Ever had difficulty explaining to professionals
why it is important that your child’s history of adoption and
institutionalisation be taken into consideration? I have! Our daughter was 3
years old when we adopted her from China and had spent most of her life prior
to placement in an orphanage. Institutionalisation and the trauma of an abrupt
placement in our family had a huge impact on her. However, most of the health
care and other professionals we dealt with had no knowledge or understanding of
how institutionalisation affects children. Educating them from scratch was
difficult, there was no single piece of writing I could give them that would
provide all the information they needed. The first year post adoption was hard
for all of our family, our daughter was traumatised and we were sleep deprived
and emotionally exhausted. I determined that when I could, I would write
something that other parents could use to easily educate their health and other
child-care professionals in the early post adoption period. The following
article is the result and is aimed at the types of professionals adoptive
families might interact with including, but not limited to, doctors, early
childhood nurses, social workers, early intervention teachers, school teachers
and child care providers. You may wish to give this article to your health or
other child care professionals to read, highlighting areas that you feel are
particularly relevant to your situation. As health and other child-care
professionals are often busy, it may be worth sending this article to them
before your appointment and include an explanatory letter like the one shown
below. In our experience, assisting the professionals, who were assisting us,
to understand the situation was extremely beneficial. I hope that this article
is of help to you as you seek to advocate for your child.
Karleen Gribble
Dear Dr Jones
My name is Mrs Smith. I have an appointment to see
you on the 26th of January with regards my daughter LiJun. Li Jun
recently joined our family via adoption and prior to placement had spent some
time in institutional care. Thus, her early life experiences were very
different from those of children growing in their family of origin, which will
impact any care plan for her. I have
included an article with this letter that details issues that health and other
childcare professionals might need to consider in caring for a child who has
spent some time living in an institution and have highlighted areas that are
particularly relevant to Li Jun. I would appreciate it if you could read this
article prior to our appointment, as I believe it will assist you to understand
the special needs of my daughter.
Regards
Issues
for paediatric health care and other child care professionals to consider in
treating the post-institutionalised child
Each year there are nearly 300 intercountry
adoptions in Australia. Many of these children have spent at least some of
their life in an orphanage, experiencing institutional care, which has had a
far-reaching impact on them. Most of these children will have some interaction
with paediatric health or other child care professionals in the months and
years after their adoption. However, knowledge of their special needs is
outside the experience of most professionals. This article aims to provide a
background on the experience of children in institutional care and highlight
issues for health or other child care professionals to consider in caring for a
post-institutionalised child.
The experience of a child in an institution is
very different from that of a child in a family. Though institutions vary
widely in the quality of care they provide, they generally have high child to
caregiver ratios, which do not allow for individualised attention; they may
also be lacking in heating, cooling, space, toys or nutrition. The physical and
emotional deprivations of institutionalisation can result in a raft of problems
including trouble with forming relationships (attachment difficulties),
physical and developmental delays, language issues and sensory integration issues.
This is institutional neglect.
Institutionalised care is generally not able to
provide a consistent and sensitive caregiver with whom the child can trust and
form a healthy attachment. Development of trust and a secure attachment
normally occurs through interactions in which a primary caregiver meets a
child’s needs in an appropriate manner resulting in reduction of discomfort and
in feelings of relief. This cycle of need-distress-gratification-relief-need is
ordinarily repeated many thousands of times in the first years of a child’s
life but is absent or greatly reduced in the experience of institutionalised
children. The absence of this attachment cycle in the early years of a child’s
life can be incredibly damaging and impact their ability to develop
relationships and function in society.
High child to caregiver ratios also limit the
physical experiences of children who may be restricted to a cot/room for
extensive periods of time, may spend very little time in interaction with any
adult and are unlikely to have treatment for any physical special need they
have. As a result, many children will not meet gross or fine motor milestones
during the time they are institutionalised. Nutritional deprivation or
contamination of food or water with toxins such as lead or mercury can also
impact development and health. Some children will experience sexual or physical
abuse and infectious diseases and parasites are easily transmitted in the
collective living conditions of an institution.
