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Medical Travel
   • Evaluating a Referral
    • Pre-adoption Preparation
     • Post-adoption checkups
      • and more

  by Deborah Borchers, M.D., F.A.A.P.
Reprinted from                                                                                          Magazine
                                                                                                             Nov/Dec 2004

What kind of referral information will I receive about a
child available for adoption, and how do I assess it?

                       DEBORAH BORCHERS, M.D., is a founding member of the               ical disorders. Photos or videos may be
                       American Academy of Pediatrics Section on Adoption and Foster     available for children. Look for assess-
                       Care, and the mother of three children adopted internationally.   ment of growth points, evaluating pat-
                                                                                         terns of growth as well as the child’s size.
                                                                                              Be aware that medical terminology
ADOPTION PLANS FOR CHILDREN are made         care) should have medical records that      from some countries may be unfamiliar,
for a variety of reasons, including pover-   include birth history, immunizations,       even confusing, to many U.S. physicians.
ty, single-parent households, previous       and previous health care, and prenatal      In Russia, for instance, terms and
abuse and neglect, maternal physical         information, if available.                  phrases describing inherent maladies in
and mental illness, drug and alcohol              You may gain developmental infor-      children are sometimes based on
abuse (both prior to and after birth),       mation through a child’s preventive         assumptions, rather than on diagnoses.
and legal regulations of a given country.    health care records. For example,
These reasons become factors in a            growth measurements (weight, length,        What to watch for
child’s medical, developmental, and                                                      Most physicians preparing pre-adoption
psychological future. That’s why it’s                                                    referrals will pay careful attention to
important to seek and understand a pre-
adoption medical review. A review will
                                                  MORE THAN THE                          information about the size of a child’s
                                                                                         head. A small head (microcephaly) may
address your concerns about the health
of a child and help you give your child
                                                COUNTRY OF BIRTH,                        suggest malnutrition, fetal alcohol
                                                                                         exposure, or a birth defect, either gene-
the best care.
     Although many families focus on
                                                    THE UNIQUE                           tic or resulting from the birth process.
                                                                                              Understand that children who have
the country of a child’s birth in assess-
ing health and development, this factor
                                                SITUATION OF EACH                        lived in institutional care are at
                                                                                         increased risk for growth delay.
is not as important as the individual sit-
uation of a given child. Premature birth,
                                                CHILD IS THE MOST                        Adoption physicians agree that a child
                                                                                         will typically lose one month of growth
poor prenatal nutrition, and living in
an orphanage all play into the present
                                                IMPORTANT FACTOR                         for every three months in an orphanage.
                                                                                         With mild malnutrition, the child may
and future health of a child. Families
adopting outside the United States need
                                                   IN ASSESSING                          be smaller than his peers, but his head
                                                                                         size should be normal.
to realize that children available for
adoption overseas may have the same
                                                      HEALTH.                                 Photos and/or videos of all children
                                                                                         (not just those from Russia and Eastern
risk factors as children adopted from                                                    Europe) should be assessed for possible
our own foster-care system.                  and head circumference) should be plot-     Fetal Alcohol Syndrome. Signs of this
                                             ted on standard North American growth       disorder include growth delay, develop-
What you’ll get                              charts (available at           mental delay, and mental health prob-
Medical information that accompanies         growthcharts). Seek any information         lems. Whenever possible (when videos
adoption referrals varies in depth, con-     about hospitalizations, surgeries, med-     are available, for example), language
tent, and accuracy. Those about to           ications, and allergies, as well.           should be assessed, particularly to rule
adopt a newborn domestically should               As for overseas adoption, some         out hearing disorders. A child should
receive information about prenatal care      countries provide only birth informa-
and diseases, as well as about any blood     tion (height, weight, general health, and              ONLINE: For more information
testing the birthmother undergoes            so on), particularly for newborn refer-                about medical tests for your
prior to delivery. In the U.S. this should   rals. Other countries may offer more                   newly adopted child, read “Post-
                                                                                             Adoption Check Ups” on the AF Web site:
include testing for hepatitis B, HIV,        detailed information, including medical
and syphilis. Older children (whether        evaluations, developmental informa-             articles.php?aid=721.
they’re adopted privately or from foster     tion, even birth-family history of med-

