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Post-Arrival Issues |
Baby's Home...
Now what do you do?
Bringing your baby home, whether you got him/her from your local airport
or went to Korea yourselves, is going to be a day long remembered by you and your family.
But after the toes are counted (and those bluish, bruise-like Mongolian
spots accounted for -- 80% of Asian children have these birthmarks which generally fade
after age 2) and you've soaked in that baby fresh smell, the real work of parenthood
begins. And those of us who adopt internationally, have even more ahead of us.
Click here for our Korean Boys/Girls
Growth Charts on pdf
So here we go!
MEDICAL ISSUES:
First Things First -- Baby's First US
Pediatrician Visit
(You'll want to decide on a pediatrician before Arrival Day. Remember,
if you're not satisfied with your child's physician, you can always change healthcare
providers at a later date. But for now you'll want your child seen by a US physician
within a few days of his/her arrival.)
Most likely, beyond the usual bottles and diapers, your baby also came
with a Pre-flight Report on the baby's general health and condition as
well as his/her immunization chart and other pertinent medical data. Take these and any
other medical information you received and make photocopies for your pediatrician. These
papers will form the basis of your child's medical history. Bring them with you, along
with any photos, for the first visit.
Your agency
will also give you a formal/notarized letter giving you and your healthcare provider
permission to treat. Give the doctor a copy of this for your child's file. Keep the
original for yourself.
If you already have children, you know the drill. If you're a first-timer,
here's an idea of what you can expect for baby's first visit (if your child has
special needs, you and your doctor will discuss whatever specific care and treatment is
required.)
- Measurements: length, weight, head circumference, age in
months/weeks
- General health: doctor will examine ears, eyes, nose, throat and listen
to the baby's heart... examine genitals... assess color and muscle tone... check for
symmetry of arms, legs, hip placement... previous illness, surgeries...
- Overall development: the doctor will be looking for age-related
milestones, e.g. can the baby lift head while on tummy, sit unassisted, grasp with hands,
etc.,
- Diet and nutrition: doctor will want to know how and what the baby has
been eating, any allergies noted, any vomiting/diarrhea or constipation
After the initial assessment, your doctor will discuss ongoing nutrition,
developmental milestones, immunizations -- all the usual stuff of babyhood. He/she will
most likely have several questions about the adoption in general and in what environment
the baby was raised. (Our physician seemed very knowledgeable about Asian physiology and
genuinely pleased to see what good shape our son was in.)
Special Issues:
- Insurance Coverage: your agency will give you some sort of official
and/or notarized forms to be given to your health insurance carrier confirming that the
child lives with you and your family and that you accept full responsibility for the
child's medical care. Your insurance company may or may not require it to put your child
on the policy. Keep it anyway.
- Circumcision: infant boys are not routinely circumcised in Korea and
the US rate of circumcision now falls at about 60%. If you choose to have your son
circumcised, you may want to have the procedure done by a pediatric urologist since most
of us are adopting at the post-newborn age. Speak to your pediatrician about what this
entails. Note that since this is considered elective surgery your insurance may not cover
it. Check your policy. You may also want to speak with your agency to see if you need
formal permission to have the procedure performed as they remain your child's guardian
until the adoption is finalized. (Please note that
circumcision is a highly personal decision that should be discussed with your
pediatrician. More and more American families are choosing not to circumcise
their sons unless there is a medical reason to do so.)
- Mongolian Spots: you'll want to have these birthmarks noted and
documented in your child's medical file. As they strongly resemble bruises, you'll want
all physical caregivers of your child (including grandparents, babysitters, daycare
personnel) to be aware that your child, and most Asian children, have them and that they
are of no concern.
KOREAN GROWTH CHARTS - These charts cover boys
and girls, from Birth through Year 18.They are in Adobe Acrobat PDF format. Just print
them out. If you don't have the PDF Reader, click the button below and get one FREE
from Adobe - works with all platforms and operating systems. Click
here for the Charts Page!
Medical Insurance - What you
need to know!
These are the federally-mandated guidelines your medical
insurance carrier must abide by. (My thanks to Kim Breuer, adoptive mom par
excellence, for providing this for Adopting from Korea.)