Many of the medical issues that need to be
considered post adoption are obvious to medical practitioners who know to
routinely test for infectious disease and parasites, reliability of
immunisation record and to organise developmental, hearing, sight and dental
checks. Guidelines for health care professionals are readily available on these
topics, however, there are matters that may be less obvious but are nonetheless
important for health and other childcare professionals to consider. This
article will discuss some of these issues including sleep issues, peer
interaction and language acquisition, food, hospitalisation, over friendliness
or “over attachment”, developmental delays, obscure symptoms, issues of
diagnosis, and of consideration of the needs of the parents.
Different children will be impacted differently by
institutionalisation, not just because the quality of care they experience may
be different but also because their internal resources for dealing with their
environment and care or lack of care will be different. Some children,
potentially those adopted at a younger age, will appear to emerge relatively
unscathed but others may be profoundly affected. Few children will have all of
the problems listed here and those that do will likely have them only for a
short period of time. Children are remarkably resilient and sensitive
caregiving can result in incredible healing for many children. However, it is
vital that appropriate care be given in order for healing rather than
exacerbation of problems to occur.
Sleep problems are extremely common in newly
adopted, post-institutionalised children and can be the most challenging aspect
of parenting in the first year post-adoption. Both difficulty in getting to
sleep and night waking may occur and last for months to years. It is not unusual for a newly adopted child
to take several hours to go to sleep at night and to wake a dozen times or more
in distress. However, sleep difficulties are not the problem that needs to be
solved, rather they are a symptom of an underlying issue. Possible reasons for
sleep difficulties may be a result of trauma, an inability to feel safe, or
that night has been an unsafe time for them in the past.
For most post-institutionalised children, adoption
is a traumatic event. The placement is often abrupt, with little or no
preparation given to the child who experiences a change in caregivers and a
drastic change in environment. Communicating to the child what is happening to
them is often difficult because of language differences. Children may be able
to consciously control their reaction to the stress of the new environment
during their waking hours but in a more relaxed state during sleep their
anxiety and or anger is exposed. Night is also a time when grief can more
easily surface and the losses that a child has experienced may be revealed.
Children may also have difficulty sleeping because
they do not feel safe and to sleep well a feeling of safety is required. The
upheaval in the child’s life means that they know that any change is possible.
They may fear what changes may happen while they are asleep and fight sleep,
sleep with their eyes open or wake in fear during the night. Night can also be
an unsafe time in an institution as are there generally few caregivers at night
(one per 20 children is common). Thus, if children are being abused, it is
likely to happen at night, contributing to feelings of unsafety.
Since sleep difficulties are a symptom of a
deeper problem, sleep training techniques such as controlled crying/comforting
are not suitable for children who have lived in an orphanage. Such techniques,
can cause further damage to an already hurt child as they learn that they
cannot trust their parents to respond to their cries. However, in responding
sensitively to children’s cries at night over time, parents may assist the
child in working through the trauma of placement (or other past traumas) and in
feeling safe in their new environment. Being with the child as he/she goes to
sleep is advisable. Some families find that co-sleeping, placing the child’s
bed next to or in the same room as the parents’ bed alleviate symptoms.
Co-sleeping in particular has been mentioned by many parents as being pivotal
not just in improving sleep for everyone but in promoting trust and attachment.
Remaining close to the child during the day and maximising physical contact at
every opportunity (for example; avoiding the use of prams and baby chairs but
instead using arms, sling or lap) will also assist in building trust,
attachment and improving sleep. It is important to realise however, that no
intervention is likely to result in immediate alleviation of sleep difficulties
and that time is required. Parents whose child has severe sleep difficulties
will need to find strategies to assist them in coping with the situation. This
may include catching up on sleep during the day or on weekends, sleeping
whenever the child sleeps, suspending non-essential activities and assistance
garnered from family or friends to maintain the household. Support from health and
other childcare professionals is vital for parents who may struggle with sleep
deprivation and parenting in a way that is outside of the cultural norm.
