First Appointment

How to schedule your child's first appointment:

To request an initial examination and evaluation of your child, please call the office and schedule an appointment prior to traveling. Please don't wait until you return to call for an appointment, as it may be difficult to schedule in a timely fashion. We recommend giving you and your child 2 - 3 weeks to bond and recover from traveling prior to coming for your first visit. If your child is acutely ill when you get home we will see him or her earlier to address the sick issue and then return for the previously scheduled appointment for the full exam and evaluation.

What will happen at your child's first appointment?

At your first appointment Dr. Douglass will spend an extended amount of time reviewing your child's health information and development, as well as performing a thorough physical examination and a complete panel of screening labs. We hope this visit answers many of your questions and assists you in caring for your child.

• Recommended labs
  
• Recommended specialist referrals
  
• Second appointment
  
• Subsequent visits

Recommended Screening labs

It is critical that all children adopted overseas be screened for multiple illnesses:

Blood Tests:

•  Syphilis
•  Hepatitis B
•  Hepatitis C
•  HIV
•  Thyroid function
•  Lead
•  Complete blood count
•  Comprehensive metabolic panel (a general screen for liver and kidney function)
•  Other tests may be drawn for specific situations
•  Several of these tests take up to a week to come back from the lab. We will be in touch as soon as all the labs are back.

Skin Test:

•  Tuberculosis test (PPD)
•  This test must be read in 48-72 hours by a medical professional who has experience reading PPD's . There is much unnecessary confusion among lay and medical professionals in reading and interpreting PPD's in international adoptees. I prefer that my staff read the PPD's.
•  If you live far away and would prefer to have the PPD done locally that is fine but be sure that it gets done. If you are told the PPD test doesn't need to be done or can't be interpreted because your child had the TB vaccine (BCG) be sure to have someone else perform the test.

Stool Tests:

•  You will be sent home with several tubes to collect at least 3 different stool specimens to look for parasites. Some of these tubes contain preservatives that are poisonous so be sure to keep them away from your child. Be sure there's enough stool in each tube to raise the fluid to the line marked on the side. For the containers with no fluid fill them half way. If your child is having persistent diarrhea we will request a "fresh" specimen and give you separate instructions. Once you have all your specimens drop them off at our office. We only receive specimens during regular office hours (M-F 8:00 a.m. - 5:00 p.m.).

Recommended Specialist Referrals

We recommend all international adoptees receive an audiology screen . This is to provide them the same level of care that all newborns in North Carolina receive (all newborns in N.C. have a hearing test performed in the newborn nursery).

We also recommend that a pediatric ophthalmologist see all international adoptees. This is to screen for the higher incidence of strabismus ("lazy eye") seen in post-institutionalized children.

Depending on your child's situation we often recommend an in-depth developmental evaluation from a team of experts (psychologist, speech therapist, occupational therapist, and physical therapist) at a developmental evaluation center. These government-funded centers exist in most counties to screen children who are at risk for developmental delay and plug them into appropriate services such as speech or physical therapy. There are also private developmental pediatricians available.

Depending on your child's age and dental condition we may recommend a pediatric dental evaluation.

Lastly, many families ask about circumcision. We can discuss options and make a referral to a urologist if you would like.

If you live locally we will be happy to make these referrals (except for the dentists who typically don't require a referral). If you are planning on receiving care in your hometown we suggest you have your pediatrician or family doctor make these referrals in your area.

Your second appointment:

Your child's second appointment is scheduled 48 - 72 hours after the first one to allow for proper timing of reading the TB skin test (PPD). It is typically shorter than your first, extended appointment. At this appointment you will drop off any stool samples you have collected. We will review any lab data that has returned (we usually have only some of the labs back at this point). Lastly, we typically start your child's immunizations at this visit. There are varying opinions on whether to simply re-start vaccines or draw levels (titers). We will discuss the pros and cons of either option.

Once the remainder of your child's labs return we will contact you by phone with results. By law, we are not allowed to leave results on answering machines.

Subsequent Visits:

Timing of subsequent appointments depends on your child's age, vaccination status, and any other issues we may have diagnosed. Most infants and toddlers are seen every 2 months after the first 2 appointments for 2 to 3 times in order to get vaccinations caught up and to monitor development and growth.

For those who live near us we hope you will consider us your new pediatric home. For those further away, Dr. Douglass is happy to answer any questions your local physician may have regarding your child.