TB infections among international adoptees rising: study

From the Globe and Mail. An interesting article that all adoptive parents should read..

Jen' s doctor has agreed to take on Gertrude as a patient. Once we get our referral and have our travel dates, we'll book an appt with the doctor immediately after our return from China.

TB infections among international adoptees rising: study

HELEN BRANSWELL
Canadian Press
September 4, 2007 at 6:53 AM EDT

TORONTO — Tuberculosis infection rates among international adoptees to the United States has risen dramatically over the past 20 years, according to new findings which add weight to a call for Canada to screen all incoming adoptees for the disease.

The American study followed up on 869 foreign-born children adopted into U.S. families from 1986 through 2001. Twelve per cent of the children were infected with tuberculosis and the rate of TB infections among the adoptees rose 7 per cent with each passing year through the period studied.

“These kids are getting infected very, very early in life,” said lead author Dr. Anna Mandalakas, who runs the adoption health service at Rainbow Babies and Children's Hospital in Cleveland, Ohio.

“So during this first two years of life if they're in an orphanage, a huge number of these children are getting infected.”

The authors of the study, which was published Tuesday in the journal Paediatrics, say the findings support the current call from the American Academy of Paediatrics that all international adoptees undergo a skin test for tuberculosis immediately after adoption.

Two Canadian tuberculosis experts recently urged that TB screening policy for international adoptees be instituted in Canada, suggesting in a commentary in the Canadian Medical Association Journal that provinces and territories should follow up with adoptive parents to ensure these children get timely and thorough testing.

TB rates among the children in the American study ranged from nearly 15 per cent in adoptees from Eastern Europe, 14 per cent from Russia and 13 per cent from Korea to between 12.5 per cent and 11 per cent in India, China and South America, 8.3 per cent in Central America and the Caribbean and 2.8 per cent in Southeast Asia.

Canadians routinely adopt children from these same regions or countries, some of which have among the highest rates of tuberculosis globally. According to Citizenship and Immigration Canada, an average of 2,000 children a year are adopted into Canadian families from abroad.

The medical examination required of immigrants to Canada isn't geared towards detecting latent tuberculosis infection or TB disease in children under 11 years of age, Dr. Richard Long and co-author Jody Boffa of the tuberculosis program evaluation and research unit at the University of Alberta wrote in the Canadian Medical Association Journal earlier this summer.

But given the risk faced by international adoptees, this special group ought to be screened, Dr. Long and Ms. Boffa suggested. Their commentary noted that four in 10 foreign-born children under the age of five found to be infected with tuberculosis in Alberta between 2004 and 2006 were international adoptees.

Dr. Long said children infected with latent or even active TB don't pose a risk to others, because children under nine or 10 years of age rarely transmit disease. But the infection is a real threat to their own health, he said in an interview.

Infection with Mycobacterium tuberculosis, the bug that causes TB, doesn't always lead to active disease. In many people the bacteria remains latent. Infected adults have about a five to 10 per cent chance of developing active tuberculosis some time in their lifetime.

With young children, however, the risk that infection will lead to disease is much higher. Infants under a year have a roughly 50 per cent chance of developing disease and children aged one to two have a 20 per cent chance. And if active TB develops, it can progress beyond the lungs, the typical site of disease.

“Little children not only have a higher risk of getting disease from infection itself, they're at higher risk of getting severe forms of disease — and by severe forms I mean central nervous system or disseminated TB,” said Dr. Long, who also serves as Alberta's medical officer of health for tuberculosis.

A TB expert at Toronto's University Health Network agreed.

“They're a relatively small population, but they're a really high risk population,” said Dr. Michael Gardam, who is head of infection control for that network of three central Toronto hospitals. Dr. Gardam was not involved in either the study or the commentary.

“Because these kids are not coming from healthy, happy homes. They're coming from environments where they're very likely to have been exposed to tuberculosis. And I think it makes perfect sense to be screening them.”

Both Dr. Mandalakas' study and Dr. Long's commentary recommend the screening begin swiftly after an international adoptee arrives in his or her new home.

And both recommended that the initial skin test be followed up three to six months later with another. That's because a test performed immediately after arrival might not detect an infection that occurred shortly before a child left an overseas orphanage.

Children who test positive should be put on a nine month course of antibiotics, Dr. Mandalakas said. She also suggested orphanages involved in international adoptions should test for tuberculosis among employees.

Do's and Don'ts on attachment

Here is another post of DO's and DON'Ts on attachment. This comes fromanother adoption website I was browsing. There seems to be some good points in this article.

