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Healthy kids at home and abroad

The Freeman family now includes Robyn, Margo, Don, and Myles. (Photo: Eliesa Johnson, Photogen, Inc.)

The International Adoption Clinic celebrates 25 years

Ten-month-old Margo Freeman couldn’t have looked any healthier. Yet, when Don and Robyn Freeman learned that their adoptive baby girl was waiting for them in Ethiopia, they sought an expert evaluation of her medical records and advice on what to expect when adopting a baby from a foreign country.

“We were already in love with her just from seeing her picture, so there was probably nothing that would have changed our minds,” says Robyn Freeman. Still, they wondered what medical challenges might lie ahead.

They turned to the International Adoption Clinic (IAC) at the University of Minnesota. Now celebrating its 25th anniversary, the clinic was the first of its kind in the country and helped to establish the field of adoption medicine as a specialty in pediatrics. It has become a model for other clinics around the country, garnered an international reputation, and through extensive research, has created a greater understanding of the special medical and developmental needs of adopted children.

Even before they went to Ethiopia, the couple sent the medical information they had about Margo to the clinic for a pre-adoption assessment. The IAC staff conducts roughly 1,500 of these annually and sees 300 to 400 children in the clinic each year.

A wealth of expertise

One problem for adopting families is that medical information is inconsistent from country to country, and a number of factors — different calendars, incomplete paperwork, and translation issues, for example — can paint a confusing and misleading picture of a child’s health.

As it turned out, Margo had tuberculosis, which was treated successfully in Ethiopia. Says Freeman, “The IAC did a great job of ensuring that the TB was completely treated and performed many follow-up tests that gave us peace of mind.”

“It’s important to have the expertise to view medical reports in the context of each child’s country of origin,” says associate professor Cynthia Howard, M.D., the clinic’s director since 2005 and also the proud mother of two daughters adopted from Democratic Republic of Congo. “We often know the orphanage and the medical staff personally.

“We like to see kids in the clinic two to three weeks after they arrive home,” she adds. “We do baseline screening to address any immediate physical problems as well as long-term cognitive and attachment concerns.”

Depending on the child’s needs, the clinic draws from the University’s wealth of expertise across the medical spectrum — ophthalmology to occupational therapy — and coordinates the child’s care among all of these specialties. According to Howard, the sooner they can address a child’s needs, the greater the chances for the child’s success, not just medically, but also psychologically, socially, and academically.

Concerns shift with geography

Parents wishing to adopt a child internationally haven’t always had these medical resources. In 1986, when the clinic was founded, Americans were adopting about 8,000 international children per year, mostly from Korea. The number of Korean adoptions dropped by half in the early ’90s, but new regions and countries such as Russia, Romania, China, South America, and sub-Saharan Africa opened for adoption.

This change brought children with entirely new medical issues. In Eastern Europe, for example, children live in orphanages rather than foster homes, which has profound implications for their development; whereas children in Ethiopia are at risk for infectious diseases such as malaria and tuberculosis. It is difficult for primary care providers in the United States to be entirely familiar with the health risks that affect children in these parts of the world.

The clinic’s research has pinpointed some of the physical and developmental challenges that many of these children face, including growth delays, attachment difficulties, sensory processing disorders, and learning problems.

From the IAC’s work, a broader view of clinical support necessary for internationally adopted children like Margo has evolved. Over its first 25 years the IAC has improved care and supportive strategies not only for children at the clinic but also from around the world.

Margo is a happy and thriving 18-month-old now. And throughout her childhood, says her mom, “the International Adoption Clinic will continue to play a key role in her development.”

By Terri Peterson Smith, a freelance science writer and editor

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