It is conventional wisdom that children need to
socialise with other children in a group environment in order to develop social
competence. However, group childcare environments are not appropriate for the
post-institutionalised child in the immediate post-adoption period. If children
are placed in a group care environment they may become stressed because it
reminds them of the institution they came from and they fear abandonment.
Alternatively, they may seem to fit right in and wish to spend more time there,
finding the closeness of family life stressful and wishing to avoid the
intimacy there. Neither of these situations are in the child’s best interests.
Some families of post-institutionalised children find that the needs of their
child may necessitate delaying schooling or homeschooling. If entry into
daycare or school is necessary, the introduction should be made gradually and
parents should be supported in any requests they make, with regards the special
needs of their children. Teachers may need to assist the child to distinguish
between themselves as temporary, part-time carers and the parents as permanent
family and take care that they do not inadvertently usurp the parental role.
It is often suggested to migrant families that
daycare or school may be helpful in language acquisition. However, as
mentioned, group childcare environments are problematic for
post-institutionalised children and since their adoptive families speak
English, it is in interactions with parents and siblings that the new language
is best acquired. It also needs to be recognised that issues associated with
language acquisition for post-institutionalised children may be different from
migrant children learning English as a second language. This is because migrant
children are generally learning English within the context of speaking their
first language at home and often after having obtained competence in their
first language. However, post-institutionalised children most often do not have
parents who speak their first language. In addition, children may not have
developed age appropriate language competency prior to placement because the
low child to caregiver ratio in institutions means that children associate
primarily with same aged peers with similar language deficiencies. Thus, the
building blocks of language may have been missed, presenting special issues for
post-institutionalised children.
There are several situations in which food
can be an issue for the post-institutional child. Because many children have
experienced food scarcity in institutional care they may hoard or overeat. This
problem is usually mitigated with time and allowing the child to have free
access to food (placing nutritious snacks where the child can reach them or
packing a lunch box for the child to carry around). Restricting access to food
may make the problem worse. Children may also not have developed the capacity
to recognise the feeling of satiety or hunger since they may have been given
food on a schedule and regardless of individual need. Parents may need to
encourage their child to make a connection between body signals of hunger or
fullness and their relationship to food.
Some children may not have experienced much
variety in food and may need a gradual transition to other foods. In some
cases, children may have been sustained solely on bottle feeds well past the
age at which solid food would normally have been introduced and may refuse
solid food. Professional assistance with a speech pathologist familiar with
sensory integration work may be required to ameliorate this problem.
It is also common for children to regress in
eating habits at the time they are adopted. Regression is a frequently observed
response to trauma and, as discussed previously, placement is traumatic.
Children may also seek to regress in order to experience some of the nurturing
that they missed out on earlier in life. Thus, children capable of feeding
themselves may wish to be fed, children long weaned may request bottle feeding
and some children pursue breastfeeding with their new mother. Regression should
not be viewed as a problem but as an opportunity for the child to experience
the care that they did not get as an infant. Adoptive families are encouraged
to provide times where their child can be ‘babied’ if their child does not seek
it and bottle feeding especially is promoted well beyond the normal age at
which a child would be weaned. Health care professionals concerned about dental
caries should suggest preventive measures that do not involve weaning from the
bottle.
Hospitals and the procedures that happen
there can be frightening for any child but for post-institutionalised children
there are additional reasons why they might be anxious. The hospital
environment, for many children, is reminiscent of the institution in which they
once lived and this can create great fear as they may believe they will be
abandoned at the hospital. In the short term they may react to this stress by
shutting down, disassociating, becoming hyperactive or uncooperative (note:
these symptoms may be seen in any stressful situation). Some parents have found
that even a day visit to a hospital can disrupt the child for several weeks.
