Nutrition & Your Adopted Child

When children are adopted, they often have had trauma in their lives that can affect many aspects of their lives, with eating being one of them.  In fact, nearly 80% of children with developmental issues also have feeding issues.  So it is no wonder that our children who are adopted, who are often developmentally delayed and have experienced many issues, such as bottle propping as infants and then given mushy and limited number of foods often have eating problems.

These issues do not just apply to internationally adopted children but can be seen in children who have been in foster-care.  If your child was adopted from foster care, she may be normal weight, but she may have been deprived of certain foods, given lots of snack foods, and may not have been provided any structure around meal time.  On the other hand, if your child is from an orphanage, he may have had overly structured meal times and had to consume limited amounts of food very quickly.

In the  book Love Me Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More ,  Katja Rowell, a medical doctor, does not so much  provide nutritional goals for the adopted  child but  she explains the best ways to establish a positive relationship between you and your child.  Food and dietary habits can become an integral part of what Dr. Rowell call the Trust Model for establishing attachment with your child.  This Trust Model helps to provide nurture as well as means of establishing healthy eating habits in your child.  You may be asking, “But what about my other kids who have not had difficult starts in life? How am I going to make meal time different for all my children?  As with any positive attachment and trust model, this model can be used with all children.

This Trust Model promotes shared power: you the parent determine when, where and what your child will eat, and your child gets to determine if and how much to eat based on what foods are there.  This allows you to decide on what nutritional foods your child can select from and where and when your child will eat, but the child gets to decide on what food to select from and how much to eat.  Now, of course, an infant, who has nearly all the power when it comes to feeding, decides the when, where and how much to eat; you, the parent, just decide on what milk to give her.

The Trust Model gives children the structure that they need as they know what to expect. And as with feeding a baby, sometimes you must take your cues from your child.   For example, younger children need to be fed more often, so they will ask for snacks more often in-between meals.  If your child is malnourished, you may need to offer your child food more often until you get to know your child’s signals as to when he is hungry.

Feeding your child with the family helps your child see others eating, sets a model of portions, and to be able to know when he is hungry and full.  At meal time, it is best to have different types of foods at the table—especially those that your child likes based on taste and texture—so that your child can have familiar foods as well as try new foods in a non-coercive setting.

Giving your child a snack—in the afternoon—or perhaps two snacks—can help a child who gets cranky in the afternoon waiting for dinner to feel more relaxed and content  Do not be concerned with a “ruined appetite” before dinner.    Your child may eat less at meal time, but as long as the snacks provide healthful foods, your child will get the nutrients he needs.

Simple but practical solutions for children who come from difficult pasts can help solve food and meal time problems.  However, some children, especially those with medical and sensory problems, may require more therapeutic assistance.  Often an occupational therapist (OT) is the first professional who may become involved, as the OT usually assesses sensory and gross and fine motor skills and the child’s ability to feed herself.  A registered dietitian (RD) may assess the child’s nutritional intake and growth patterns and if more serious steps must be taken, such as tube feedings, are necessary.   As with any type of professional who is going to provide advice and some counseling, certain factors must be taken into consideration.  A mental health counselor would be involved to assess the parents’ and child’s interactions surrounding food and may also assess attachment issues.  The counselor would also work closely with the other professionals such as an OT and RD.

If you, as a parent, are having major food issues with your child, your child’s pediatrician may not give the advice you need, unless your pediatrician is very familiar with adopted children’s needs.  Instead, you may need to consult with a pediatrician at an international clinic for a referral to a feeding clinic or OT.

If you feel that your child is growing steadily but there are still major issues surrounding  eating issues, then you may want to consult with a counselor who has experience with adoption and attachment issues and can help you use trust based approaches in helping you and your child with behavioral issues surrounding food.  If your child is having eating issues and may also have sensory and other issues related to motor skills, then  the  counselor and OT  need to be working together.  The approach needs to be parent focused as adopted children need to be attaching to their parents—not separated from them.

Rowell has a list of questions you may need to ask before working with a professional:

  • How do you help the parents integrate the skills at home?
  • Am going to be involved in the treatment plan, or am I going to be separated from my child? (Parents are the ones who ultimately work with the child.)
  • Do you use negative/positive reinforcement? (Either type of reinforcement can feel like coercion to a child and can result in a power struggle.)
  • Do you require the child to eat food she does not want or hold food in front of the child until she eats it? (This leads to a power a struggle.)
  • What resources do you suggest?

