traister	That;s proabably because they have a medical system which is comparable to ours
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Tony	What problems do children with Fetal Alcohol Syndrome exhibit?
Traister	That's tough, I actually have been favorably impressed with khazistan (?spelling)
Traister	Fetal alcohol syndrome have many different problems - first, they tend to be small - and many have verbal - language difficulties
tenayagirl2	thanks. what would be the areas w/ the children w/ the most brain devel problems?
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Traister	That's a tough questions, it's hard to generalize
Tony	Are these difficulties conquerable with treatment or inate for life?
tenayagirl2	doctor, do iunderstand u r saying babies from khazistan are not exhibiting as much of the FAS like russian kids?
Traister	So far, I have not seen any fetal alcohol from China or khazistan.
denise	are there birth defects from the nuclear testing that went on for years in Khazistan (sp?)
Traister	They were some kids from the Chernobyl region who have been adopted - so far, there have not been problems...but
Traister	Things like cancers may take years to develop, so no one know, for sure
Traister	Getting back to developmental problems - you can't tell which problems will be outgrown
Traister	Gross motor skills tend to be the most "correctable" severe language tend to be the most difficult
deb_capone	Generally speaking, Dr. Traister, how do the kids fare?
Tony	How many years of data do we have on adoptions from these areas?
Traister	China and russia which "opened" in the early 1990's
Traister	They now are the most represented groups in international adoptions
Tony	Does the age of the child at adoption affect the possibility of developmental issues?
Traister	Yes, Tony...but not as much as once thought
Tony	.so the younger the better or vice versa?
Traister	In the past, the data suggested that there was a linear relationship between months of delay and months in the orphange
Traister	The fewer months in an orphange, the better the kids did
Traister	Most of the kids, i have be seeing now are about 12-18 months of age from China
Tony	Apart from Hepatitis then, they exhibit a conventional health track?
Traister	Even from the same orphange, I see tremendous differences in size, in development - that's why carefully reviewing the referrals are important
Tony	Why is size such a factor with health or development?
deb_capone	Some great resources for general information: www.adoption.com and www.travel.state.gov/family/adoption and of course, the American Fertilty Association has a wealth of information on adoption-both domestic and international as well as a thriving adoption message board. Don't hesitate to check it out at www.theafa.org
tenayagirl2	could you please talk more about referrals? do you receive a referral on a child that has already been matched with you?
Traister	It does appear thata size seems to correlate with development
Traister	Yes, tenayagril 2, you will get a referral for a specific child
Tony	Are these size issues nutritionally-based?
Traister	Yes, Tony, most are - i can tell that from followin the kids after they arrive here
deb_capone	Dr. Traister, can you comment on the medical reports that you get. What do you look at. What raises a red flag. What do we need to know?
Tony	..and those early deficiencies carry consequences far in the future?
Traister	By following the kids over a yera, we frequently see the length, the weight and the development pick up dramatically
tenayagirl2	if we wanted to do more research on brain development in international orpans, do you have any websites or resource you could recommend?
Traister	There are soem researches who are doing long-term studies on dvelopmental issues - the team from Minnesota - Dr. Dana Johnson
Traister	It's called the International Adoption Clinic at thte University of Minnesota or google Dana Johnson - i don't think that they have pubished anything yet
tenayagirl2	thnks
Traister	Deb asked about the "red flags"
Traister	Almost everything can be a red flag
Tony	Are adopted children as a whole - from all regions, including local children - less healthy than children with their original families?
Traister	First, we plot out the growth - length, weight adn head circumference - we don;t like to see the head too small fro the body
Traister	Tony, what do you mean oriniginal familes
Tony	non-adopted children
deb_capone	Don't most children of adoption 'catch up' with their peers?
Traister	While most adopted children do catch up, i think adopted children in general weather domestic or interantional have an increase in learning/developpmental problem compared to "biologic" children
deb_capone	Here is a personal comment: my daughter joined my family through international adoption. She weighed 15 lbs at nine months of age...was not sitting up and did not have any teeth. Today she is a very healthy and robust six year old.
deb_capone	She came from China!
Traister	I agree Deb, most kids catch up esp if it's just a wieght issue
Traister	15 pounds is the size of the average 5 month old in this country
tenayagirl2	that is a serious issue --learning developmental problems. do u think it is more related to the lack of prenatal or early childhood medical care or the lack of motional bonding and stimulation in early life?
Traister	No one knows, tenaygirl12
Tony	The developmental issues must aggravate the acclimation of the children into a new society...how long does the transition period normally last?
Traister	But learnignissues come in many forms - most kids are happy, well-adjusted kids - they may need help in learning to read or early intervention for language kills
Traister	Tony, remember that these kids are usually young - - a 18 month adapts very well - by the time you get home 2 weeks they are acclimated to their parents and surrounding
Tony	Really? That quickly? How sharp is the learning curve with age progression?
