Adopting from Russia - Medical Evaluation Information

<<  Evaluating a referral

Here are some guidelines for evaluating an infant, provided by David Hall of FRUA San Antonio:

I would much prefer to see a doctor do the evaluation than a parent. Doctors know what they are looking for and can adapt when things go different than what they expected.

If you are planning to use any of my suggestions, please check them out with your pediatrician before you go. He or she would be able to tell you more specifics of what to look for.

This is an evaluation for an infant. I have not put much thought into evaluating a toddler, but it would be quite a bit different.

The doctors who do this professionally all seem to realize that do-it-yourself screening is not recommended - even for themselves for their own children. The reason is that you will be seriously emotionally involved and might overlook something on a cutesy baby that is significant to that child's future health. Having said that, our adoption system is putting us in the place of being the screener. I suppose it is better to be armed with the tools even if you don't have the medical background and follow-up training to use them. I must say that I am an engineer, not a doctor.

The Denver Developmental Screening Test is a place to start. You should be able to get that from your pediatrician. The only one I've seen looked like a bad copy of a blueprint. Someone needs to transcribe it to a website? Unfortunately the best way to view it is by unrolling it and rolling it. It covers all the developmental activities that children should be able to do at various ages 0-6 years old. There are professionals who do nothing but psychological testing using this test, so it's not a trivial thing to use.

What else can you do? Start with a naked baby (have one of your own diapers ready). The easy thing to do is look for deformities and birthmarks. Look for malformed genitals. Boys will not be circumcised, so be aware of that. For a girl, nothing outside or inside the vagina should look reddened or raw. There should be a small opening. Put the baby on it's tummy and look at the back of the legs for creases where the knees bend and at the buttocks. The creases should be the same on both legs. If they are not, the baby might have a hip problem which tends to make him/her favor one side or the other. While the baby is on its tummy, run your thumbs up the spine checking for unusual curvature. Turn the baby over and see if it has painless full range of motion with arms and legs.

Check the hands to see if he/she clenches and unclenches the fist. You want both. Give the child a rattle to hold and see how he grabs it. While he has one toy, give him another and watch how he figures out this dilemma. Does he reach equally with both hands? Can he pass the toy from one hand to the other? Can he find the toy if he drops it? It is normal for the toys to go into the mouth, and it would be abnormal if toys did not go into the mouth sometime. If you have a flashlight, shine it into one eye and watch the pupil constrict; then do the other eye. The speed at which the pupil constricts and dilates should be the same for each eye. And the baby should show some realization at having had a light shined in its eyes. Hold the light about 18 inches away from the baby but not shining it his eyes and slowly move it across from left to right and back. The baby's eyes should track the light together without crossing or drifting relative to each other. While you're doing all this, listen for vocalizations and watch for smiling. Both are good. Okay, turn off your flashlight. Have your spouse stand on one side of the baby and clap hands one time. The baby should turn eyes and face toward the direction of the clapping. If not, try again and try doing it on the other side. If the child cannot find the source of the sound, he might have a hearing problem.

Look closely at the face and head. The head should be perfectly symmetrical left to right. Rub your hands over the entire skull (including under the jaws) feeling for bumps and flat spots. During the first year the cranium changes shape dramatically, so this is more of an orientation for you rather than a diagnostic tool. The hair, if there is any, will normally lack luster and body. After changing to an American diet the hair will completely change texture, body, and appearance. The eyes should be on the same level and same depth. The distance between the eyes across the nose should be about the same as the opening of the eye itself. If this distance is unusually wide between the eyes, it could indicate fetal alcohol syndrome. The white part of the eyes should be white, not red, pink, gray, or yellowish. The iris, the colored part of the eye, should be flecked with multiple colors if you look VERY closely, but there should not be a brown, gray, or yellow ring around the outside of iris.

Ears should be same height on the head and look the same left to right. Lobes might be attached or detached, but both should be the same. Make sure both ear canals are properly located inside the ear and they are unobstructed. You won't have the tools to examine the ear drums, so don't worry about that. The nose should look normal with two separate and distinct nostrils. Look for the ridge on the upper lip between the center part of the nose and top lip. Lack of a ridge is another indication of FAS. Push the top lip up to see that the upper palate is completely formed and closed in the middle. Cleft palate is relatively easily treated in the US, but you want to know what you're dealing with during this evaluation.

Give him a baby bottle and see if he can aim it at his mouth and connect on the first try. See if the baby will crawl or even stand up. Some stand even before coordinating the crawling motion. Can he do the push-up needed to get into crawling position? Do both legs cooperate equally? Does he look around painlessly (I'm thinking neck here). Can he sit up? Can he go from crawling position to sitting and back again? Okay, now pick the baby up and hold it in your arms. It should be somewhat curious about your face and, for women, your jewelry.

This list seems long, but there's more I'm sure. As I said, I'm an engineer, so doctoring isn't my bag. I've gleaned all this from listening to and watching doctors with my girls. Now what do you do after this examination? Beats me! Probably you'll go with your gut feel for what to do. You couldn't possibly do this with more than a few children as it would take too long.

Take notes and report back to your pediatrician when you return. Beyond that, I would say take lots of videotape and pictures while you are doing the exam. Bring those home with you and send them off to the normal doctors and to your own pediatrician to let them look. Nothing's final until you go to court.

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