Children who have had difficult starts in life had little control in their lives and often feel shame.  So any approach that takes away power from a child (instead of offering shared power with the parent) or shames a child into eating often leads to more problems.

Bad formal therapy is worse than no therapy.    But good therapy need not be formal–it can be done by the parents if the parents can take cues from the child.  The parent can trust the child to do the eating while the child trusts the parent to be “there” for him and builds upon the relationship.

To learn more about your child’s nutritional and feeding needs, these websites provide very valuable information, tools, and even equipment:

 

  • http://adoptionnutrition.org/ This website provides information related to the nutritional needs of adopted children—even by country—as well as addresses some feeding issues such as hoarding and children who will not eat.

 

  • http://mealtimenotions.com/  This site offers stories, articles and information regarding the feeding and nutritional needs of children with special physical and sensory issues.

 

Celebrating Read Across America Day With Your Adopted Child

With the goal of motivating children to read and ultimately creating successful and life-long learners, over 50 organizations and over three million educators partner with the National Education Association to celebrate reading and provide materials and resources to help children continue to read 365 days a year! Through much research, we have learned that “children who are motivated and spend more time reading do better in school.”

The NEA’s website offers a wealth of resources to be able to celebrate throughout the month. Look for the following exciting and helpful resources: an opportunity for families to participate in a Facebook Live Event, an article noting book recommendations written by a diverse group of children’s book authors, a fun Share Your ‘Shelfie’ Challenge, reading resources for each month of the year, and much more!

Read Across America Day provides a great opportunity to introduce your adopted child to some great children’s books that they can relate to and enjoy!  Many are great tools to celebrate with your child their unique and beautiful adoption story. Perhaps you have a family member or friend preparing to adopt a little one—something like this would be a helpful and treasured gift. Below, we have provided some of the book titles that many adoptive families have enjoyed sharing with their children.

Children’s Books for Domestically Adopted Children:

A Blessing from Above: Patti Henderson

A Koala for Katie: Jonathan London

A Mother for Choco: Keiko Kasra

Did My First Mother Love Me: Kathryn Ann Miller

God Gave Us You: Lisa Tawn Bergren and Laura J. Bryant

Families are Forever: Deborah Capone

Horace (Reading Rainbow Book): Holly Keller

Is That Your Sister: Catherine and Sherry Bunin

Just in Case you Ever Wonder: Max Lucado

The Keeping Quilt: Patricia Polacco (September 1994)

Let’s Talk About It: Adoption: Fred Rogers

Little Miss Spider: David Kirk + A Christmas Wish

A Little Story About a Big Turnip: Tatiana Zunshine (ages 2-8)

Megan’s Birthday Tree: A Story about Open Adoption: Laurie Lears

My Special Someone: A Child’s Perspective of Adoption: Brittany and Sherry Kyle

The Mulberry Bird: Anne Braff Brodzinsky

Never, Never, Never Will She Stop Loving You: Jolene Durrant

Oliver: A Story About Adoption: Lois Wickstrom

Our Twitchy: Kes Gray and Mary McQuillan

Sam’s Sister: Juliet Bond

Tell Me Again About the Night I Was Born: Jamie Lee Curtis

Through Moon and Stars and Night Skies: Kristine Wise

 

Children’s Books for Internationally Adopted Children:

At Home in This World. . . A China Adoption Story: Jean MacLeod

Just Add One Chinese Sister: Patricia McMahon and Conor Clarke McCarthy

I Love You Like Crazy Cakes:  Rose A. Lewis

Moonbeams, Dumplings and Dragon Boats: A Treasury of Chinese Holiday Tales:  Nina Simonds, Leslie Swartz and The Children’s Museum, Boston

Waiting for May:  Janet Morgan Stoeke

Families Are Forever: Deborah Capone

Horace: Holly Keller

I Love You Like Crazy Cakes: Rose Lewis

Is That Your Sister?: Catherine and Sherry Bunin

Babies Come from Airports: Erin Dealey

 

Children’s Books for Transracially Adoption Children:

The Keeping Quilt: Patricia Polacco

Little Miss Spider: David Kirk

The Little Snowgirl: Carollyn Croll

A Little Story About A Big Turnip: Tatiana Zunshine

A Mother for Choco: Keiko Kasra

Over The Moon: Karen Katz

Seeds of Love: Mary Ebejer Peteryl

Three Cheers for Catherine the Great! : Cari Best

Through Moon and Stars and Night Skies: Kristine Wise

Best of Nightlight: Adopting out of the “Birth Order”

by Laura Godwin

Are you like your siblings? Or do you think that your birth order played more of role in who you are? Or does your genetic make-up determine more of your personality and qualities? Because siblings are raised essentially in the same environment, it stands to reason that we would be more like our brothers and sisters. Yet, reportedly the same home environment makes up only 5-10% of our personality, while genetic factors may have more impact—perhaps up to 50%. This then leaves birth order as another factor that could affect personality. In fact, much research has been done on this subject and quite a few books have been written on the topic of birth order. Most of us have heard that the oldest child is more assertive, conscientious, in addition to being more neurotic, envious, and nervous. Younger siblings are noted to be more creative, open to new ideas as well as rebellious.

So how does birth order affect the adopted child? Does it matter if children are adopted out of the “birth order”? In 1990, researchers wanted to find this out as no study had looked at the impact that an adopted child’s position in the family has on the child’s personality. [1] These researchers studied first-born children placed into the younger child position in the adoptive families. Many such adopted children could fall into this category—the first born child of a birth mother–placed into a family with one or more children. Of course, the reverse is also possible: children could be the second, third, fourth child of a birth mother and the first child of an adoptive couple. In an analysis by these researchers, the rearing order of the children had little impact on personality except for conscientiousness, which was higher for children who were raised as first-born. The child’s sex had more impact than did rearing order.

Although the cited study may be of interest, most adoptive families are not asking what impact rearing order will have on infants who are first born to their biological parents if they enter a home as the second or third child. If a child is an infant, then it is assumed that such a child will have the characteristics associated with the order placed into the adoptive family. What families want to know is what impact adopting children out of age order has on the children already there— especially on the oldest child in the home.

This subject is not found in scientific literature, but common sense and attention to each child’s needs can help in making the decision to adopt out of the rearing order as well as help in the adjustment of the children after the adoption.

First, consider your children’s present ages.  If your children are young, adopting out of order most likely will have less impact on them, than if they are older.

Next, consider sibling rivalry and the need for attention. If you have two young children and are thinking of adopting an 8-year old child, who most likely will need lots of nurturing and attention–especially if the child has more profound attachment issues–you need to consider how a school -age child, who may be more like a 4-year-old emotionally, will affect your life and those of the other children in the home. Although a child may be 8 years old, the child may be physically smaller and much less mature than a 4-year-old child in your home. If the newly adopted child looks like an 8-year-old, it can be easy to see this child as being much older than the other children and expecting more than the child is capable of doing. In fact, most children entering a home are going to have lots of needs and most likely will not be emotionally on par with other children of the same age. You will have to adjust your expectations for such a child. If an 11-year old from an orphanage is an only child, it is easier to treat the child like an 8-year old or younger. However, if you have a 6-year-old in your home, you may find yourself  requiring more of the older child.

Some families have larger age gaps in their children and adopt a child who can fill in the age difference. This means that neither the oldest nor the youngest child’s position in the family is displaced. Again, the chronological age of the child entering the family can be quite different from the child’s emotional age; you may find that this new “middle” child is more like the youngest child in the family.  As stated, it is all about expectations. If you adopt a child who fits nicely into the age range where your children are right now, this  newly adopted child may not blend as well as you had anticipated.

Children, who are older, can also have attachment issues and may have been sexually abused. This means that it can be difficult for such a child to be around younger children. Such children may try to harm the younger children—even if in subtle ways. It is natural for adults  to be protective of younger children. Behavior that parents may tolerate if there are no other children or only older children in the home becomes intolerable when younger children may become victims.

Some therapists indicate that a large percentage of older children coming from orphanages have been sexually abused on some level. (This is also true for children coming from the foster care system.) Precautions need to be put into place, and this will further change the family’s dynamics. The integration of such a child into the family should be done cautiously.  An older child should not be left alone with younger children until a pattern of behavior is well-established. Children should sleep in separate bedrooms and chimes may need to go  also on these doors.