Traister	If you ask people who adoptied internationally -90% + will say what a positive experience it has been
Traister	Tony, the learning curve for most kids is very steep - by six months, most catch up - that's when we begin to differentiate between which kids may need further services
tenayagirl2	we hear about the importance of brain devel early in life--women are advisd to take omega-3 supplements during pregnancy and while nursing--if a child is adopted from 12-18months, is there still chance to greatly affect brain devel thru nutrition, etc?
Traister	Yes, the cheapest way is to take iron-containing formula or vitamins -
Traister	I recommend all familes start the kids in China or Russia on multivitamins with iron ASAP
Traister	Research studies on 1 year old and kids with ADHD show that kids who are iron deficient did not do as well as their peers who were not iron-deficient
Traister	Tha's a cheap, easy thing to do
Tony	Any diet issues with the South-American children?
Traister	No, Tony, the south/central american kids get a Nestles or Enfamil (US) type of formula
tenayagirl2	thanks-- are there certain countries where it is possible to send these supplments for them to give to your waiting child while he/she is in foster care?
Traister	Yes, but you have to work through your agency
Tony	So in your opinion developmentally-speaking it's Korea, Kazakhstan, and South America...
Traister	Of course, we never know, did the exact child really get the supplemnet but we try to have the family donate vitmains
Tony	..and are there different areas in South America?
Traister	yes, tony, but my biggest group is from china
Traister	There are different areas in South America...but currently most are from Guatemala
Traister	I have followed 100's of girl from china - most are doing great
tenayagirl2	how is the general brain development of these children--from guatmala?
Traister	Some do have problems but actually they are, as a group, great kids
deb_capone	We are five minutes from the end of our session. One of the ways we get such great guests is to respect their time. So get in your last questions for Dr. Traister.
Tony	Are there studies about whether there's societal issues with children that differ racially from their adopted parents?
Traister	Tony, societal issues are a concern witrh trans-racial adoptions
Traister	But, i think all this will change
tenayagirl2	please comment on the emional/behavioral problems you see in int'l kids and which groups you see overcoming these
deb_capone	I want to thank Dr. Traister for his time tonight. This has been a great session.
deb_capone	Dr. Traister, do you want to make a few closing comments.
Traister	Remember in the past - transracial adoptions were rare and the families felt alone an dstigmatized
Tony	Thanks Dr. Traister for all your help
luly	Thank you Dr. Traister for you time and the information you have provided
denise	Thank you - Dr. Traister - I have learned a lot from reading your responses. Much appreciated.
tenayagirl2	thank you!
luly	It is a great starting point
Traister	Yes, thanks - i encourage poeple to contact families who have adopted and speak to them
deb_capone	Can people contact you if they have questions?
Traister	Many families are very happy to share thier experiences
tenayagirl2	is there a website for this?
deb_capone	Any adoption agency you use will be happy to provide families for you to talk to.
Traister	Of course...they can call my office at 914-725-7555 or e-mail me directly michael.traister@nyu.edu
tenayagirl2	thnks, can you mention some good agencies for int'l adoption in so. calif?
deb_capone	YOu can also use the afa's message boards: www. theafa.org
Traister	Gladney, alliance for children, Brightside
Traister	Most have local offices or web sites
deb_capone	And you might want to take a look at Dr. Jane Aronson's article that ran in last month's Connections online newsletter for more info. Dr. Aronson, like dr. Traister is an expert on the health and development of internationally adopted kids
deb_capone	For general info try www.adoption.com
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deb_capone	Good night..see you all next week.!
Tony	Good night
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deb_capone	Thanks once again, Dr. Traister. This was a great session....
tenayagirl2	thanks deb and dr traister
Traister	I think the most important think is to talk to people who have been through it
Traister	Thanks
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Traister	Any other questions that i can help you guys with?
luly	Dr. Traister - I do have a quick question if you don't mind?
Traister	no problem
luly	What is the benefit of adopting internationally vs. domestically?
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Traister	This is a tough question but... personally, i think domestically there is a higher incidecnce of learning issues
Tony	Are there also legal consequences to adopting locally?
Traister	Everyone, domiestically is looking for a sweet, catholic girl who accidentally got pregantn but they are rare
Tony	..with birth-parents changing their minds?
Traister	Yes, i have many experience like that
luly	Is it easier to adopt internationally?
Traister	Easier emotionally
Tony	..so you absolutely recommend international adoption over local...
Traister	No birth parents to change their minds
luly	And what about the cost - is there added cost because of travel?
Traister	I tend to favor international but there are risks
Traister	you're talking 25-30k
Tony	..on a personal note, have you adopted?
luly	Is open adoption common internationally as I know it is practiced domestically?
