66 Mount Lucas Road, Princeton, NJ 08540-2733, USA
tel 609-924-4892, fax 609-921-9380
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Mark B. Levin, M.D., F.A.A.P.
John M. Cotton, M.D., F.A.A.P.
Timothy J. Patrick-Miller, M.D., F.A.A.P.
Louis J. Tesoro, M.D., F.A.A.P.
Helen M. Rose, M.D., F.A.A.P.
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We are happy to answer any general questions about medical topics and about ouor practice. We can answer specific questions only regarding patients who are currently enrolled in our practice. The material provided on this website is for informative purposes only. If you need specific advice, please contact your treating physician.
Raising a child is undoubtedly one of the most exciting and rewarding endeavors life has to offer. For couples who cannot or desire not to bear children, adoption provides an alternative way of experiencing these rewards. There are so many children in the world who need nurturing, love and a stable home that both the parents and the child can benefit from the gift that is adoption.
Preparation, After-Hours Appointment, Interpretation of Data, Medical Screening and Immunizations, How to Use The Pediatric Group, Circumcision, Feedings, Supplies, Adjustment, Car Seat Safety
All new parents, whether adoptive or natural, face uncertainties about the health and well being of their child and about their own ability to be good parents. Yet adoptive parents, despite limited time for preparation, also face many concerns that are unique to their situation - questions about the process of adoption, the family medical history of the child, the care the child received (both inside and outside of the womb) before being introduced into the adoptive family, whether the new child will resemble the family physically, emotionally and culturally and how the child will grow up and develop given all of these unknowns. Although these uncertainties do not always have definitive answers, getting on the right track can often alleviate some of the anxiety associated with them. As a first step, we recommend having an experienced adoption attorney or adoption agency help you through the legal process. Agency personnel can also help guide you through the emotional process by providing counseling. As an additional step, meeting with a pediatrician experienced in adoption issues can be of great value by helping you understand the psychosocial and medical issues involved in acquiring and raising an adopted child.
We encourage you to make an after-hours appointment for a pre-adoption
visit with
one of us to discuss discernible aspects of the child's health as
well as how to best prepare for the child's arrival. Try to get
all the information you can from the biologic mother, either
directly or through your lawyer or adoption agency. If at all
possible, obtain a photograph or videotape of the infant to show
to us. We will search for clues that help us distinguish between
a healthy and an at-risk child. Some examples include the
soundness of the child's prenatal life and the history of medical
conditions in the child's biologic parents. A well nourished
mother who gives birth at term to a normal birth weight infant
having a normal examination and apgar scores and having made an
uneventful transition and adoption to extrauterine life is a very
reassuring story. Likewise, a history of birth parents with
normal physical and mental health, and who have refrained from
illicit drugs, alcohol and cigarettes during the pregnancy is
comforting. For children being adopted at some time after birth,
sequential growth measurements (height, weight and head
circumference) and a description of the child's developmental
milestone acquisition provide excellent indicators of the baby's
overall health. If you can give us this information prior to your
visit, the time we spend together will be much more fruitful.
Careful interpretation of this information is essential, because it is sometimes inaccurate, as in some international adoptions. For example, the stated age of a child may not be the real age. The pediatrician in this case must use other independent parameters such as growth, dentition and psychomotor development, to assess the real age of a child. Growth is reflective not only of genetics of the biologic parents. but also of prenatal care, postnatal nutrition and wellness. The growth capacity of children may exceed that of the birth parents, who may have experienced untoward influences during their formative and growth years (i.e., protein-calorie malnutrition, diseases) or be delayed due to these same factors in the child. Eruption of dentition usually follows a genetic pattern, but can be slowed by nutritional deficiencies. Psychomotor development (when a child achieves developmental milestones) is strongly influenced by environmental emotional factors. Often, a child who waits in an orphanage for placement does not experience the rich environment (s)he will have with his or her new family. A child who seems delayed upon first assessment may progress at a super-normal rate once in an adoptive home with consistent nutritive emotional support and parenting.
