59 Internationally Adopted Children; The Edmonton Clinic Experience

One of the services of the Adoption Clinic in Edmonton, Alberta, is to address the unique medical and social health concerns for internationally adopted children and their families. To our knowledge, this is the only service in Western Canada, and only one of three of its kind in Canada. Through a retrospective chart review, we report our early experience with this clinic. The charts of 43 internationally adopted children (28 girls and 15 boys) were reviewed for epidemiological data, including prenatal and birth history, place of birth, age at adoption, orphanage placement, and any known past medical history. In addition, at the time of initial assessment in the adoption clinic, significant findings on initial physical examination and laboratory investigations were documented. The majority of children were adopted from China (n=15, of whom 14 were girls). Haiti was the next most common country from which to adopt (n=11). Other children were adopted from Romania (n=5), the Phillipines (n=3), Malawi (n=3), and individual children were adopted from Kazakhstan, Brazil, St. Vincent, Vietnam, Ukraine, and Lithuania. In the majority of cases there was no prenatal, birth or family history available. The average age of the adopted children was 27.2 months (±3.7 months) with the majority (30 children) having spent most of their lives in an orphanage. Although several children had a history of diarrhea and malnutrition, by the time of their first clinic visit only 2 met the criteria of failure to thrive. Ten children had abnormal stools, Giardia lamblia and Blastocystis hominis being the most common organisms. At initial consultation, only three children had an abnormal physical exam, siblings with splenomegaly, which was later determined to be caused by malaria. Single cases each of rickets, hepatitis B, hepatitis C, lead toxicity and alpha-and beta-thalassemia trait, hypothyroidism and iron-deficiency anemia were found on routine screening tests. Developmental delay was evident in 32 of the 43 children; of these 26 were from an orphanage. Psychiatric disorders were also observed: anxiety (n=3), attachment disorder (n=2), and attention-deficit disorder (n=3). Two children also had fetal alcohol spectrum disorder. These children will be assessed long-term for the outcome of their physical and social development. These data can help provide further information for physicians involved in pre-adoption counseling, and offer guidance for appropriate investigations for the internationally adopted child.

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