Thus, post-institutionalised children who are hospitalised may need to have
their parents with them at all times, regardless of their age. Usual hospital
procedures may need to be modified in order to accommodate this and provision
made for parents to sleep with their child. The potential seriousness of the
long-term consequences of not doing this cannot be understated. If the child
feels that they have been abandoned in the hospital because their parents have
not been allowed to remain with them the attachment relationship that has been
developed since adoption may be severely damaged. Delaying procedures that
require hospitalisation should be considered to allow the child time to adjust
to life in their new family and for strengthening of relationships prior to
another stressful event. If the primary caregiver of a child requires
hospitalisation, accommodations may be needed to minimise the impact on the
child. Illness affecting a parent can be extremely scary for children who may
regress or exhibit changes in behaviour as a result of anxiety.
Over friendless to strangers (called
indiscriminate affection in the literature) is a common behaviour in
post-institutionalised children. In institutions, where there are few carers,
children learn to be cute and engaging in order to maximise adult attention.
This is a survival mechanism since children who receive no human touch are at
increased risk of morbidity or death. Post-placement, children sometimes seek
to be attractive to strangers, seeing every adult as a potential new caregiver.
Children presenting with this behaviour need to learn that there are different
types of relationships with adults and that family is something special. Parents have had success in teaching their
children this by limiting the opportunity for contact with other adults and
instructing those adults that they interact with of the boundaries they have
set with their child. Children are told with whom they may cuddle (initially it
is advisable that this is only mum and dad) or hold hands or talk and specific
instruction on relationships provided. Emphasis can be placed on how parents
care for their children and that children in families do not need to look after
themselves. Explaining to children the concept of “circle of care” is often
helpful in aiding children understand the inner sanctum of family and how
extended family, friends and acquaintances are spread out like ripples on a
pond; the distance from the centre indicating the closeness of the
relationship.
At the same time that children are seeking the
attention of strangers (or sometimes apart from this behaviour), these same
children may strive to distance themselves from their parents, particularly
their mother. Thus, children may avoid making eye contact, avoid physical
contact or be stiff while being held or act in such a way as to attempt to make
themselves undesirable to their parents. Fear of intimacy is behind this
behaviour as post-institutionalised children have experienced multiple
caregiver loss and learnt that they can rely only on themselves. This can be
very difficult for parents to deal with, particularly the mother who is often
the primary caregiver and the focus of the child’s rejection. It can also be
easy for parents to come to consider that their child is naturally independent
and to allow them to maintain emotional distance. This however, is not in the
child’s best interest as healthy independence can only grow from healthy
dependence on a primary caregiver and the long-term consequences of accepting
distancing are serious. Families may need to be supported by family, friends
and professionals if they are not to take the rejection of their child
personally. They also need health and other childcare providers to believe them
when they describe their experiences, as children will often present very well
in public, saving their troublesome behaviour for home.
Parents often find that they are able to assist
their child to trust and build attachment with them by gently persisting with
closeness and not accepting the rejection at face value. It is not a case of
forcing closeness on a child but providing closeness in ways that the child
finds acceptable and gently increasing their tolerance over time. Activities
that build trust and maximise close physical contact can also assist with this;
for example, carrying the child in a sling, cosleeping, cobathing, swimming
together, playing games that initiate eye contact, dancing together, massage
and hand feeding. Assisting the child to develop a secure attachment with a
primary caregiver may be the most difficult part of parenting a child with past
hurts. There is a continuum of attachment from securely attached to severely
attachment disordered. As children with severe attachment disorder may exhibit
extreme antisocial behaviour as they grow (including aggression, lying, cruelty
and self destructive behaviour) and find it difficult to function in society
early intervention on attachment is vital. Families with children with severe
attachment issues may need professional assistance.
Some children rather than rejecting parental care
become what some view as “over attached,” usually to the mother, and cannot
tolerate being out of her sight. In fact, such children are insecurely attached
and, fearing loss of another caregiver, determine to never leave her side. This
can be wearing for mothers however, resolution can only be achieved if the mother
gives her child the closeness needed, allowing separation only when the child
is ready to do so, moving from short periods of separation to longer and
emphasising the permanence of the relationship. Forcing separation will have
the opposite affect of what is desired and will prolong insecurity of
attachment.