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Reprinted from                                                                                                                    Magazine
                                                                                                                                       Nov/Dec 2004
also be assessed for unusual stiffness                at the 9-month level developmentally                    determine what other (if any) informa-
(increase in muscle tone) and/or asym-                [see chart, below]. Extreme delays may                  tion is needed to make an informed deci-
metry in the way she uses her body.                   indicate long-term challenges.                          sion. Many such physicians are mem-
     Specific medical diagnoses, such as                   Particular attention should be paid                bers of the American Academy of
cleft lip and palate, heart defects, and              to a child’s social interactions and lan-               Pediatrics Section on Adoption and
limb abnormalities, should be identified              guage skills, especially if a video is avail-           Foster Care (
with a review of pertinent medical                    able. A video can reflect only moments                  adoption), and are available for consul-
records. The availability and accuracy of             in a child’s life, but it may demonstrate               tation before you travel.
such records varies depending upon the                how a child responds to familiar adults                       Even with the most complete med-
child’s birth country. Sometimes addi-                and children. Behaviors such as seeking                 ical referral, there are still uncertainties
tional information can be requested, to               affection, responding to verbal com-                    ahead. While an objective review of the
give more data about an identified spe-               mands, and looking for solace when                      health information will help you decide
cial need, but this is not always available.          upset are important in assessing how a                  whether you are able to provide a good
     Development should be assessed                   child may attach to a new family.                       home for a child, adoption is ultimately
closely, using written information, as                                                                        a leap of faith. Children who come with
well as pictures and videos. Develop-                 Putting it together                                     a past that may influence their future
mental milestones should coincide with                Prospective adoptive parents often seek                 will do best in a loving home prepared
a child’s growth, as recorded on a                    out a physician with experience in adop-                to meet their challenges.
growth chart. For example, a 1-year-old               tion and foster-care medicine who will
child the size of a 9-month-old should be             review medical-referral information to

 At these ages, most children...
         •Lift head a little when lying on stomach                                         •Pull themselves to stand and occasionally step with support
 1       •Watch objects for a short time
         •Make “noise in throat” sounds
                                                                                12         •Nod their heads to signal “yes”
                                                                                           •Give love
month    •Stay away from annoying sensations, such as a cloth or blanket      months       •Pick things up with thumb and one finger
          on the face                                                                      •Say two or three words

         •Hold their heads up (bobbing when held in sitting position)                      •Walk without support
 2       •Sometimes imitate or respond to a smiling person
         •Roll partway to side
                                                                                15         •Do some self-feeding
                                                                                           •Speak and make their voice go up and down
months   •Make sounds of discomfort                                            months      •Drink from a cup held by someone
                                                                                           •Use four or five words
         •Lift head and chest when lying on stomach
 3       •Recognize bottle or breast
         •Smile when talked to                                                  18
                                                                                           •Walk (may run a bit)
                                                                                           •Use five to 10 words
months   •Show active body movement                                                        •Climb up or down one stair
         •Follow moving things with their eyes                                months       •Pull toys that have wheels
                                                                                           •Mark on paper with crayons
                                                                                           •Understand easy directions
         •Hold head up for a long time without bobbing
 4       •Laugh out loud
         •Roll from front to back                                                          •Give toys when asked
months   •Like to play
         •Grab an object held near their hand
                                                                                  2        •Recognize a familiar picture and know if it is upside down
                                                                                           •Kick a large ball
         •Make sounds when talked to                                            years      •Turn pages in a book (two or three at a time)
                                                                                           •Use two or three words together, such as “more juice”
         •Sit with little support
 6       •Respond to a friendly voice with a smile or coo
         •Roll from back to stomach                                               3
                                                                                           •Walk up stairs holding railing
                                                                                           •Unbutton large buttons
months   •Turn and look when hearing sounds                                                •Stand for a moment on one foot
         •Change object from hand to hand and from hand to mouth                years      •Talk of toilet needs
                                                                                           •Open doors
                                                                                           •Stack objects by size
         •Sit alone and change positions
 9       •Say “mama” and “dada”
                                                                                           •Ask and answer simple questions
                                                                                           •Speak clearly and be understood by family members
months   •Respond to people they know                                         From the U.S. Department of Education online archives, adapted from the
         •Respond to their own name                                           Illinois State Board of Education’s Child Find materials.