Do
1. Trust the parent's instincts. Even a first time parent may notice subtle symptoms that well-meaning family and friends attribute to "normal" behavior.
2. Accept that attachment issues are difficult for anyone outside of the parents to see and understand.
3. Be supportive even if you think everything looks fine to you.
4. Allow the parents to be the center of the baby's world. One grandparent, when greeting their grandchild, immediately turns him back to his mom and dad and says positive statements about his good mommy and daddy.
5. As hard as it may be for you, abide by the requests of the parents. Even if the baby looks like he really wants to be with Person X, for example, he needs to have a strong attachment to his parents first. Something as simple as passing the baby from one person to another or allowing others, to hold a baby who is not "attached" can make the attachment process that much longer and harder.
6. Accept that parenting children who are at-risk for or who suffer from attachment issues goes against traditional parenting methods and beliefs. Parenting methods that work for many children can be detrimental to a child with attachment issues.
7. Remember that there is often a honeymoon period after the child arrives. Many babies do not show signs of grief, distress, or anxiety until months after they come home. If the parents are taking precautions, they are smart and should be commended and supported!

Don't
1. Assume an infant is too young to suffer from emotional issues related to attachment. Babies are not immune.
2. Underestimate a new parent's instincts that something isn't right.
3. Judge the parent's parenting abilities. What looks like spoiling or coddling may be exactly what the child needs to overcome a serious attachment disorder. Parenting methods that work for many children can be detrimental to a child with attachment issues.
4. Make excuses for the child's behaviors or try to make the parent feel better by calling certain behaviors "normal". For example, many children who suffer from attachment issues may be labeled strong-willed by well-meaning family members. While being strong-willed can be seen as a positive personality trait, this type of behavior in an attachment-impaired child may signify problems.
5. Accuse the parent of being overly sensitive or neurotic. They are in a position to see subtle symptoms as no one else can.
6. Take it personally if asked to step back so the parents can help their child heal and form a healthy and secure attachment. You may be asked not to hold the baby for more than a minute. This is not meant to hurt you. It is meant to help prove to the baby who his mommy and daddy are. Up until now the child's experience has been that mommies and daddies are replaceable. Allowing people to hold the baby before he has accepted his forever mommy and daddy can be detrimental to the attachment process.
7. Put your own timeframes on how long attachment should take. One mother was hurt when she was chastised by a relative who couldn't understand...after all, the baby had been home six months. It could take weeks, months, even years. Every child is different.
8. Offer traditional parenting advice. Some well-meaning family members will tell a new parent not to pick the baby up every time he cries because it will spoil him. A child who is at-risk or who suffers from attachment issues must be picked up every single time he cries. He needs consistent reinforcement that his mommy & daddy will always take care of him and always keep him safe.
9. Fall into the appearance trap. Some babies/toddlers with attachment issues can put on a great show to those outside of the mother/father. What you see is not always a true picture of the child. Even babies as young as 6-months-old are capable of "putting on a good face" in public.
10. Lose hope. With the right kind of parenting and therapy, a child with attachment issues can learn to trust and have healthy relationships. But it does take a lot of work and a good understanding of what these children need.

Understanding what the babies go thru / attachment issues

Here’s some great reading on what the babies go thru. We can only imagine what we think the babies are going thru in their early days of life but articles like this help us to better understand what they truly go thru.

The article and more about attachment issues with adopted children is HERE

One cold early Spring morning a beautiful, healthy baby girl, 3 days old, wakes up to find herself alone on a deserted street, hungry and cold. Her mother does not answer her cries, and in fact no one responds for hours. The baby, increasingly agitated and distressed, screams with primal urgency. Eventually a stranger happens by, picks up the crying baby and delivers her to the police station. Through several more intermediaries, the baby is eventually delivered to the local social welfare institute.

Examined by a doctor and then wrapped in blankets and fed a bottle, she is deposited into a crib and left alone for much of the rest of the day. That night, no one comes to answer her frantic cries. More days go by, more cries unanswered. Feeding and diapering are administered on a rigid schedule, since the caregivers have so many babies to attend to, and there is minimal opportunity to be held, carried, or spoken to. Stimulation is limited to what the baby can see, hear and feel from her crib. Feedings are piping hot bottles of formula, propped for maximum efficiency, delivered through extra large holes in the nipple. Occasionally the baby's mouth loses its place on the nipple and the entire contents of the bottle pours onto her body. When that happens she misses her feeding, and her wet clothes aren't changed for another hour or more.

