Almost immediately after Yvette and Paul Hubbman brought their adopted daughter home from Russia, they made some puzzling discoveries: Louise avoided making eye contact. She got upset when they left the room. She had no interest in eating solid foods. She rocked herself to sleep by kicking her tiny legs.
But most troubling of all, their precious little girl who was born prematurely and spent all of her life in a state orphanage in St. Petersburg made none of the babbling or cooing sounds you’d expect from an infant.
Less than two weeks later, the Hubbmans found themselves at a pediatric clinic in St. Louis that specializes in caring for foreign-born adopted children. The couple’s 2-year-old son, Nicholas, who also was adopted from Russia, already was a patient.
“We notice she’s a lot less easygoing than Nicholas,” Paul Hubbman said at the time. “She’s noisy, very vocal.”
The clinic at SSM Cardinal Glennon Children’s Hospital has been a godsend to the Hubbmans, providing pediatricians who understand Louise’s behavior and know what treatment is best for her, all the while calming her parents.
The Foreign Adoption Clinic and Educational Services draws patients from Missouri, Kansas, Iowa, Nebraska and Illinois, and routinely tests each child for anemia, rickets, parasites, lead, HIV, hepatitis B and C, congenital syphilis and tuberculosis. Children are vaccinated and evaluated for physical growth and brain development, as well as nutrition and sleep habits.
The Hubbmans — he’s an architect, she’s a teacher — were concerned that Louise may have been exposed to liver-destroying hepatitis C, a worry because it’s often accompanied by the HIV virus. But Louise’s tests were negative.
Several weeks after arriving in St. Louis, 1-year-old Louise is eating Cheerios, smiling at mom and dad and, her mother said, “a whole lot happier.” Antibiotics are working to clear up her ear infections and she is wearing corrective lenses for an astigmatism.
Louise didn’t like solid foods, doctors told the Hubbmans, probably because she wasn’t accustomed to it, having been only bottle-fed at the orphanage.
Dr. Jennifer Ladage, an assistant professor of pediatrics at Saint Louis University School of Medicine who founded the clinic in 2000, said she will monitor Louise’s physical growth and brain development in the coming months and check her language progress.
Some pediatricians, psychologists and school districts blame poor language skills on the challenges of switching to English, Ladage said. But pediatricians specializing in foreign-born adopted children attribute it to hearing loss or worse, abnormal brain development.
It wasn’t long after Ladage brought home the first of her own three adopted children from China that she realized the complex medical and emotional issues she would have to help him overcome. Her son, Alex, had severe rickets and a cleft lip and palate. He would be, at turns, friendly, mistrusting and uncomfortable around new people or situations.
Ladage opened the clinic in response to her own frustrations.
Children adopted from foreign countries often have unique illnesses and problems that have made caring for them a pediatric specialty that has developed over the last 15 years. Roughly 50 international adoption clinics exist nationwide.
The need for this specialty also was made clear to pediatrician Julia Bledsoe when she adopted a son from South Korea. “I decided this is what I wanted to do,” said Bledsoe, who works for the university’s fetal alcohol syndrome clinic and in 1998 founded the Center for Adoption Medicine at the University of Washington Medical Center in Seattle. Fetal alcohol syndrome turns up in some adopted children, both domestic and international.
Through pre-adoption consultation, Bledsoe helps prospective parents determine if the child is at high risk for certain medical problems. She said the University of Washington has developed a way to evaluate facial features for evidence the child was exposed to alcohol as a fetus.
“I’m also on call when families travel,” she said. “Last night I got a call at 1 in the morning from India. It’s kind of a pain, but if kids are sick, at least (the parents) are not hanging out there in the breeze.”
Malnutrition, developmental delays
The most common ailments she sees are malnutrition and developmental delays, as well as intestinal parasites, low blood counts, anemia and elevated lead levels. Bledsoe has seen a drop in the number of children with HIV and hepatitis — a credit, she says, to orphanages having access to adoption funds to buy sterile needles.
During an initial exam, Bledsoe screens for neurological development, knowing that interacting with a parent or caregiver in the first months of life helps stimulate brain functions.
“Lying on your back looking at the ceiling for days is not good for brain development,” Bledsoe said. “But I’ve seen kids come back from horrendous conditions.” She calls them the “resilient rascals” whose brains grew with love and stimulation once they were adopted.
The International Adoption Clinic at Floating Hospital for Children, Tufts-New England Medical Center, does long-term research on the well-being of orphans in Russia and those who have been adopted. The Boston-based clinic also runs a Big Sisters humanitarian program that matches young Russian women with orphans for four hours a day, said director and pediatrician Laurie Miller, who founded the clinic in 1988.
“Everyone knows about the need to assess for infectious disease,” Miller said. “What’s becoming obvious is the developmental, emotional and behavioral issues. Our goal is to identify problems early ... and try to intervene.”
Ladage said up to 15 percent of her patients test positive for latent tuberculosis infections. Many are undersized for their age and anemic. Most are developmentally slow. Children typically lose one month of development for every three months they spend in an institution, she said.
But it’s the behavioral and emotional issues that can be most challenging.
Mothers in impoverished countries may not have access to adequate, if any, prenatal care. Some moms may be malnourished, may have used illicit drugs or alcohol, or had an infection during pregnancy, Ladage said. Their babies may spend their first months in orphanages where limited staff and resources deprive them of adequate nutrition or physical and mental stimulation.
That can lead to abnormal neurological development which, in turn, can result in emotional, behavioral and learning problems, Ladage said.
She said an estimated 5 percent of adopted children have severe behavioral problems, and many are prone to depression and anxiety. Such children are more difficult to nurture and do best with highly committed parents who are willing to make sacrifices to give them consistency and security.
“They’re an extra emotional burden, but they do make progress,” Ladage said, recalling that Alex, now 9, couldn’t sit through a haircut without being held down and still can’t tolerate clothing tags rubbing against his neck.
Alex has since graduated to orthodontic work without incident, she said.
Parents simply need to go into adoption with their eyes open.
“At some level I’m rooting for every one of those kids,” said Dr. Matthew Daley, a pediatrician who runs the International Adoption Clinic in Denver. But, he added, “parents have to be comfortable with potential risk.”