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Since 1991 there has been a 12-fold increase in the number of children placed for adoption in the US from the Peoples Republic of China (FY91=62, FY94=748). Counseling prospective adoptive parents about medical needs of these children is challenging since virtually no health information is available. Over a 36-month period, information was collected via direct examination (49%) or through a mail-in questionnaire (51%) from 154 Chinese children (98% F) adopted to the US. Children arrived at a mean age of 10.4±11.2m (range=1-104m) and had been living in orphanages for an average of 9.2±11.2m (range=0.75-100m). Of five tests for infectious diseases recommended by the AAP, 3.5% were HBsAg+ (n=143), 0% HIV+ (n=125), 0.8% VDRL/RPR+ (n=120), 3.7% positive for intestinal parasites [Giardia=2, Ascaris=1 (n=81)] and 1.4% PPD+ (n=71). An unexplained cluster of hepatitis C infected infants in Yangzhou was confirmed. Whole blood lead levels were<10 μg/dl in 90% of children tested (n=31) and 10-24 μg/dl in the remainder. Assessment of 19 infants in six areas revealed abnormalities in one or more areas of development in 68% of children-strength-63%, gross motor skills-58%, fine motor skills-42%, language-26%, social skills -16% and tone-5%. Delays usually improved rapidly after arrival. Stature was affected, with children falling behind one month of linear growth for each three months in the orphanage (r=0.82, p<.001). Rickets, a diagnosis made frequently in China, was not clinically obvious in any child, but alkaline phosphatase (AP) levels increased with age (p<0.05, r=0.38). Ca/P levels(9.4±4/5.0±.9) in children with high AP levels (474±37 U/L, range 326-587, n=7) were lower (p<0.001) than Ca/P levels(10.3±.3/6.4±.7) in children with lower AP levels (201±42 U/L, range 115-288, n=38). Chinese adoptees have few major medical problems on arrival, probably due to their young age and limited exposure to institutional care. Older Chinese orphans show more sequelae of orphanage life.

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Johnson, D., Traister, M., Iverson, S. et al. HEALTH STATUS OF US ADOPTED CHINESE ORPHANS. † 793. Pediatr Res 39, 135 (1996).

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