Eventually the baby stops crying altogether because she has learned that crying rarely draws anyone to her. She is often lonely and scared, especially at night. The sounds of other babies crying and in distress cause her great anxiety, which she learns to tolerate by shutting down and withdrawing deeper inside herself in an attempt to protect herself from the constant stressors in her environment.

One day many months later, the baby is bundled up and brought by bus to a city several hours away. She is handed to a stranger with just the clothes on her back and one bottle of prepared formula. Otherwise, everything of her old life has vanished in an instant. The stranger brings her to a hotel across town, where she is changed into new, peculiar smelling clothes. The stranger shakes a brightly colored rattle in her face. The baby's environment has gone from one of minimal stimulation to one of hyper stimulation; new sounds, new smells, new sights, new sensations, delivered in rapid fire sequence. The stranger tries to feed her a Cheerio, but the baby reflexively gags because she's never had solid food in her mouth. The stranger tries to bathe her in the sink but the sensation is unfamiliar and terrifying. The stressed baby, overwhelmed, sinks deeper and deeper into a state of shock and withdrawal.

And they lived happily ever after.

Myths About Bonding

Hi. I read this today and thought it was important for anybody involved in an adoption process to understand this. This is important not just for the parents, but also for friends and family to understand as they are also an intricate part of the baby’s life. This was stolen from another blog who stole it from a book called The Post Adoption Blues: Overcoming the Unforeseen Challenges of Adoption

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Myth #1: “I will immediately feel that this is my child.”

Everything we’ve heard about bonding tells us it’s supposed to be natural, spontaneous, instantaneous, and intense. I’ve had many parents tell me, “I saw a photo listing on the Internet and a picture of this sweet little girl just jumped out at me. I knew instantly that she was my child.”

While Super-Glue bonding does take place, more often than not, it doesn’t. And when a parent struggles, after weeks or even months, to feel any sense of connection with their child, everyone’s anxiety levels skyrocket.

Myth #2: “I will like this child.”

Of course we all plan to like our children. We are determined to like them. But many parents admit, “I love my child but I don’t like her.” The reluctance to like one’s child can occur when parent and child have different temperaments, personalities and life experiences (particularly in the case of an institutionalized child).

Myth #3: “If I maintain some emotional distance, I won’t get hurt.”

Guarding one’s emotions happens regularly with foster parents who are making the transition between fostering and becoming legal parents. During this taxing time, there may be custody issues, court appearances and stressful visits with birth parents. The adoptive parents begin to wonder, “Will I ever be this child’s parent?” They try to protect their feelings by erecting emotional walls between themselves and the child. (A note from Scott… this doesn’t really apply to us as we’re not fostering, but it still is a point worth mentioning)

Myth #4: “I will handle the changes in lifestyle that parenting brings.”

“Children are children: dependent, raw, impulse-driven small beings who need direction, time, and discipline. They are not little adults. They are not born with an innate sense of right and wrong. They are exhausting, lovable little creatures that make you nearly forget what life was like before they came to you.”

The day-to-day reality of parenting is very different – and extraordinarily more tiring – than what many parents envisioned, testing the mettle of even the most stalwart parent.

How to cope? Thankfully, the authors don’t just leave us hanging, but offer some helpful coping strategies. They include:

Know when to seek help. If you’ve given the bonding thing some time and you’re still feeling overwhelmingly sad, paralyzed or panicked, seek help.

Forgive yourself. Your decision to adopt was made in good faith and with good intentions. Give yourself a break. You don’t have to be Super Parent.

Prioritize your life. The addition of a child can shake your equilibrium. Spend some time setting priorities, determining how realistic they are and figuring out what adjustments you need to make.

Provide respite care for yourself. Spending 24/7 with your child and feeling frustrated because you aren’t bonding can make you feel even more frustrated. A parenting break – which could be as simple as a dinner out or as complex as putting your child in daycare – may be the fix you need to save your sanity.

Seek professional help through counselling. A counsellor who understands the dynamics of adoption and who is well acquainted with loss, grief and separation issues might be just the ticket. When looking for a therapist, the authors recommend asking “what therapeutic interventions are used, what the therapist’s background in adoption is, their philosophy of adoption and what contact with adoption they have had personally and professionally.” Local adoption professionals should be able to refer you to therapists who specialize in adoption issues.

Confide in someone who loves you. “Sharing the secrets of your heart takes away the secrets’ power.” Disclosing your shame, guilt and anger to a non-judgemental friend who validates your feelings may help get you over the hump.

Seek strength in spiritual renewal. Your faith is very likely what led you to adopt in the first place; call on it to help you cope with the stress and learn to truly love your child.