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Reprinted from                                                                                          Magazine
                                                                                                            May/Jun 2004
My family and I are traveling to meet our new baby. What
medical preparations should I make?
WHETHER YOU’RE TRAVELING in the U.S.        CONSULT AN ADOPTION MEDICAL                    ✔ Consult with your family doctor
or abroad, preparing for medical emer-      SPECIALIST ABOUT YOUR NEW BABY:                  (and pediatrician) about the spe-
gencies—even minor ones—is always a         Adoption medical specialists are in tune         cialist’s prescriptions.
smart idea. The less you worry about ill-   to children’s health risks around the          ✔ Do your own research: Visit the
ness, the more you can focus on what’s      world. Consult one before you leave              Centers for Disease Control at
really important—your new family. Of        home. She’ll help you decide what to    and click on
course, situations vary, and the medical    pack (for example, antibiotics or no             “Traveler’s Health.”
precautions you take will largely depend    antibiotics?), and can tell you of specific   HOW TO PACK MEDICATIONS:
on where you are going and how long         risks to your child depending on where         ✔ Keep medications in their original
you will be there. As soon as you know      he was born. Here’s what to ask:                 bottles—you won’t mix them up
you’ll be traveling, consult your family      ✔ Should you pack special medica-              or forget the dosage.
doctor (and your child’s pediatrician)           tions for the new baby?                   ✔ If the original container is too
about how to make your trip a healthy         ✔ What kind of medical exams will              large, ask the pharmacist to give
one. Here are some things you’ll want to         the new adoptee have had?                   you a smaller one and label it.
cover.                                        ✔ What vaccines will your child              ✔ Never put two medications into
                                                 need when she comes home to                 one container to save space.
IMMUNIZATIONS: Routine immuniza-                 the United States?                          Drugs can chemically react to
tions may not be enough if you’re trav-     For a list of adoption specialists, visit        one another.
eling to certain foreign countries. In and search “adoption and           ✔ Bring more medication than you
many places, your family needs vaccina-     foster care.”                                    think you will need.
tions against diseases that you wouldn’t                                                   ✔ If you’re packing prescription
encounter at home.                          THE GREAT DEBATE: SHOULD YOU PACK                medications, take along a letter
  ✔ Check with your doctor and              ANTIBIOTICS? Nervous about various               from your doctor, stating his
     pediatrician to make sure every-       bacterial infections, many adoptive par-         name, phone number, what
     one’s standard immunizations           ents are inclined to pack antibiotics—just       you’re taking, and why. If you
     are up-to-date.                        in case. Doctors have some mixed opin-           have severe allergies, the letter
  ✔ Consult a travel-medicine special-      ions about this. Some feel they’d rather         should say exactly what you’re
    ist about the specific vaccines         see you prepared for everything, and             allergic to and what your allergic
    you’ll need for your destination.       write prescriptions with no fuss. Others         reaction is. (Diabetes patients
    Your primary-care physician prob-       say there are many kinds of antibiotics,         who need routine injections must
    ably won’t know about the current       and only a doctor who has assessed your          carry a doctor’s letter stating the
    health risks in the Hunan province      illness should decide which one you              need for syringes and needles.)
    of China—and if he does, he may         need. Talk with a doctor, and make a           ✔ Pack all prescription medications
    not have the vaccines you require       decision based on where you’re going             in your carry-on luggage in case
    in his office (say, typhoid or          and how long you plan to be there.               your bags get lost or delayed.
    Japanese encephalitis). A travel-
    medicine specialist will. To find       PROPHYLACTIC MEDICATION: In some              DOCUMENTS: Documentation regarding
    one, ask your physician for a refer-     countries, you’ll want to protect yourself   your family can make emergency room
    ral, or visit the International         against diseases by taking
    Society of Travel Medicine’s direc-     prophylactic medication.
    tory at                   For example, if you’re trav-
  ✔ Make appointments as soon as            eling to Guatemala, your
                                                                                SOME HEALTH INSURANCE
     possible—some vaccinations             doctor may prescribe an             COMPANIES WON’T COVER
     (such as hepatitis B) require sever-   antimalarial drug like
     al doses to work effectively.          Chloroquine. (Certain anti-          MEDICAL EMERGENCIES
  ✔ Do your own research. Know              malarial drugs are safe for
     which diseases—and which vac-          infants     and     children,     OUTSIDE THE U.S. TRAVELING
     cines—to ask about. Visit the          depending on dosages.)
     Centers for Disease Control and          ✔ Consult with a travel-         ABROAD? CONSIDER TRAVEL
     Prevention’s Web site,                      medicine specialist, and click on                   about prophylactic               HEALTH INSURANCE.
     “Traveler’s Health.”                        medication.