THE OMNIBUS BUDGET RECONCILIATION ACT OF 1993:
Subtitle D-Group Health Plans
Sec. 4301, Standards for Group Health Plan Coverage
© Group Health Plan Coverage of Dependent Children in Cases of adoption
Coverage effective upon placement for adoption:
In any case in which a group health plan provides coverage
for dependent children of participants or beneficiaries, such plan shall
provide benefits to dependent children placed with participants or
beneficiaries for adoption under the same terms and conditions
as apply in the
case of dependent children who are natural children of participants of
beneficiaries under the plan, irrespective of whether the adoption has become
final.
Restrictions based on preexisting conditions at the time of
placement for adoption prohibited:
A group health plan may not restrict coverage
under the
plan of any dependent child adopted by a participant or beneficiary, or placed
with a participant or beneficiary for adoption solely on the basis of
preexisting condition of each child at the time that such child would
otherwise become eligible for coverage under the plan, if the adoption or
placement for adoption occurs while the participant or beneficiary is eligible
for coverage under the plan.
AT HOME:
Settling in --
Putting You and Your Baby At Ease
When you're finding yourself totally sleep-deprived and totally besotted
with your baby -- boring everyone in sight with stories of every little cute thing your
child does -- welcome! You've joined the ranks of official parenthood.
But there are adjustments, some easier than others. And every member of
your family -- you, the baby, to the family pet -- will continue to make them. Most
agencies require that one parent remain home some length of time, ranging from a minimum
of 6 weeks to a few months. So while you're home and enjoying getting to know your new son
or daughter, here are just some of the major adjustments you'll be looking forward to:
- Time change: your baby has flown 12-17 hours to be with you. His/her
body clock is going to be waaaay off. He'll be hungry at odd hours. She'll want to play
when you want to sleep. Just try to get as much rest as you can and know that this
adjustment won't last forever. While many babies transition easily (our son took about 3-4
days), others may take a few weeks. Rule of thumb -- one day for every time-zone crossed,
more or less.
- Eating/diet: while pediatricians in this country don't like to see
solids introduced much before the 6th month, chances are your child has already been
eating solids (among other foods) in Korea well before then. (At 5-1/2 months, my son
was eating cereal, bread, orange and apple juice, and cookies! as well as formula.) I've
kept the cereal and apple juice and nixed the bread and cookies for now. Work with your
pediatrician on this. You might want to experiment with different formulas, soy and
milk-based to see how your child responds.
Note: if your child eyes your meal with obvious relish, he/she just
might be ready for something more substantial than formula. My son practically salivated
while we ate dinner!
- Sleeping: the bane of every parent since dawn began and everyone's got
their own theories. But just briefly, you can expect many late night/early am
disturbances based on your child's age, temperament, and basic sleep needs. How you
deal with it is also going to depend on your own age, temperament, and basic
sleep needs.
Also, too,
although cribs are becoming more popular, your baby may also have become accustomed to
sleeping with his/her foster mother on the floor. You may need to spend time helping your
baby transition to a crib and/or sleeping alone.
Me? I'm a big believer on letting your child "tell" you what
they need -- so I generally fed on demand and if that meant a 2am bottle that
was
ok. But for late night feedings and diaper changes I kept the room dark and limited my
conversation. I would smile and cuddle and kiss, but try to keep activity and animation to a
minimum. Even with an actively teething infant, more times than not our kids
would drift back to
sleep right after a bottle. Sometimes all that is needed is a few rubs and pats.
We also invested in an electric bottle warmer that we kept in our bedroom
with the crib. We could stock two cold bottles of formula and heat them within a few
minutes. Worked great and was definitely worth the investment.
With some children, though, you're going to need to do more.
Some parents use the "family bed" approach. Others, like me, prefer to sleep
with the child in the child's room. I spent many weeks with each one of my kids
sleeping in the recliner with a cover over us at one time or another. I could
sleep, they could sleep. We were happy.
My belief is this ... whatever gives you and your child the most
decent rest is the right one for you. I will, however, recommend one book about
sleep issues,
Healthy Sleep Habits, Happy Child. Although he pooh-poohs adoption issues,
he does have good ideas that worked for us. (Some folks like Ferber, however I don't
recommend the Ferber method for adopted children. Other folks like Sears. He's a
family bed enthusiast.)