These three behaviours can be challenging for
parents not just because they may be difficult to deal with but also because
Western culture values independence in children. Thus, the support of health
and other childcare professionals for parents in caring for their children in
such a way to promote a secure attachment is invaluable.
Children who have spent an extended period
of time in institutional care are often developmental delayed and physically
retarded in growth due to physical and emotional deprivation. Children will
often have three different “ages,” a chronological age, a developmental age and
an emotional age, which may vary widely from one another. Their developmental
age will depend upon the care they have received prior to adoption. In many
institutions, babies are left lying on their backs for extended periods of time
and preschool aged children may be restricted to a cot for most of the day and
therefore have poor gross motor skills. Even older children are likely to have
had a limited opportunities for physical or fine motor activities and thus will
compare poorly to children in families. However, children often experience
enormous catch up growth developmentally and physically after placement and can
benefit from the assistance of physical therapy and early intervention
services. Developmental assessments shortly after placement can assist in
tracking the child’s progress though it should be kept in mind that they may
not be a good indication of the long-term prospects for the child. It is also
worth considering that although children often rapidly improve post-placement
some children have permanent damage as a result of their early experiences, it
should not be assumed that children will catch up or that they do not need
assistance. Children’s emotional age will be related to the quality of
relationships the child has had prior to placement. If the child has not had
sensitive care from a primary caregiver their emotional growth will be severely
retarded. Many suggest that the emotional age of the child is linked to the
length of time they have been in a family. Thus, a 5 year old adopted at 3
years will have emotional needs close to those of a 2 year old born into their
family and may express this in their needs and behaviour. This may be important
in considering for example how tests might be administered matching testing
procedure with emotional maturity rather than chronological age (eg hearing or
sight tests).
Some unusual behaviours may present in
post-institutionalised children that may not at first appear to be connected to
a child’s history but are indeed related.
Children who have been institutionalised may have
difficulty in recognising the signals their body is sending them. Such abnormal
physical responses have already been discussed in relation to feeding but can
also present in relation to pain responses and waste elimination. Thus,
children may have an abnormally high tolerance to pain and may not recognise
the need to go to the toilet (for example, physical discomfort may be expressed
as emotional discomfort or as anger). The lack of recognition of body signals
in relation to food and waste elimination is a direct result of the regimented
life of an institution where eating, sleeping and toileting are on a schedule,
regardless of body signals. A separation of body signals and action results in
the quenching of normal response in some children. High pain thresholds can result as caregivers are consistently
unable to respond to a child’s pain or discomfort. Parents of newly adopted
children who exhibit an inability to recognise body signals may need to assist
their child to make a connection between what their body is experiencing and
why they are experiencing it.
Lack of a responsive primary caregiver can also
result in a child not developing normal object constancy (since the primary
caregiver is the first ‘object’) and they may have difficulty in
recognising/recalling the existence of something they cannot see or in
distinguishing their own boundaries. For example, a school aged child who
stands in front of a parent with eyes covered saying, “you can’t see me”. This “real space” conceptual incapacity
fuels its emotional counterpart and for example, a child seen to commit a
naughty deed may deny responsibility expressing the same emotional lack of
objectivity (often referred to as “crazy lying”). Responsive care giving and
playing baby games that involve breaking and regaining contact (eg peek a boo)
can assist children in developing this vital developmental milestone.
Another impact of non-responsive care in
institutions is that post-adoption some children expect that their parents will
be similarly unresponsive and so do not cry when they are hurt or in need. For
instance children have been known to be sick during the night but will not call
out to awaken their parents but will lie in their vomit and waste until
morning. A baby who does not cry when upset, hurt or in need because they do
not think their parent will respond is not a “good” baby but a badly hurt
child. Such children need to be taught that parents care for their children and
want them to ask for help. Parents can assist their child by watching them
carefully for any signs of discomfort, intervening to provide what is needed as
early as they can. Children may also
appear very happy in after only a few days post-placement, laughing, joking and
being very engaging. However, this response has a similar root as “over
friendliness” in children believing that they need to be attractive to adults
in order to survive and families and professionals should not be fooled.