During our talk, we will discuss any laboratory tests and immunizations your child might need upon adoption. Unless already performed appropriately in a reliable laboratory, we will want screening laboratory tests to rule out intestinal bacterial infections, intestinal parasitic infections, Hepatitis A, B and C, Human Immunodeficiency Virus (HIV), Tuberculosis (TB), Syphilis, Hypothyroidism, Galactosemia, Phenylketonuria (PKU), and kidney disease. The evaluation requires stool, blood and urine samples. In parts of the world where storage and shipment of vaccines is not optimal, especially in warmer climates, vaccines may lose their potency. Depending on your child's age at adoption, place of birth and immunization history, we will recommend either to continue the immunization schedule already begun or to start over.
Our brochure entitled "Our Practice" and other pages in this website (see
below) will acquaint you with some commonly faced problems, such
as normal and sick care, what constitutes an emergency (and how
to contact us in these instances), when to discuss parenting,
developmental, and behavioral issues, how our office functions
and our administrative policies. You should feel free to ask
questions of the doctors or the nurses regarding nail clipping,
skin care. diaper rashes, burping, vomiting, diarrhea, fevers,
parenting advice and any other topic you need information about.
If you are considering a circumcision for your son, we will be happy to discuss
this issue with you. Most circumcisions are performed by an
obstetrician, urologist or a ritual circumciser (e.g.. a mohel).
depending on the parents' preference.
Once your medical questions have been addressed, you will need to prepare yourself for your child in several other ways. The first involves deciding what to use for feedings. Unless a child is older and has had experience with solid foods, it is best to defer solids until feeding patterns and food tolerance can be determined. For infants adopted from the Far East, we usually recommend a soy bean-based formula because of the increased likelihood of intolerance of cow milk products. Our brochure entitled "Formula Feeding Information" contains information on preparation of formula and recognition of signs of intolerance or allergy. The child's bowel habits will vary depending on his or her pre-adoption nutritional status, any food reactions and changes due to traveling from one area of the world to another (just as yours would).
Supplies to have at home include bottles, nipples and formula, cotton swabs, baby soap, baby shampoo, diapers. baby clothing (undershirts or "onesies", sleepers or "stretchies" and receiving blankets), washcloths, cotton puffs, a bassinet (for an infant under four months of age) or crib, some acetaminophen infant drops, petroleum jelly, rubbing alcohol and a rectal thermometer. Items for an older child will depend on the child's age. We can discuss this at our visit.
You should be prepared to spend several days allowing the child to adjust to his or her new environment, especially if you live in a time zone other than the place of adoption. A child who has been cared for in a foster home, an orphanage or sometimes by a birth parent may exhibit a flat affect and delayed socialization initially. Try not to be disappointed if your child seems distant. Marked improvement in social interaction often results from even a brief stay in an adoptive home because of the closeness and emotional support that you will shower on him or her. Any assessment you or we make regarding your child's behavior and developmental status must await his or her adjustment to your family.
An essential part of your child's new environment is a suitable auto restraint. The car seat should be placed in the back seat of the car, away from air bags and the windshield and dashboard. It is tempting, yet dangerous, to take your eyes off of the road to look at your child in the front seat. Until a child reaches one year of age and twenty pounds of body weight, (s)he must face the rear. By nine months, children often fuss in this position because they prefer a more entertaining view and are sometimes cramped in the seat. But your child is safer in this position.
Childproofing your home prior to your baby's arrival is essential. It is preferable to prevent accidents than to deal with their consequences. You may find yourself too fatigued to pursue the necessary rearrangement of your home once the child consumes the lion's share of your energy! Be particularly careful to put poisonous substances (e.g., medicines, cleaning agents, some house plants) out of reach in secure places. Always check with us or the national poison control center (1-800-222-1222) in the event of an accidental ingestion or poisoning. Keep this number in your wallet and by your phone so it is always handy. You should be familiar with infant cardio-pulmonary resuscitation (CPR). Although we all hope never to encounter a situation when such knowledge is necessary, preparedness can save a child's life. After all, children excel at finding the most dangerous things to do at the worst possible time.
The challenge of instant parenthood is exceeded by the joy you and your child bring to each other's lives. You can ask your attorney or adoption agency for support groups of other adoptive parents. We stand ready to assist you. You should feel free to consult with us about any issues that might arise. We are all one big family. You can be confident that you are capable of raising a child, whether or not you have the same genetic background.
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