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Reprinted from                                                                                         Magazine
                                                                                                           May/Jun 2004
visits—and getting through customs—a         ✔ Beware of mosquitoes where
whole lot easier.                               malaria is a concern. Use insect             TRAVEL HEALTH KIT
  ✔ If only mom is traveling, take a            repellents that contain DEET—it’s         If you’re traveling in the U.S., you’ll
      notarized letter from dad stating         safe for adults, children, and            probably be able to find a drugstore if
      that she has permission to leave          infants older than 2 months—and           your baby suddenly needs cough
                                                                                          syrup. Outside the U.S., however,
      the country with their child.             wear long sleeves, pants, and hats.
                                                                                          medication and first-aid supplies may
  ✔ In addition to passports, bring
                                                                                          not be so easy to come by. Pack these
      copies of your adoption decree        AT HOME: If you become ill after you          items, and relief will never be further
      and birth certificate for any child   return home, remind your physician or         away than your suitcase.
      who was previously adopted.           specialist that you were in another coun-
                                                                                           ✔ Band-Aids
                                            try. Your doctor can focus on illnesses to
FINDING A DOCTOR AWAY FROM HOME:            which you may have been exposed, and           ✔ alcohol swabs
Ideally, your baby won’t need to see a      help you make a speedy recovery.               ✔ antibacterial hand-wash or wipes
doctor during your trip—but on the off                                                     ✔ anti-diarrhea medicine for
chance she does, be prepared.               TRAVEL MEDICAL INSURANCE: Some                    adults (not recommended for
  ✔ Ask your adoption agency to refer       health insurance companies won’t cover            babies and children)
    pediatricians in your destination.      medical emergencies if you’re outside of       ✔ diaper-rash cream
    Since the agency has worked in          the U.S. If you’re traveling abroad, con-      ✔ baby cold/cough medication
    the region before, they may have        sider purchasing a travel medical insur-       ✔ oral antihistamine (baby dose)
    some great referrals to offer.          ance policy. For $119 per couple, per
                                                                                           ✔ Pedialyte
  ✔ Call your hotel and ask if it has a     year, American Express offers $50,000
    doctor on call, and ask how it          (per person) worth of coverage for card-       ✔ bandage tape
    handles medical emergencies.            members who are more than 150 miles            ✔ antibiotic ointment
  ✔ Ask your facilitator for the names      from home. Not a cardmember? Book              ✔ hydrocortisone cream for
    of local pediatricians.                 with an insurance company that offers             non-blistery rashes
  ✔ Talk with your own primary-care         policies on a per-trip basis. Premiums are     ✔ acetaminophen and/or ibuprofen
    physician about recommenda-             generally nominal for coverage up to           ✔ thermometer
    tions for medical care away from        $50,000. Their cost depends on the age         ✔ teething gel
    home. Ask if you can call him/her       of the traveler, and the length and cost of
                                                                                           ✔ latex gloves
    from abroad.                            the getaway. To find an insurance com-
  ✔ Ask your child’s future physician       pany and compare premiums, visit               ✔ glycerin suppositories
    about how to handle medical situ-                          ✔ medication spoons or droppers
    ations on the road.                                                                    ✔ baby lotion
                                                                                           ✔ powder
STAYING HEALTHY AWAY FROM HOME:                       WRITE TO US: Is there a medical
                                                                                           ✔ cotton-swabs
Aside from taking medications, these                  question you’d like AF to answer?
                                                      Let us know by e-mailing to          ✔ nail clipper
simple practices, recommended by the
Centers of Disease Control, can help
                                                    ✔ bottles and assorted nipples
keep you and your family healthy in for-      ONLINE: Read “The Top 10 Secrets of          ✔ diapers
                                              Successful Adoption Travel,” by Carrie
eign places.                                  Howard (
  ✔ Wash your hands often with soap           articles.php?aid=247).
     and water.
  ✔ Don’t eat or drink dairy products
     that are not pasteurized.
  ✔ Eat only thoroughly cooked
     foods, or fruits and vegetables
     you have peeled yourself.
  ✔ Drink only bottled water.
  ✔ Drink only soft drinks from cans
     or bottles.
  ✔ Don’t drink beverages with ice.
  ✔ Don’t eat food purchased from
     street vendors.