Self-soothing is common in post-institutionalised
children who have not had comfort from caregivers. Children frequently
self-sooth using such methods as finger sucking, rocking, head banging or
masturbation. It is unwise for parents to seek to forcibly remove
self-comforting behaviours from their children. However, such behaviours can be
gently discouraged with the parent attempting to be a source of comfort to the
child. It is important that the child not be made to feel that they are doing
something shameful in self-soothing.
Some post-institutionalised children self-mutilate
by scratching or biting/hitting themselves or pulling off fingernails. In some
cases they are hurting themselves because they have the poor physical
boundaries and abnormal physical responses described earlier and causing pain
to themselves helps them to feel something. In other cases, the neglect a child
has experienced has left them feeling unlovable and with a deep sense of shame
and their self-harm is in response (this sense of shame is also seen in out of
proportion responses to correction, lack of confidence, performance anxiety or
perfectionism). In still further cases, self-mutilation occurs in response to
stress and as a distraction from emotional pain. In order for self-mutilation
to be extinguished, the root cause of the behaviour needs to be addressed.
Sensory integration therapy, reducing stress and assisting the child to develop
a secure attachment are helpful in reducing self-mutilation. Parents need
support in tackling self-mutilation; most find this expression of hurt deeply
upsetting.
Post-institutionalised children are often bossy
and controlling in relationships having been used to needing to look after
themselves and seeking to control their world post adoption. This is an
artefact of anxiety and one that needs to be resolved so that the child can
learn to trust their parents to care for them. Parents may need to constantly
remind children that it is their job to look after them and that the child does
not need to worry about looking after themselves. Providing some predictability
in daily life and preparation for changes can also assist the child to feel
safer. Allowing the child to control everything will be counterproductive in
the long term.
It is tempting to think that a child from
deprived conditions should be given as much stimulation as possible in order to
help them to catch up. However, this is not a good idea as children are under
an incredible amount of stress post-placement as they learn to survive in a new
world. This stress has been measured in high cortisol levels and is evident in
some of their behaviours. For instance, it is common for children to be
hypervigilant meaning that they never relax but watch everything very
carefully, seeking patterns and understanding of what is required of them. This
often results in children picking up new things very quickly. However,
minimisation of stress should be something that parents aim for and since
post-institutionalised children have been used to a very small, predictable
world it is advisable for parents to also restrict the flow of new things so
there is not too much for the child to have to process.
The stress that children are under and the
limited world they have lived in leads to other problems. Many children have
difficulty with any transition (eg from wake to sleep, from home to out etc)
and also may take a long time to be comfortable in a new environment or with
new people, including situations in which they are seen by health or other
childcare professionals. Routine is often very important to children, in their
eyes predictability means safety. In these cases it may take months of
interaction before the real personality of the child is revealed. In addition,
many experiences normal to children in families are foreign to them and extreme
reactions to situations such as seeing a dog or walking on grass are to be
expected. Older children may not know how to play with toys and need to be
taught how to play.
Many children exhibit great grief at the loss of
previous caregivers. Exhibition of grief is a sign that the child had been
attached to their caregiver and this is a good thing as the child can transfer
this attachment to their new parents. A child who does not grieve a previous
caregiver may not have been attached to anyone and may have difficulty building
attachment without prior experience of an attachment figure. Thus, allowing the
child to grieve is important and if possible, it is helpful to maintain contact
with previous caregivers.
Issues associated with trauma, abuse or neglect
can make diagnosis and treatment of other problems difficult. Thus, a holistic,
multidisciplinary approach is required. Although the effects of
institutionalisation on children can be devastating and long lasting, not all
of the problems that a child presents with may be a result of
institutionalisation and it is important not to assume that this is the
case. Since many of problems can get
worse without treatment rather than better with time it is important to watch
these children very closely and refer to specialist care when necessary.
