Thursday 27th of April 2017

A pediatrician's View

In the last six months, as a pediatrician and consultant for Wide Horizons for Children, I have been privileged to be the facilitator for five groups of parents traveling to China to adopt. In the preceding 26 years, I was a full time pediatrician in practice in Concord and Carlisle. I've been asked to comment on the health of the infants and children from the nine orphanages I have so far seen in China.

In a word: impressive. Despite the meager resources at hand, the children are lovingly cared for; the primary care givers are typically very attached to the individual babies and vice versa. In a number of orphanages, once a baby has been identified for international adoption, she is sent into family foster care, so the capacity to attach is even further developed. Because the adoption process has steadily become more streamlined, even in the six months I've been involved, we are being referred more and more younger babies in the four to six month range.

As for physical health, the problems we have needed to deal with on site for the most part have been typical of what one sees in America: some ear infections, some chest infections, gastroenteritis, and skin problems. If we are given a group of 10 babies, typically four or five will have something, not life threatening, which I can treat on the spot, making the adjustment period and the trip home easier on the new parents and child. One has to remember that the children probably didn't get sick the day we got there, and as in the U.S. in the days before antibiotics, they might well have gotten over their colds if left to their own devices. My experience is that these children respond very quickly to antibiotics: unlike their State-side cohorts, they haven't been exposed to antibiotic resistant organisms!

Developmentally, the children almost always have lags. They have often been stimulated less because of group living, and they have lacked developmental opportunities because of relative crowding in living conditions. They have not being able to get down on cold cement floors to move about, many are immobilized by layers of clothing in cold weather, and they have not been exposed to toys. They have little experience with light and color, and they havenpt had doting parents to play with and exercise them. With adoption, development tends to proceed on a fast forward track: one advantage parents often feel is, they haven't missed much of it.

As far as chronic physical defects, we have really no surprises. In "special needs" kids, we've had a few non-physiologically important heart murmurs, a few extra digits _ easy to remove _ and lots of physiologically normal bowing of legs labeled rickets, but not.

Hepatitis B is the big question, since testing in foreign countries has proved unreliable. The current incidence of Hep B from China is running 5-10 percent. Immunization _ a series of three shots _ is not given in China (Ed. Note: It is given, to some children in Zhejiang province) ; the general belief there, even if Hep B vaccine is available, is not to give any vaccines under six months to a year, unlike here where we start in the newborn nursery. An adopting family can be entirely protected by being given vaccine, and the American Academy of Pediatrics strongly recommends that all U.S. children born after January 1, 1992 and all teenagers be vaccinated. School health law in Massachusetts will soon require Hep B for admission. For the young adoptee, being a Hepatitis B carrier is not something they would wish, but two-thirds of the time the individual will never in her life get sick from it. Those numbers may be even growig up in the U.S. with more stringent standards for air pollution, smoking, pesticides in food and water, etc. In all studies, males are more likely to have the serious effects of carrying Hep B. Hepatitis B carrier state is something one can live with perfectly well more times than not. We have had three Hep B carriers, after testing in the U.S., in 169 children brought home from China, and not one of their families can imagine life without their particular daughter.

I'm more than happy to talk with parents and prospective parents about health issues, how to choose a pediatrician, where to go for good Hep B advice, and what the American Academy of Pediatrics advises for testing once you get home. Wide Horizons expects to send many more adoptive groups to China, and I'm usually the Pediatric person to go, but, if home, you'll find me at (617) 441-0031, in Cambridge).





This article was originally printed in the May, 1995 issue of FCC Boston's newletter, China Connection.

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