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Reprinted from                                                                                              Magazine
                                                                                                                 Jul/Aug 2003

Post-Adoption Medical Evaluation
Which medical tests should our newly adopted child have now
that she’s home?
Traveling to adopt my children, I wit-        titis B, hepatitis C, and HIV. Children         age of one who have been adopted inter-
nessed firsthand the conditions in which      who have been significantly malnour-            nationally should have a metabolic
they spent their early lives. As a mom, I     ished, have been in institutional care, or      screen sent to the Department of Health
saw the caretakers’ love. As a pediatri-      who have lived in northern latitudes            of the state in which they live.
cian, I saw crowded living quarters and       (where they may not have been exposed                Validate      immunizations. If
lack of sanitary conditions. Before we        to much sunshine) should be tested for          records cannot be validated, most immu-
came home, I treated lice and scabies         rickets. For children adopted domestical-       nizations can be repeated without harm
passed to my daughter from her caretak-       ly at birth, review of birth records should     to the child. Where records exist, in
ers. But by the time of her first doctor      include attention to testing done on the        order to verify them, blood testing may
visit in the U.S., my daughter was clean,     birthmother, with repeat testing if             be done to examine for antibody protec-
free of skin diseases, and had begun to       records are unavailable or unreliable. All      tion from previous immunizations. The
adjust to her new surroundings.               children adopted from another country           same should be done for children who
      Most pediatricians treating newly       should have a repeat of any pre-adoption        arrive from other countries with a writ-
adopted children can’t judge potential        testing.                                        ten immunization record. With few
risk factors based on firsthand observa-            Assess risk for diseases. Children        exceptions, immunization records of
tion. They must rely on what parents tell     who have lived in conditions of poverty         internationally adopted children should
them about their children’s early lives.      are at risk for infectious diseases as well     not be accepted as written. Vaccines
      After a child’s placement in an adop-   as diseases related to environmental tox-       given to orphanages may be old or not
tive home—whether via a domestic or an        ins and inadequate nutrition. Risk of           refrigerated properly.
intercountry adoption—there should be         exposure to tuberculosis is much higher              Do hearing and vision screening.
a review of all medical records, a com-       in orphanages and other institutions, as        The American Academy of Pediatrics
plete physical examination, and diagnos-      well as in particular areas of the United       recommends hearing screening for all
tic testing, all taking into consideration    States. Any child who has been adopted          newborns and an eye exam in the first six
the child’s past. Since children change       abroad should be evaluated for giardia          months of life. Whatever your child’s
between the time of adoption and the          and other stool parasites. A complete           age, screening early for problems will
first medical evaluation, healthcare          blood count should be done to check for         ensure that she is fully able to respond to
workers need to be reminded about the         anemia. Non-Caucasian children should           her new environment.
child’s previous home and circumstances.      have a hemoglobin electrophoresis to                 Carry out developmental evalua-
With these in mind, healthcare workers        evaluate abnormalities in the structure of      tions. Children who have lived in foster
should take the following steps:              the blood hemoglobin. All children              homes or institutions are at risk for
      Evaluate birth history and past         beyond the newborn stage should also            developmental delays. It’s worth assess-
medical history. In cases where these         have a test done for lead toxicity. A uri-      ing a child’s psychological needs, too. Is
are unavailable, physicians must evaluate     nalysis can detect kidney disorders and         there reason to believe there is a history
a child’s potential exposures from avail-     urinary tract infections.                       of abuse or neglect? Its effects may not
able information. Children exposed to               Perform metabolic screens. In the         surface until months or years after your
drugs or alcohol prior to birth should be     U.S., all states require testing at birth for   child comes home, so this aspect of your
evaluated for blood-borne pathogens           metabolic disorders that, if left untreat-      child’s health warrants ongoing assess-
and sexually transmitted diseases, as         ed, will result in mental retardation.          ment.
should children born in countries where       Physicians should verify that this testing
risks of those diseases are higher. This      has been done, or, if results are unavail-
should include testing for syphilis, hepa-    able, repeat the test. Children under the