It is also easy to forget where
post-institutionalised children have come from when they present well groomed
and looked after with their caring adoptive family. Thus, it is easy to make
assumptions about what to look for based on the child’s current environment and
not their previous one and miss opportunities for early diagnosis and
treatment.
When a family adopts a child from an institution
they are taking a step into the unknown. Often little is known about the child
they are adopting and there is no way for them to predict how the child will
adjust to being in their family and what problems will arise. The initial
adjustment of a child post-adoption can last for a very long time, at least a
year, sometimes longer. The
best-prepared family may find themselves surprised by what they encounter,
thus, the parents of a post-institutionalised child also have special needs. A
parent or a four year old who has been with them since birth is not in the same
position as a parent of a four year old who has only been in the family 6
months. Society considers that the birth of a child into a family, though a
joyful event, is also difficult and support is often forthcoming at this time,
however, adoption of a child, particularly an older child is often not
similarly supported. Lack of support and understanding from those around them
can add to the exhaustion that new parents feel. Health and other childcare
professionals can aid families in providing a listening ear and not dismissing
the concerns they express about their children. Conversely however,
professionals should be aware that some families may not have a basis for
comparison of normal child development and may need assistance in understanding
where their child is in need of help.
Although this article presents a quite
extensive list of potential issues that families might face, it is far from
exhaustive and it is important to be aware that families may have other
concerns not mentioned here. It is also helpful for health care professionals
to consider that post-adoption the family may have a multitude of issues that
they need to deal with and will prioritise taking action. Thus, if they do not
follow a course of treatment immediately this does not mean that they are not
serious about helping their child but rather that there may be more urgent
priorities at that time. It is prudent, therefore, for healthcare professionals
to retain the lines of communication open with adoptive parents, each are
seeking to care for the child, but in different ways and each must be able to
hear and respect the others viewpoint.
A significant proportion of children
adopted to Australia have not experienced institutionalisation but resided in
foster care prior to adoption. This is generally a much better situation for
children and means that many of the issues described here are less likely to occur.
However, even children who have been in excellent foster care since shortly
after birth have still experienced multiple loss of caregivers and a dramatic
change in environment at adoption. Thus, they may still grieve post-adoption
and for example have sleep difficulties that have a root in feeling unsafe.
Generally the more moves a child has experienced the greater the impact. The
approaches for dealing with these issues in post-institutionalised children
also apply here. Many foster children with histories of abuse, neglect and/or
multiple placements will present with many of the same issues as
post-institutionalised adopted children and similar care strategies may be
helpful.
This article has presented a summary of the
issues with which post-institutionalised adopted children may present and the
ways in which health and other child care professionals may assist them and
their families. It is very important that it be kept in mind that not all
children present with these issues and that for many children the problems they
have a relatively short lived.
Post-institutionalised children are not abnormal and to pathologise them
because of their history does them and their families a great disservice. Rather,
the responses described here are normal reactions to an abnormal environment.
Children are not meant to live in institutional care but in families, for many
children growth in a family after adoption provides them the opportunity to
heal from past hurts. Although the immediate post-placement period can be
challenging for families seeing their child grow and heal is something that
parents and those who have assisted them find particularly rewarding.
Karen, R. (1994). Becoming Attached: first
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Karleen Gribble is the mother of two children, one
born to her and the other adopted as an older child from institutional care in
China. Her adopted child came home with a physical disability and developmental
delays that have necessitated consultation with and treatment by a wide range
of health and other child care professionals. Most of these health care
professionals had no experience in treating a post-institutionalised child and
did not understand the issues involved. This article has arisen out of her
experience as she found that providing information to health care professionals
about the affects of institutionalisation helped facilitate communication and
increasing the appropriate individualisation of care. Karleen is also a
scientist and is Adjunct Research Fellow in the School of Nursing, Family and
Community Health at the University of Western Sydney, NSW, Australia where her
research focuses on adoptive breastfeeding and the impact of breastfeeding on
hurt children.