In fact, it is better if a child who has newly arrived sleeps in the room on a cot in the parents’ bedroom for a while so that the child can feel secure. If the child is too old for this, then it would be better if the child has a room adjacent to the parents’ bedroom.

The same precautions that are taken when adopting an older child need to also be taken when adopting a sibling group. Sometimes the older child can harm the younger child. Often, however, the older child is very protective of the younger sibling, as the older child may have “parented”  the younger sibling(s) while in an orphange.

If an older child or sibling group is adopted, and you later plan to adopt younger children, you also need to consider the same issues of having an older child with a younger child in the home.

Experience as parents can also help you decide what age child you feel you can parent. If you are raising pre-school children, jumping to meet the needs of a middle school child can be quite an adjustment. However, if you are around meddle-school age children and feel comfortable with this group, then adopting an older child may be right for your family.

If your children are older, and you will be adopting a child (younger or older), you will want your children’s input on the matter. Although children do not make the ultimate decision on how parents grow their family (what would any “baby” in the family say about being displaced by a younger sibling?), having your children’s input can make them feel more secure and more welcoming of a new sibling. If your children do object to a new sibling, you can discuss with them their concerns and ways that the adjustment can be made better for all.

Asking the question, “Is adopting out the birth order OK?” and seeking advice means that you are seeking ways to make an adoption as successful as possible. Many families have thrived after adopting out of the birth order. It is a matter of preparation, commitment, and, if problems arise, taking appropriate steps to seek support and make adjustments.

For a discussion on adopting out of the birth order and getting advice from other experienced parents go to When Adoptive Parents Adopt Out of Birth Order by Lois Melina in Adoptive Families magazine.

 


[1] Beer, J. M., & Horn, J. M. (2000). The influence of rearing order on personality development within two adoption cohorts. Journal of Personality, 68(4), 689-819.

 

Helping families with the transitions of International Adoption

About one-third of families who adopt internationally have smooth transitions; another third or so have some difficulties, but manage to work through these issues; and another third have serious and more pervasive problems. In these more difficult circumstances, even the best parents are often not prepared. Those families who are struggling need support, like every family—sometimes from friends and families and sometimes from experts.

To get some good advice from professionals and to hear the challenges other parents face, you may want to join Beyond Consequences live 10-session parenting course right in your own home. The first class is complimentary—so take a test drive.

This Free Test Drive will be on Thursday, August 25, 2011 at 9:15 p.m. EST.

Each of the 10 sessions following be on Thursday evenings and run for 90 minutes through November 3, 2011.

You and other parents can ask questions and discuss the specifics of your family situation with the professionals.

Click here to sign-up at no charge for this first class and see how it works on the Internet. Continue reading

Medical Providers and Therapists for Internationally Adopted Children

If you are adopting internationally, you know that there are two particularly critical times that you want professional medical assistance from someone who knows about international adoption: when you get a referral, and when you come home. Nightlight has compiled a state-by-state listing of Medical Providers that specialize in helping internationally adopted children. The list also includes Therapists we know of that have experience counseling families that have adopted internationally. This guide can be found at our International Adoption Resources page.

New Home Study and Post-placement Requirements for China Adoptions

The  China Centre for Children’s Welfare and Adoption released some new home study and post-placements requirements. These new guidelines and regulations for the home study go into effect as of October 1, 2011; and those regarding post placement visits and reports apply to families who receive Notice of Coming to China for Adoption after August 1, 2011.

personwritingHome Study

First, you must have a home study completed by a Hague accredited adoption agency. Please contact Nightlight before you begin the home study process so we can advise you as to the selection of a home study agency. (As a Hague accredited agency, Nightlight provides adoption home study services in Southern California, Colorado, and South Carolina.)

China also requires certain applicants — anyone who has a history of alcohol or drug abuse, has experienced emotional loss or trauma or abuse, or is in counseling — to provide a psychological report as part of the home study process. The type of report required and the contents are not specified:  it will be up to the home study provider to determine the type of evaluation that the family may need. For example, emotional loss is a common experience — especially among those who have gone through infertility and possibly miscarriages — and the home study provider will want to address these issues with the couple. If someone has experienced serious trauma and abuse, then it may be more appropriate for counseling to be recommended if certain issues have not been resolved.