Traister	No, Tony, I have not adopted - I am the only one in teh international community who has not
Traister	Some, people think is a liablity
Traister	But i have no emotional attachment - no adoption deciseion to defend
Traister	Most interantional adoption is thru an agency = unless you are politically contacted in a country
Traister	We have had people do private from other countries, but it is rare and you have to know people
Tony	As far as benefits to the child go....which areas are where you find the neediest children?
Traister	All areas have neediest children
Traister	China of course has many
Tony	Well, I've heard about the status of females in China and the Middle East...
Traister	We now have from ethiopia,vietnam, cambodia russia, poland
Traister	The kids from China do have a advantaage
Tony	..which is?
Traister	The organization Families with Childrne from China is very active
Traister	They encourage retaining the identidy and cuture
Traister	They run support groups
Tony	Am I gonna hafta learn Mandarin?
Traister	theya re verr ware of teenage adn young adults having identy issues
luly	When you mention the 25k to 30k is that for international adoption or domestic?
Traister	Many families take Chinese lessons on saturdays at teh lcoal school with their kids!
Traister	But you have to learn mandarin...unless you want to!!!
Traister	Luly, both
Tony	..well, as long as I don't have to write it...
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luly	ok great
Traister	Domestic is different with cost
luly	in which way?
Traister	many people get "husstled"
Tony	I've heard domestic the legal fees are higher...
Traister	pregnant women who get money for doctors,etc, playing 2 or 3 families off against each other
Tony	..have you known this to be the case?
Tony	No kidding!!
luly	very interesting
Traister	Remember that may domestic adoptions are with women who have somewhat shady social situations
Tony	..whereas insternationally it's normally just a financial issue?
Traister	Adopting families advertise for pregantn women in small local papers
luly	But wouldn't that be the same assumption for the international women as well.
Traister	Correct Tony
luly	I see
Traister	No, many places the childrne are abandoned early in life
Tony	..especially the girls...
Traister	Yes, esp china
Traister	if the girls are abandned just because they are girls then the risk of problems whould be no different thatn in the US
Tony	.do you find the same thing in Russia or is it less rural and agricultural...can you adopt boys in Russia?
Traister	Russia - more boys - but they are more likely to be premature and i do worry about alcohol
Tony	..is it that prevalent?
Traister	Many of the reports have young or older mothers, reports of syphilies and admit to alchol
Traister	i would use Russia only if i get nice photos to look at the face carefully
Tony	..because the face tells you what...
Traister	Fetal alcohol frequently have physical characteristics
Traister	thin upper lip
Traister	smooth area above the lip (the philthrum)
Traister	low- set ears
Traister	small head for the body
Tony	Wow...how sad....they have no regard for the pregnancy?
Traister	My patients with fetal alcohol are actually charming kids but with language problmes and i worry long-term
Traister	My women don't think about the outcome of the pregnancy - i don't know if it;s denial or ignorance or what
Tony	Do you normally get involved pre- or post-adoption?
Traister	Domestically, we see alot of drug use during pregancy
Traister	Both, Tony, i have many families who cotnact me as soon as they get a referral
Tony	..and you think it's a good idea to take pictures (if available) of the child to a pediatrician for evaluation?
Traister	we review the info - interpret the info and tell you what you can trust adn what you can't trust
Tony	Doctor, what is your specialty if you don't mind me asking? And how did you get into this?
Traister	Also, what things to ask the agency - most photos, another height adn wieght, etc. what things to take on your trip to pick up the child
Traister	If you guys are in NYC, i think i am giving a talk at Gladny in May
Traister	It will be on teh role of the pediatrician in interantional adoptions
Tony	Unfortunately I'm in the 6th borough
Tony	..Miami
Traister	Maybe i can come down and talk there!
Tony	We'll be waiting!!
Traister	If i had only known, i could have taken my winter vacation and deducted it as a business expense! maybe next year!
Tony	We have good weather waiting for you
Traister	It's actually nice in NY this week
Traister	Anything else i can help you guys with?
Tony	Dr. you have answered MANY MANY of our questions
luly	We thank you for staying the extra time to talk with us
Tony	I will keep your name handy as we advance in the adoption process
luly	It has been extremely helpful
Traister	Thanks, but please speak to people - only by speaking to people can you feel comfortable with your choice
luly	We will definitely do so
Traister	Whatever you decide, it's an important decision
Tony	We're going to join a local adoption group
Traister	You have to feel comfortable in your gut...not just your head...
Traister	You have to dcide that whatever life (or adoption) brings who will face it in a positive way
Tony	Absolutely...good advice in any situation
luly	thank you for that very important piece of advice
Traister	That's why most people are happy with their decision - because i think the international adoption community has made peace with their choice
Traister	Good-night guys
Traister	\Thanks for the time
luly	Good night
luly	again - thank you
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Tony	Good night doctor....thanks for everything
Traister	If you need to ask questions, just e-mail
Tony	I will.....goodbye
Traister	BYe
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