The Canadian Clinic for Adopted Children offers medical consultation services to individuals and families involved in domestic and international adoption. With the increase in international and domestic adoptions in Canada, the Canadian Paediatric society recognizes that there is a need for medical service providers to address the special needs of these children. Dr. Simone, Board Certified Paediatrician and Endocrinologist, is the Chief of Paediatrics for the Trillium Health Center in Mississauga. He offers his expertise with these special medical issues, providing pre-adoptive and post-adoptive consultations at his clinic. The Canadian Clinic for Adopted Children has an extensive health care network with specialists in the area of cardiology, radiology & ultrasound, paediatric infectious diseases, nutrition, orthopedics, dermatology, neurology, nephrology, gastroenterology, urology, oncology, endocrinology, paediatric psychiatry, ear, nose & throat and dentistry. DOMESTIC AND INTERNATIONAL ADOPTION The Canadian Clinic for Adopted Children counsels prospective adoptive parents, and reviews video and medical reports. In preparation for an international adoption we suggest that the parent/s contact our office about 3 months before the child actually arrives in Canada. Medical guidance usually begins when the parents receive the medical abstract from their adoption agency in the form of a referral. Often, along with the medical abstract, a video and photograph is included with these referrals. When videos are available, they are studied for abnormal physical characteristics and developmental / behavioral levels. Photographs are examined and evaluated for facial dysmorphism and other abnormal physical characteristics. When the video is not available before the adoption, the parent/s can elect to courier the video to Dr. Simone from the foreign country. Priority is placed on expediting information immediately back to the parent/s regarding the potential adopted child. This medical consultation would be transmitted via email or fascimile. The child's medical abstract must be translated, studied and evaluated. It is the parent/s responsibility to supply the translated medical abstract to our medical team. It is later discussed with the parent/s. Growth parameters are placed on a growth curve to assess height, weight, head circumference as compared to a general population of children of the same age. Developmental milestones are discussed so parents can understand the expectations for their particular child. Issues of post intituitionalization will be reviewed as well. Parents can then make decisions more knowledgeably regarding their prospective adoption. Dr. Simone screens the adopted children after arrival, and provides ongoing follow-up and referral. The initial physical examination and interview will clarify immediate medical issues that the parent/s may have for their child. Blood is obtained during this initial office visit and laboratory evaluations are completed. Full screening of the adopted child may involve many tests being performed, and would ultimately depend on what the parent/s are most concerned about. Screening would be conducted in stages so not to overwhelm the child. The child's wellness, both physical and psychological, is always given priority. TESTS CBC with differential and platelets (RDW, Retics) Glucose-6-phosphate dehydrogenase Urinalysis with microscopic examination Stools O&P X4 with Giardia antigen and Cryptosporidia smear (acid fast) Stool C & S X1 (Salmonella, Shigella, Campylobacter, Yersinia) Liver enzymes (SGOT, SGPT) PPD (Mantoux test for tuberculosis) Rickets screen (Alkaline phosphatase, Calcium, Phosphorus) Lead levels Syphilis serology (RPR, FTA-ABS) Hepatitis B screening HIV serology Thyroid function tests (Free T4, TSH) Metabolic screen (PKU, Galactokinase, Biotinidase, etc.) Bone age x-rays (as needed) Neurologic and ophthalmologic specialty exams based on physical examination Hearing and vision evaluations (especially in premature infants) Developmental evaluation DEVELOPMENTAL EVALUATIONS The focus of the first examination is developmental. Children adopted from abroad who have lived in foster care or orphanages may be developmentally delayed. Often consistent nutrition and care, and a loving home can facilitate a child's development. After a 6-8 month transition period, several developmental screening examinations are conducted to assess the child's level. Referrals for early intervention are made after a sufficient time for adaptation and naturalization is allowed. IMMUNIZATIONS Immunizations are offered and encouraged since the past medical history of adopted children is not easily verified. An Immunization Chart is established for each child and included with the referral / consultation letter. CONSULTATION LETTERS To the parents and pediatrician of record, we send a detailed letter summarizing the history and physical, the developmental exam, the results of screening tests, and any recommendations for on-going treatment for the child's care. The letter also summaries management strategies prescribed for the more common medical problems associated with international adoption such as scabies, lice, anemia, parasitic infection, rickets, TB infection, failure to thrive, and developmental delays. Feeding is a major focus of the initial medical evaluation and recommendations are reviewed in the letter. Letters are also prepared to document any medical diagnoses in the process of substantiating parental leave from jobs as well as for health insurance companies requiring documentation for reimbursement. Referrals for paediatric sub specialists are also recommended as needed. FEES *Fees are quoted in Canadian funds ~ Review of video / photograph: $200 ~ Pre-adoptive interview & discussion of material provided: $200 ~ Post-adoptive medical assessment: $200 (Paid by OHIP once child obtains coverage) ~ Ongoing assessment and follow-up: Most services are covered by OHIP. Fees vary if no OHIP coverage is obtained depending on service required The Canadian Clinic for Adopted Children 2338 Hurontario Street, Suite 200, Mississauga, Ontario, L5B 1N1 Canada. Telephone: 905-848-8303. Fax: 905-848-5727 e-mail address: asimone@thc.on.ca |