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Clubfoot: Treatments – Part II

clubfeet in castsLast week we discussed what causes clubfoot.  Depending upon what caused the clubfoot and the severity of the clubfoot, there are different levels and types of treatment.  For example, if a child has clubfoot because of the child’s position in the womb, then the foot may be adjusted through physical therapy. Nearly all children with clubfoot are treated with serial castings and braces.  Those who have other complications, such as spina bifida, may need surgery.  Yet, one study showed even children with other medical issues may be able to be also treated through castings and braces, [reference 1] although some studies show that they probably need more intensive treatment. [2]

Treatment usually begins at 1 week old to 2-and-a-half years old.[2]  Most children are treated with the Ponseti method, which involves serial castings.  These are casts that are put on every week to few weeks; each time the castings go on, they slowly change the position of the foot. [1]  For example, a child may have 6 castings done between one and 3 months old.  Of course, if your child is in China, he may not be receiving such treatment.

Once the series of castings are done , the child will usually wear a foot adjunction brace to keep the foot in proper position — much as people wear retainers after having braces on their teeth.  Like a retainer, these shoe braces are initially worn nearly all the time and then just at night. Continue reading

Part III: What Parents Can Do If a Child Has an SPD

DaughterHelpingDadwithTieIf your child is having behavioral problems and seems to have difficulty in every day tasks, you may first want to assess if your child has sensory problems. Many counselors may first require your child to have a complete physical evaluation to rule-out certain physiological and neurological problems. There are self-reporting tests, based on your child’s behavior, which you can take to determine if your child meets one or more criteria of an SPD. EEGs and other brain imaging tests holds promise for making a diagnosis—especially of an auditory processing disorder.

If your child does have an SPD and does require occupational therapy, you will want to be actively involved in the exercises and play. An hour or two per week of therapy will not be as effective as your continuing these learned activities throughout the week with your child. Also, an OT can help you change the environment so that your child can better manage stimuli within your home.

SPDs are often associated with other disorders and disabilities, so other professionals may need to be involved. It is not uncommon for children with SPDs to have other delays and may need to be treated by speech pathologists and other specialists.

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Sensory Processing Disorders and Your Child: Part I–Description

This is a Part I in a three part series on sensory processing disorders. On Wednesday, I will address why children develop these disorders and on Friday, you, as a parent, can learn more about what you can do for your child.

flyingMany children adopted internationally have what are known as Sensory Processing Disorders (SPDs). These children have problems processing and appropriately responding to stimuli, such as touch and noise. The SPDs can affect children’s behavior and emotions and may impact their ability to learn and socially function. SPDs are found in 5-10% of non-disabled children and in 40 to 88 % of children with disabilities. It is also more prevalent in children with ADHD.

There are different types of SPDs. Some children overreact to stimuli that most others do not find annoying. These are the kids who cannot stand tags in their clothes or being lightly touched; others may have a “melt-down” if their nails are trimmed or their teeth brushed. If the children have auditory processing problems, they may over react to the vacuum cleaner or other “normal” noises. Others with auditory processing problems can hear just fine but can have difficulty understanding what is being said. These are children who are told, “You are not paying attention.” Continue reading

Nutrition and the Child from China

ChildNutritionIf you listen to the webinar “Food for Thought” on Adoption Learning Partners, featuring Dr. Dana Johnson, you will see that parents are very concerned how the nutritional status of their children may affect their cognitive abilities [1]. What the parents are really asking is, “Will my child be smart, even if my child had a less than optimum diet while living in the orphanage?” The answer is usually “Yes,” but there are a few things you should know.

Overall, children from China have good nutrient status upon arrival home. In one study Dr. Johnson noted the percentage of children from China who were low or deficient in the following nutrients: iodine or selenium (20%), iron (8%); zinc (50%); and vitamin D (13%). None of the children were deficient in vitamin A, folic acid, or vitamin B 12. Of course, this is only one sampling of children [1]. The dates the children came home were not mentioned but, overall, the care of the children in the orphanages in China has been improving.

For nearly all children living in orphanages, the primary concern is getting enough calories and protein for growth and development. In general, babies in orphanages may receive less than adequate nutrition. In some cases, even if they are given plenty of formula, the children’s bottles are usually propped up, so the children may have limited ability and time to get the milk out of the bottles. Continue reading