Your home - now what? Post adoption responsibilities.

Unless your child has pressing health issues, I suggest just hanging low, hunkering down and getting settled in. Allow your new little one to get comfortable in their new surroundings. And, of course you need to sleep off some jet lag and get your head back in the game.

Just when you thought all the paperwork is beyond you - not quite. I know... go ahead, kick something.

You'll want to bookmark this, because you will be lacking sleep and operational brain cells when you get home. You'll need someone to hold your hand through this....

First thing to do is to apply to your Provincial Health Care Provider to 'change' your account to add your new child.

Second thing is to fill out the Canadian Citizenship Certificate Preparation Form to have them send you the Citizenship Certificate. Note - you do require a passport photo.

Thirdly - you need to apply to the Federal Government to start receiving your Universal Child Care Benefit. The benefit will be back dated from the date you started fostering the child.

Last, but not least, once you get your certificate, you can apply for a passport.

If you have not already done so, by at least the 2 month mark of your entry to Canada, you want to start making appointments for check ups and assessments. (By now you should have your Health Card. IF you need to see a Dr. prior to receiving your card, you can call the Health Dept and ask for your number, or you can pay cash and be reimbursed later.)

Start by taking your little one to a family Doctor. Preferably of African descent, or someone with experience in Africa. Your Dr. will go over the history (be sure to bring all the medical records you have!), and concerns etc. Ears, throat, eyes, heart and lungs will be checked. Be sure you relay the following to your Doctor:

Important Information for Your Child’s Doctor

(Excerpt from healthychildren.org)

Children adopted internationally often have lived in conditions of poverty with limited nutrition, limited stimulation, various traumatic events, and environmental and infectious disease hazards. As such, a comprehensive evaluation is recommended by the American Academy of Pediatrics (AAP) to evaluate for diseases that may be present, with no initial signs or symptoms.

Below is a list of testing that is recommended for children adopted internationally, regardless of the absence of symptoms or test results from the child’s birth country.

Growth and Nutritional Issues

• Measure length, height, weight (unclothed), and head circumference (for ALL children). Use standard CDC or WHO growth charts to determine growth percentiles.
• Growth should be monitored with further work-up done if there is not catch-up growth by 6 months after arrival in the home.
• CBC to evaluate for anemia, blood disorders. Hemoglobin electrophoresis should be done for children at risk for hemoglobinopathies.
• Lead level for environmental risks.
• TSH (in some countries the soil is deficient of iodine).
• Newborn metabolic screen up to 2 years.

Infectious Diseases

• PPD or currently recommended testing for tuberculosis exposure (this should be done even if the child was immunized with the BCG vaccine; please refer to the Red Book for more information)
• Hepatitis B virus serologic testing: Hepatitis B surface antigen (HBsAg)
• Hepatitis C virus serologic testing
• HIV serologic testing
• Testing for tuberculosis, Hepatitis B, Hepatitis C, and HIV should be repeated after the child has been home 6 months. (Some children may not respond initially if the incubation period is inadequate or if they are malnourished.)
• Syphilis serologic testing: RPR or VDRL, and FTA-ABS or TPPA
• Stool examination for ova and parasites (3 recommended, best collected 48 hours apart) with specific request for Giardia and Cryptosporidium testing
• Stool bacterial culture (if diarrhea present)
• Serologic testing for other parasites such as Trypanosoma cruzi, lymphatic filariasis, Strongyloides, Schistosoma species may be indicated for certain children
• Evaluate immunization status by checking antibody titers for vaccines previously given (eg, diphtheria, tetanus, polio neutralizing titers) OR repeat immunizations. (Exceptions may include children from foster homes in Korea.)

So, you should be leaving the office with some requisition forms for these tests. You want to be sure that you also get a requisition for parasite screening for yourself and any other family members.

Parasite testing is extremely important! Parasites can cause irreparable damage. I do not know of one child from Africa without at least one parasite. They can test negative, and still be positive. If your child tests negative, it is recommended to be retested in a couple of weeks. Also, just because you have treated the parasite, does not mean it is gone. Retest and test. Yes, speaking from experience here.

Next, you want to contact your local Public Health Office. Tell them you have a newly adopted child and would like a general appointment to get his/her weight/length/head circumference documented and to speak with someone about other possible assessments that may be needed (ie. speech, dental, hearing etc.

If you have the blood work back and a vaccine history, then you can consult with your public health nurse about a recommended vaccine schedule.

Next, you will want a development assessment. Public Health or your SW should be able to refer you to the right early intervention department. Public Health may even be able to do an ASQ (Ages to Stages Questionnaire) at their office. Here in the Kootenays, it is within Kootenay Family Place. This is good to have EVEN if you think your child is on schedule. It's good to have it documented, and it will be used in your Post Placement Report.

In the Kenya program, Post Placement Reports are due every 3 months for 2 years, and every 6 months for the following 3 years. (First 2 years are overkill I think... but I appreciate their thoroughness.) This involves a Social Worker visiting, interviewing you and then sending a report to your local agency who then forwards it to Kenya.

There are many things on the list of items they are supposed to cover, so it would be super helpful (and important) that you have the following available.

1. Child's current vaccine card.
2. Growth Chart
3. Results from any and all blood/stool tests.
4. The Development assessment.

Nice to include:
5. Current photo of your child
6. Picture drawn by your child (will be great for comparison to the upcoming reports.)



Z's drawing. We are learning about circles - so this is what she likes to draw.

At first, I did think this was all overkill. Being a seasoned Mom, I know that Z is healthy and developing within the normal ranges (and in fact she is well over her avg. growth range.), so I didn't really feel this was necessary. However, I think it can only be beneficial to have this documented 'officially' by professionals, rather than just my opinion, and I am very curious what her development score will be.

We are behind in our appointments as we didn't know what was required (Why I am preparing you! I hate being behind the 8 ball!). I will report back with more details of the Public Health/ ASQ visits when they are through.

Good Luck, and Congratulations on bringing your little one home!