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Reprinted from                                                                                         Magazine
                                                                                                            Jul/Aug 2003

                             ✁              Recommended
                                         Evaluations Checklist
                                    Clip out this list to take to your child’s first doctor visit.
                                  ✔ DISEASE SCREENS: Review risks of sexually transmitted dis-
                                     eases, as well as blood-borne pathogens. For children with
                                     prenatal drug exposure, as well as any children adopted
                                     internationally, blood should be screened for hepatitis B
                                     surface antigen, hepatitis B surface antibody, hepatitis B
                                     core antibody. Test for syphilis, hepatitis C and HIV, as well.
                                  ✔ STOOL EXAMINATION: For all children who have lived in
                                     substandard housing, including orphanages or foster care
                                     in other countries, stool examination should be done for
                                     ova and parasites, giardia antigen, and bacterial culture.
                                     Three specimens, obtained 48 hours apart, are strongly
                                  ✔ BLOOD COUNT: Hemoglobin electrophoresis is recommended
                                     for children who are anemic and at risk for abnormal hemo-
                                     globins—those of African, Asian, or Mediterranean descent.
                                  ✔ LEAD LEVEL TESTING
                                  ✔ METABOLIC SCREEN: if the child is less than one year of
                                     age. This should include thyroid testing (TSH).
                                  ✔ TUBERCULOSIS TESTING (PPD): A test of 10 mm is consid-
                                     ered positive for children adopted internationally. Prior BCG
                                     immunization is not a contraindication for TB testing, and
                                     results should be read as if no BCG had been given.
                                  ✔ URINALYSIS DIPSTICK
                                  ✔ IMMUNIZATION CHECK: Validate immunizations by accurate
                                     records for children adopted domestically. For those adopted
                                     internationally, most immunizations can be repeated with-
                                     out harm. Blood testing can be done to validate immunity.
                                  ✔ EVALUATION OF DEVELOPMENT
                                  ✔ VISION AND HEARING SCREENING
                                  ✔ REPEAT TESTING: Six months after arrival in the U.S., chil-
                                     dren adopted internationally should have repeat testing for
                                     hepatitis B and C, HIV, and TB (with a repeat PPD test).
                                  Additional information is available from the American
                                  Academy of Pediatrics, The Red Book, updated
                                  every three years, is the report from the Committee on
                                  Infectious Diseases. A chapter is devoted to the infectious
                                  disease testing recommended for international adoptees.

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Reprinted from                                                                                               Magazine
                                                                                                                  Mar/Apr 2005