- High-touch babies: Korea is a high-touch culture. Babies are carried in
baby wraps on the mother's back and only put down to sleep. America, on the other hand, is
a low-touch culture. We put our babies into bouncers and swings and car seats -- all
off-body appliances. So I strongly urge all prospective adoptive parents of Korean
children to invest in a snugli or sling-thing and be prepared to carry your child a lot
during their transition. As they grow more secure and comfortable, you can begin
experimenting with their ability to physically separate from you. But they can't or
shouldn't be pushed any faster then they can tolerate. (The time will come all too
fast when children won't even let you hug them, so try to enjoy the closeness this time
provides.)
- Bathing/skin care: Asian babies may have particularly dry skin so I
suggest a mild soap like Dove or Aveeno and don't bathe them more than every other day,
unless they're really a mess, and moisturize their skin with a good quality cream like
Lubriderm or Eucerin. Also, too, Asian babies seem to have particularly dry and pasty ear
wax. I'm NOT suggesting you go digging in their ears (leave that to the pediatrician), but
you might want to use baby oil and swabs to clean the outer ear of build-up. Asian hair
also tends to be coarse (I referred to my son's hair as "buoyant".) You
might want to try a baby hair conditioner on longer hair.
- Siblings: Ahh, the roughest one of all. Children "dethroned"
from old roles and thrust into new ones. Trust your instincts on this one, but I do have
one BIG suggestion: DON'T PUSH CLOSENESS. Let your older children warm up
to the newest family member at their own speed. Ask for their help, don't demand it.
Settle for grudging acceptance (and no hitting) if love is slow to develop. Remember, YOU
as parent wanted this new child in your life -- your older child/children maybe aren't
feeling so excited. (How would you feel if your spouse came home one day and said,
"Hey, honey, guess what? We're going to add another husband/wife to our household.
Isn't that great?") Give your children plenty of time and room to grow as
siblings. And let them do it at their own pace.
POST-ADOPTION DEPRESSION
Your Baby is Home, So Why
Are You So Miserable?
Thought this was a pregnancy-related hormonal thing? It's not and it's
very common. It can happen to experienced parents as well as first-timers. The adoption
process, especially the waiting, is tension-riddled and exhausting -- even under the best
of circumstances. You're keyed-up. Your spouse is keyed-up. Friends and family don't stop
asking, "Have you heard anything yet?" You jump every time the phone rings. Who
can live like this for very long?
So you're already tired and vulnerable. Then THE CALL comes! You're
frantic to get ready and the frenzy only gets worse until the day of your baby's arrival.
BABY DAY COMES! You're happy, ecstatic, nervous -- simply
out of your mind. Family and friends coming and going. Gifts and flowers arriving. It's a
glorious madness.
And then you realize -- maybe it's at 2am when you've been woken up
for the 3rd time in 3 hours for nights on end or maybe when the baby has been crying
nonstop for half an afternoon -- uh, oh. What have I gotten myself into?
First, this is a normal reaction. Your sweet little baby in the
referral photo to whom you blew little kisses is now a screaming, smelly person all his
own -- and you're totally responsible!
This is a frightening, paralyzing realization for ALL parents, so you're
certainly not alone. If you're finding yourself totally overwhelmed to the point
you're a danger to the baby or yourself -- don't wait, get help immediately. But
if you're like the great majority of us who could just use a little rest and support, here
are a few suggestions:
- Sleep when the baby sleeps (or at least lie down and rest) -- forget
the household chores or, if you can, hire a service for several weeks or ask
family/friends to help out. Forget fancy meals, too. Go easy and nutritious. With enough
rest, you'll have the reserves to manage your baby's transition with a little more grace
and lots less yelling and guilt.
Roberta's Note: Sleep deprivation, to my experience,
is one of the worst aspects of this whole process. You must get
enough quality sleep to function enough to handle your child,
your day, and yourself. Raising my three, I learned to sleep
comfortably in rockers, recliners, on the floor, on a couch, in
and out of my bed. The key is getting the sleep. Doesn't have to
be pretty or elegant. Try to get at least three undisturbed
hours at a clip.
