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Clinic provides care for internationlly adopted children by Heather Woolwine Public Relations In the U.S., international adoptions surged in recent years from 7,000 children adopted in 1990 to approximately 22,800 in 2004.   With this influx of children also comes an array of medical and health issues placed on families and communities who welcome them, often due to the horrific conditions they face during institutionalization in the orphanages of poor and developing nations.   Andrea Summer, M.D., Pediatrics, and Angela LaRosa, M.D., Developmental Pediatrics, address the special needs and issues for these children on Wednesday afternoons in the MUSC International Adoption Clinic (IAC). The one-year-old clinic serves the needs of adopted children and their families.   Summer and LaRosa evaluate patients jointly, with Summer focusing on nutrition, growth, and screening and treatment of infectious diseases, while LaRosa works with patients in terms of their behavioral and developmental growth.   “We love these two ladies,” said Jennie Olbrych, an Episcopalian minister who adopted three children from the Ukraine a little less than a year ago. “They really want to engage the children and my prayer for them is that they continue to care and love these children the way they do for a long time.” Ruslan and his mom, right, update Drs. Summer, far left, and Larosa on his progress since his arrival in America.   Olbrych and her husband discussed their spiritual desire to expand their family before traveling to the Ukraine for son Ruslan, 13, daughter Oksana, 7, and son Maxine, 6. Olbrych learned through her research that because older children usually aren’t adopted as readily, their chance for survival is minimal after leaving the orphanage at 16. Many boys resort to a life of organized crime or drug abuse and many girls become prostitutes or enslaved. Both sexes suffer greatly from the AIDS epidemic sweeping Eastern Europe. After learning that sibling groups may not be separated for adoption in the Ukraine, the Olbrychs decided that while originally prepared to take one or two children into their home and hearts, they would in fact take three. “Our biological children, John (15) and Anna (8), have been remarkably gracious,” Olbrych said. “The literature says that it takes about a year to really achieve that sense of oneness within this new family structure and we’re working towards that.”   According to Summer, many internationally adopted children, like the Olbrych children, were institutionalized for all or a part of their lives, putting them at huge risk for stunted growth, malnourishment, abuse, infectious diseases, and an array of behavior or developmental problems.   “These are children from developing countries that have an incredibly low per capita income where the orphanages are government run institutions with conditions that vary drastically,” Summer said. “They often don’t have adequate nutrition and are neglected. In those conditions, children can’t grow or develop like they should.”   The most common physical problem that Summer sees in her patients is the massive delay in growth. However, once the children are here, they usually experience rapid catch-up growth. In addition to growth problems, some of Summer’s patients have infectious diseases like intestinal parasites and latent tuberculosis infection. Screening for other infectious diseases such as hepatitis B and C, syphilis, and HIV  is also routinely conducted. Even though internationally adopted children are at an increased risk for these infections, fortunately, they are rarely present. Some suffered horrific neglect and physical, sexual, or emotional abuse.   LaRosa sees neglect as the biggest issue hampering her patients’ emotional and behavioral development. “You don’t have to hit or yell at a child to inhibit their development or growth,” she said. “Not speaking to them or addressing their emotional needs will achieve the same thing.”   When patients meet with LaRosa, she conducts a full developmental and behavioral assessment to discover what milestones the child passed successfully and those that still exist. Some of the most common issues she sees in internationally adopted children are sensory integration disorder, ADHD, learning disabilities and attachment disorders that range in severity and type.   Most children in normal circumstances develop healthy attachment to caregivers by ten months of age, but children raised in orphanages often are neglected or have too many caregivers to form that necessary relationship. The result might be indiscriminate friendliness or a child who is too inhibited to seek comfort when hurt or out of sorts.   “I tell our families that attachment is very important and is all about trust, and children have to learn how to trust,” LaRosa said. “If the child is experiencing a attachment disorder, I advise families to limit the number of caregivers during their first year to help the child beyond the disorder.”   Another concern for most families according to LaRosa is fetal alcohol syndrome and the developmental delays that can arise from a mother’s abuse of alcohol while pregnant.    Both LaRosa and Summers work to assuage families’ concerns and address them as soon as they became apparent, and try to prevent issues from arising as well. It’s important to both physicians that new patients come to the clinic within their first two-three weeks in the United States to allow for early intervention and immediate treatment of major physical ailments. In addition to the clinic, patients see a primary care physician  for routine pediatric issues.     “It’s important to say that not all of the children we see have these problems,” LaRosa said. “But they are at an increased risk so the earlier we identify any problems they may face, the better chance we have at improving their outcomes.”   “It’s a huge relief to know that we’re dealing with people that understand the issues that these children face,” Olbrych said. “There are a lot of pediatricians that are on top of treating post-institutional children, but during my self-education process I realized the importance of finding a clinic that wouldn’t argue with me when I suggested testing for parasites or TB. Sometimes the medical records the children come with are not accurate, as was the case with Ruslan. It was great to be able to hit the ground running with the team here at MUSC.”   Olbrych also mentioned her satisfaction at knowing the clinic was at MUSC. “It’s wonderful to be able to have a full diagnostic check-up, along with the behavior and developmental assessments and know that the resources to further address any problems the children had were all in the same place. There’s an ease of communication with the clinic, MUSC, and our pediatrician at (MUSC affiliate) Parkwood Pediatrics.”   Most of the clinic’s patients do well in their new homes, like Ruslan and his siblings, with the best predictor of their progress related to the amount of time spent institutionalized. “For every three months in an orphanage, development is delayed a month,” LaRosa said. “So if a child has been there since birth, at one year, they will developmentally be more like an eight month old.”   Once a child is assessed within those first critical weeks, all patients come back after six months for disease re-screenings, growth checks and development testing. As a general rule, the younger a child is once adopted, the better their development will recover. This rule is not always true though, and is at the heart of what LaRosa and Summer hope to conduct research on in the future. “There’s not a lot of long-term follow-up out there for these patients,” Summer said. LaRosa echoed her, “and it would be nice to have more information on the outcomes of these children.”   In addition to their regular clinic duties, both physicians also evaluate potential adoptees as best they can for would-be parents through medical records, pictures, and sometimes video tape, looking for evidence of developmental and physical progress or the lack thereof.   As for Ruslan and his siblings, life in America is good.   Ruslan enjoys soccer and American food, noting that he’ll eat anything that “mom and dad give me.” School is different here, with more in-class discussion then he was exposed to in Ukraine and less time confined to a desk. He described the difference in medical treatment here and in the Ukraine, one of the most notable differences in the way caregivers treat their patients. “They are much more caring, like when giving a shot,” he said. “They don’t tie you down here.”   Embracing all that his new life has to offer, by way of everything from medical treatment to his basics needs, Ruslan kept it simple when he left the orphanage, “Goodbye Ukraine, Hello America!”     Friday, April 29, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. 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