What to Expect From Your Post-Adoption Visit
By Kelly Hicks, RN, MSN
You have arrived home and have an appointment at the International Adoption Center (IAC) at Cincinnati Children's Hospital Medical Center. The following is a description of what to expect during your visit with us.
The IAC at Cincinnati Children's offers medical and developmental evaluations for internationally adopted children. When you arrive for your visit you will be greeted by the front desk staff where you will register and sign in. They will ask for your insurance card and proof of guardianship if necessary.
Once you have checked in, your child will then have their weight, height and head circumference along with a temperature taken. These will be plotted on your child's growth chart. Once in a room you will meet with the IAC staff. Your child's medical records will be reviewed along with having a comprehensive physical and developmental evaluation.
You will meet with an occupational therapist who will perform a developmental assessment on your child. This evaluation may take up to an hour. During that time the therapist will ask you questions about your child's development and discuss any concerns you may have regarding possible delays. The occupational therapist will look at five areas of development:
- Gross motor skills
- Fine motor skills
- Language and communication
- Personal / social skills / self-care
- Sensory processing
One of the benefits of having your visit with the IAC is that an interpreter will be present during the assessment if your child is 18 months of age or older. This evaluation will provide you with a better understanding of your child's current development. If delays are identified you will be connected with developmental services in the community or at Cincinnati Children's for ongoing therapy.
A comprehensive medical exam is also done. After reviewing your child's medical and immunization history we will discuss any problems or concerns you may have. A physical assessment will be performed by the IAC medical staff. We will discuss your child's growth, nutrition/ f eeding, sleep and attachment issues. This portion of the assessment will take approximately an hour. Afterwards, a tuberculosis skin test will be placed on your child's forearm. The purpose of the test is to screen for tuberculosis infection. Instructions on the purpose of the test and when it should be interpreted will be reviewed.
After this discussion, you will meet with Mary Allen Staat, MD, MPH. She will discuss your concerns and findings from the developmental and physical assessment. She will perform a brief physical examination of your child as well. Together you and Dr. Staat will discuss ways to address the medical and developmental issues identified. If there are medical conditions identified that require further attention we will help coordinate visits with the necessary medical specialists. The visit with Dr. Staat may take up to 20 to 30 minutes.
Once your visit with Dr. Staat is complete, you will proceed onto the Test Referral Center to have blood work obtained. It is important for your child to have lab tests done to screen for conditions commonly seen in internationally adopted children. These include:
- Infectious diseases such as HIV, hepatitis B and C and syphilis
- Environmental exposures such as blood lead levels
- Metabolic screening including a thyroid function test
- Complete blood count
- Immunization antibody levels
- Stool testing for intestinal parasites
It is not uncommon for internationally adopted children to have intestinal parasites. Therefore, you will be asked to collect your child's stool for parasite testing.
A numbing cream called EMLA will be placed on your child's arms prior to having the blood drawn. This cream considerably decreases the pain of the venipuncture. Your child may need to have an X-ray done and is usually done following the blood work.
Your visit is finished at the conclusion of the testing. You will receive a comprehensive written developmental evaluation report from the occupational therapist within approximately 4 weeks from your visit. You will receive a comprehensive medical report including immunization recommendations within approximately six weeks of your visit. These reports are also sent to your primary physician.
You will have a follow-up visit with us in six months. Based on the findings from your initial visit, you may be asked to come back in three months as well. The purpose of the three and six month visits are to review your child's developmental progress, adjustment, behavioral issues and any medical conditions. If there are problems identified during the visit then we may recommend additional services as needed.
It is important for all children who have been internationally adopted to have a comprehensive evaluation. The IAC can provide these services with a staff whose expertise is in the health of internationally adopted children in addition to using the expertise of other disciplines within Cincinnati Children's.