- Talk to your agency about connecting with other adoptive parents --
formal or informal, in-person or via telephone (even e-mail) can help give you the support
you need and make you feel a lot less alone. There are numerous groups on the Web, too,
where you can find a compassionate ear, even at 4am.
- Take advantage of every offer of help -- you have friends who want to
do for you? Let them! One could make and freeze a few casseroles for you. One could take
your older child out to the movies. Another could watch your baby so you can get out and
get a haircut and massage. Keep saying yes whenever asked. Then don't be shy about asking
yourself when you need a hand.
- Give yourself and your baby time to get to know each other -- bonding
happens over time, not in a single magic moment. This is especially true if your baby is
older. He/she may withdraw from you, even regress for a time, while trying to sort out
their new family and his/her place in this strange new place. So try not to take your
baby's apparent rejection of you personally. In less time than you think, that unhappy
little person will start smiling right at you with unabashed joy and delight.
- Find some good books about post-partum depression -- you'll find a lot
of good advice applicable to your needs as an adoptive parent that's far more than dealing
with depleted hormones.
And finally, there's nothing wrong with getting a little
counseling either. Adopting and raising a child can stir up lots of deep-seated
emotions. Talk with a therapist experienced with infertility and adoption issues, if you
can. Ask your agency or other adoptive parents for references. The help is out there, all
you have to do is ask.
This is a big and important subject (see my Book Tip for
an excellent overview to the topic), but I do want to spend a little bit of time
on the subject.
Even though the majority of Korean children are adopted as
infants, they don't "forget" their caregivers - foster mothers or even their
birthmothers - in just a few days. They don't forget the smells, sights,
language - its sound and cadence, or the particular way a caregiver has held
them, fed them, bathed them, and put them to sleep.
One of the best parts of the Korean program is that these
children are raised in loving foster homes where they get the close, one-on-one
attention to vital to their physical, emotional, and mental development. Our
babies learn to trust and to love because their needs are attended to by loving
adults worthy of trust. That's why it's so important for us, as adoptive
parents, to understand the process of bewilderment and grief our children may
experience and exhibit when they're placed with us.
Remember - by the time our infant is placed in our arms,
he/she has lost a birthparent... a foster parent... and even the escort who has
accompanied him/her to us. Nothing looks, smells, is heard, or even tastes the
same. That's a lot of change and confusion for one little baby to process.
Some children do better than others. At 5-1/2 months old, our
son greeted us with big drooling smiles and giggles. He was then, and remains so
now, a very social, easy-going, goofy little guy. Little fazes him and he has a
wonderfully expansive and silly sense of humor. His bonding/attachment process
was relatively smooth. He loved everyone and everyone loved him.
He was easy. Our youngest daughter arrived at the airport
screaming her lungs out and remained an unhappy little baby for many months. At
4 months of age, her grief and I would term outrage at the huge changes in her
life were palpable. (I've often said it was a good thing that I was a pretty
experienced mom by this time - I knew my daughter's anger wasn't personal. She
was just angry and miserable at having her life so up-ended in such a short
amount of time.)
So for many months, I "wore" her in a sling as much as possible.
Lots of physical contact, lots of games to encourage eye-contact, and we were
slow to introduce major changes in her life (I kept some nannies in my employ
too long because the continuity of care was more important at the time.)
In time though, the angry little peanut relaxed and began to
enjoy her new family with gusto. She's still a pistol with a hot to boil temper
but she is fully "our child" grounded and rooted with us.
Every child is different as every parent is different. But we
make a big promise to our children, either born to us or adopted by us. Yes, we
promise to love, nurture, care for - all good stuff. But implied is the promise
to be patient while this new little creature - all his or her own - develops and
unfolds before our eyes. In their own time, in their own speed, in their own
way.
Our adopted children may need more of our patience, more of our
willingness to forego old routines for a while, so that they can learn to love
us and trust us in due time. Their experience tells them that familiar routines
can be abruptly altered. We need to help them regain a sense of balance and
continuity.
And above all, please don't take their anger and grief
personally. It's not about you and your needs. It's about them and their needs.
Believe it or not, you're only half done with your adoption agency and the
adoption process. Even though your baby is home, he or she isn't quite yours
just yet.
Next stop, post-placement reports.
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Baby Book Tips
Post-Adoption Depression
Book Tip
Pediatric Health Links
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