Otherwise, you'll often have to start from scratch, using the Red Book catch-up schedule. Note, however, that there is no pertussis coverage for children aged 7-11 years. One alternative is to use Tdap off-label. “You sometimes have to fight with the insurance company,” Dr. Springer said. “They say, 'You gave it at the wrong age.' And you say, 'Would you rather pay for pertussis?'”
Among the common psychosocial issues likely to crop up in this visit are the following:
▸ Malnourished youngsters may hide food in their pockets, their beds, or even their cheeks. They also may eat ravenously. Dr. Schulte's advice: Let them have as much food as they want so that they will lose their fear of scarcity.
▸ Some children are affectionate with everyone because they are so starved for attention. They must learn to distinguish between strangers and family.
▸ Some are stubborn or angry, testing to see whether their new families really want to keep them. Parents must simply insist that they will always be there for these children.
▸ Other children may cling to one parent, crying uncontrollably if left for even a minute. Dr. Schulte advised helping these children by playing with them on the floor until they let go, then getting up to leave, promising to return and fulfilling the promise each time. Caregivers can start with separations of a couple of minutes, then gradually increase the interval.
▸ Adopted children may not sleep well. Because they often fear abandonment, Dr. Schulte advised against using “cry-it-out” technique to teach them good sleep patterns.
▸ Many children rock themselves or display other self-stimulating behavior which they embraced because they did not get any other stimulation.
▸ Internationally adopted kids have elevated rates of schizophrenia, bipolar disease, fetal alcohol syndrome, attention-deficit/hyperactivity disorder (ADHD), and a host of other mental illnesses.
So after that first visit, see the children often. Many will grow swiftly, catching up to their normal height, overcoming emotional challenges, and recovering from illnesses. Others will need years of special education and other support.
Dr. Springer and Dr. Schulte said they had no conflicts of interest to report, but they did discuss an unapproved/investigative use of the Tdap vaccine.