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Off the Charts

Some pediatricians dismiss the notion that adoptive infants have special medical needs, but try telling that to the parents of a Chinese-born baby who has oral motor dysfunction.

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"I looked at the video a lot. I looked at it four times. Let's talk about Marina," says Dr. Jane Aronson, one of about a dozen pediatricians in the country who specialize in adoptive children. She's letting me listen as she talks via speakerphone from her Upper East Side office to an American couple in London. "Admitted to orphanage at 3 months," Aronson, who has a grown-into handsomeness and self-assurance, reads from the file on her desk. "They call her name and she doesn't answer, but a lot of children living in orphanages don't know their name. I'm not inclined to get excited about that. Now, the problem is, the chart doesn't have all her measurements."

"Take a deep breath," the man is telling his wife on the other end of the line. Aronson may be about to suggest something they don't want to hear, namely that 8-month-old Marina and 3 and 1?2-month-old Natasha, both in Russian orphanages, present sufficient problems -- physical, emotional, developmental, and God knows what else -- to make them injudicious choices for adoption.

The couple have been down this road a few times, so they already know about the possibility of fetal alcohol syndrome (one of the reasons Aronson scrutinized the tapes of the babies so carefully -- and why she's so frustrated that there's no close-up of Natasha's face). They know that the little girls could have conditions not recorded in their medical reports. And by now they surely know that children lose one month of growth and development, doctors like Aronson estimate, for every three months spent in an institution.

"You need to know you're not going to get a child for a few months," Aronson tells the couple. "But it's not bad that you have to provide the proper resources to help her catch up. That's your job as parents, to boost them up."

As she sees it, Aronson's job is to help parents process such information, to cheer them on, and to be there for the long haul. She greets 5-year-old Emily Mair, who's been her patient since she arrived from China not long after her 1st birthday and is here for a flu shot. "Where's my little girl? Where's my little weed?" she says. "Ems, did Mommy tell you what was going on today? Do you want me to give you the medicine out here in the waiting room? The Band-Aid is very important, so let's pick a nice one," she says, wielding the syringe. "What a good girl you are, the best girl!"

In 1989, 8,102 immigrant visas were granted to orphans. Last year, the figure was 18,441, to some degree a reflection of the number of older couples who'd put career before conception for too long. New York State has the most international adoptions -- 1,200 or so per year, the majority in Manhattan and environs. The numbers show no sign of letting up, and that keeps adoption pediatricians like Aronson, Michael Traister, and Andrew Adesman very busy.

Not long ago, parents considering international adoption were pretty much on their own when it came to risk assessment. There was next to nothing in the medical literature about the special needs and the particular health issues -- HIV, TB exposure, syphilis, hepatitis B, malnutrition, parasites, sensory deprivation -- of children housed in institutions abroad. "There was a heightened concern," says Adesman, director of adoption evaluation at Schneider Children's Hospital in New Hyde Park, "because so many families thought that a little bit of love would fix everything."

Armed with brief videos (often murky), medical histories (often incomplete and misleading), and intuition, adoption pediatricians form their own picture of a child. Then they wait for the question they know will come: Should we go for it?

"I don't tell anyone to adopt or not to adopt -- not my job," says Aronson, and like most of her colleagues, she's adamant on the subject. "Never will do it, never have done it. I don't like my words to have the kind of impact that dictates destiny." She will, however, rate referrals as average, mild, moderate, or extreme risk. ("No risk" does not exist in her hierarchy.) The Russian orphan Marina, for instance, is an average risk but because of her small head circumference is in the bottom 50 percent of the category, tipping into mild.

"I make sure they understand we can only deal with the information that's provided," says Traister, a slightly shaggy-looking Upper West Side pediatrician who's become a sort of de facto expert on baby girls adopted from China. "I tell them it's a leap of faith."

"Adoption pediatricians think of stuff you wouldn't know to ask," says novelist Karen Moline, who sought Aronson out after hearing her speak and was duly impressed that she had a Vietnamese growth chart. "Jane would know the special situation of a child adopted from an orphanage."

Some pediatricians question the need for such specialists. "Most of us can handle these things," sniffs one physician who requested anonymity. "We read about the stuff. It's not a hidden science."

But Traister, who in addition to his adoption work does general pediatrics, begs to differ. "There is a different type of neglect with these kids," he says. "You can't always trust the vaccination records that these kids come with, so we'll frequently repeat the immunization. Most pediatricians would probably accept the cards and they wouldn't necessarily do the blood tests for hepatitis B and C. They'd accept at face value that the kid looks okay."

"Some pediatricians think I may be stealing patients," says Aronson, who adopted a Vietnamese baby last year. "Lots of generalists will be very educated, but you have to know your limits. Adoption medicine is not just doing the labs on the list in the Red Book of Pediatric Infectious Diseases.

"How many pediatricians know the ins and outs of oral motor dysfunction, a common result of bottle propping and feeding babies from bottles with large holes in the nipple?" she wonders. "They wouldn't know why a kid is staring at his hand all day long" (because he's been wrapped in multiple layers and sees only his hands for months). "A pediatrician may think it's autism if he sees a kid who's banging his head or rocking, and we know that this may be a kid who's stimulating himself because he's bored. We are fine-tuning the epidemiology of children adopted from abroad."

In so doing, Aronson adds, "I'm helping children find parents and helping families be created. What drives me is that thought, Another family. How wonderful for them."


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