The child we’re adopting is at risk for developmental delays. Our
family doctor mentioned Early Intervention. What is it and how does
it work?
 to identify and treat developmental            What’s the next step?                          What services will we receive?
 problems in children through 35                Once a referral is made, the state is obli-    Once the determination is made that a
 months of age. These programs were             gated to conduct an initial evaluation         child qualifies for services, the next
 put into place in the United States            and assessment within 45 days. During          step is to write an Individualized
 through the Individuals with Dis-              the initial screening assessment, a devel-     Family Service Plan (IFSP). This written
 abilities Education Act (IDEA), guaran-        opmental specialist determines whether         plan is similar to the Individualized
 teeing certain rights to children with         further evaluations are needed. If the         Education Program (IEP) that provides
 special needs. Because these federal           specialist believes there is reason to be      assistance to school-age children with
 programs are administered on a state           concerned about the child’s develop-           special needs. The IFSP has a dual
 level, specific services vary across the       ment, a comprehensive, multidiscipli-          focus, providing care to the child as
 country.                                       nary evaluation is undertaken to deter-        well as to the family. Parents should be
                                                mine the child’s specific needs.               involved in the writing of the IFSP, to
 Who should be assessed?                        Referrals may be made to evaluate              ensure that their child’s developmen-
 No matter where you live, the first step       delays in the child’s overall intelligence,    tal needs will be met. Review of the
 in Early Intervention is to determine          physical development, communication            IFSP by the developmental team
 whether your child is at risk for a dis-       skills, social or emotional development,       (including the child’s physician, teach-
 ability. A child’s physician is usually the    or daily living skills.                        ers, and other friends or professionals
 one who makes the referral, but par-                If specialists identify a disability or   whom the parents choose) and the
 ents, social workers, and child-care           developmental delay in an eligible             child’s family should take place at least
 providers can recommend that a child                                                          every six to 12 months to make certain
 be assessed. A child who joins her fami-                                                      that the child’s needs are still being
 ly through adoption often qualifies for                                                       met through the provided services.
 assessment based on multiple risk fac-             IF A DISABILITY                                 Developmental services provided
 tors in her past. These may include (but                                                      through Early Intervention programs
 are not limited to) previous abuse or
                                                   OR DEVELOPMENTAL                            will vary, depending upon state law, the
 neglect, exposure to drugs and/or alco-          DELAY IS IDENTIFIED                          specific needs of the child and family,
 hol prior to birth, premature birth, cleft                                                    and the availability of services where
 lip/palate, vision or hearing deficits, or a     IN A CHILD YOUNGER                           the family lives. The IFSP may include
 previous history of living in an orphan-                                                      recommendations for home-based serv-
 age. Even children with subtle develop-          THAN 3, THE STATE IS                         ices, classroom services (with or with-
 mental delays qualify for screening for                                                       out the parent present), or medical-
 Early Intervention programs.
                                                      MANDATED TO                              based services (in a hospital or outpa-
      Parents should consider initiating           PROVIDE SERVICES.
 a referral if their child has any risk fac-
 tors for developmental delays, even if                                                                   ONLINE: For more information
 there is not yet a specific concern.           child younger than 3 years old, the state                 about EI services, read “Early
                                                                                                          Intervention: Spotting Problems in
 Research has shown that a routine              is mandated to provide therapeutic
                                                                                                  Your Child’s Development” on the AF Web
 office visit to a physician will identify      services. Some states also provide servic-        site:
 fewer than 30 percent of the children          es to children identified as being “at            articles.php?aid=645.
 who have developmental problems.               risk” for delays.

Reprinted with permission from Adoptive Families magazine. For more articles like this one, to subscribe, or to
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Reprinted from                                                                                                         Magazine
                                                                                                                            Mar/Apr 2005

   tient setting). [For descriptions of              to the family. In some states, services are           As you begin navigating the Early
common interventions, see box below.]                provided on a sliding fee scale or are           Intervention system, remember that a
                                                     billed to private health insurance or gov-       key component of the evaluation
What should families expect?                         ernment medical assistance. Treatment            process is determining the needs of
Because Early Intervention is a federal              sessions, as well as the initial evalua-         your family as a whole, as well as the
program, the initial evaluation is pro-              tion, may be provided in the child’s             needs of your child as an individual. In
vided at no cost to families. If a child is          home, a child care center, a clinic or           the medical field we recognize that, by
deemed eligible for ongoing services,                hospital’s outpatient facility, or even in       assisting the family, we also provide
these are frequently provided at no cost             a public agency office.                          assistance to the child.

A Quick Guide to Early Intervention Services                                Early Intervention Resources
A range of therapeutic services is offered under EI. These may include:        To find out how to access services near you, contact the National
   Speech-language services to help children with language delays              Dissemination Center for Children with Disabilities, 1-800-695-0285,
   Occupational therapy to improve fine motor skills
                                                                               More information is available from the National Early Childhood
   Physical therapy to assist with major muscle skills (i.e., walking)         Technical Assistance Center (NECTAC),, and the
   Vision therapy                                                              National Center of Medical Home Initiatives for Children with Special
   Hearing aids
                                                                               The U.S. Department of Education Web site
   Nutrition assistance for children who are undernourished or have            ( provides
   sensitivities to food                                                       information about the IDEA legislation, and about programs for
   Assistive technology devices                                                children who are too old to qualify for Early Intervention programs.
   Nursing services, social work services, mental health services, and is a dependable site for parents of kids with
   other family assistance, depending upon the state                           special-education needs.

Reprinted with permission from Adoptive Families magazine. For more articles like this one, to subscribe, or to
sign up for the free monthly e-newsletter, visit