After School Programs
Many children receive most of their recreational experiences through these programs. Coaches can be wonderful mentors and for some families after school programs eliminate some daycare needs.

Audiologist
An audiologist provides intervention strategies and services for individuals with deafness or hearing impairments.

Classroom Teacher
Your child’s classroom teacher is the person who will spend the most time with your child and will know her best. A classroom teacher is a valuable resource for helping identify any educational, emotional or social issues the child may be having in school.

Early Intervention Services
Every state offers an early intervention program to help identify infants and toddlers (up to age three) who may have developmental delays or disabilities. An evaluation is completed to determine the child’s cognitive, physical/motor, speech, language, social, emotional and adaptive development. A physician or the local school district can direct families to those services.

Educational Advocate
An Educational Advisor or Advocate helps parents work with the child’s school. As an additional member of an Individual Education Plan (IEP) team, an Educational Advocate provides additional experience and expertise to get the best outcome for the child.

Occupational Therapist
An occupational therapist is a licensed health professional who provides strategies and services to assist individuals with motor or sensorimotor functions, including fine motor manipulation, self-help, adaptive work skills, and play or leisure skills.

Physical Therapist
A physical therapist is a licensed health professional who works with individuals with motor or sensorimotor functioning in such areas as mobility and positioning.

School Counselor
A school counselor may assist in the identification of a child’s needs and may help to determine appropriate responses.

School Nurse
A school nurse provides medical care during the school day, monitors allergic reactions and may administer medication needed during school hours.

School Psychologist
A school psychologist assists in the identification of a child’s behavioral, social, emotional, educational and vocational needs and helps to determine appropriate responses.

School Social Worker
A school social worker is trained to assess a child’s educational needs including social, emotional, behavioral and adaptive needs. She provides intervention services including individual, group, parent and family counseling and serves as liaison between home, school and community.

Special Education Instructional Specialist
The special education instructional specialist provides ongoing support to special and general education instructional personnel. The specialist helps to identify and plan for the least restrictive environment appropriate for the child.

Speech-Language Pathologist
A speech-language pathologist provides intervention strategies and services related to speech and language development as well as disorders of language, voice, articulation and fluency.

Transportation Specialist
A transportation specialist works with the school district to provide special transportation and equipment for students with disabilities.

Tutoring Services
Many children can benefit from short or long-term use of a tutor. Families receiving federal (and some state) subsidies should look to the schools for help rather than Children and Family Services.

Malnutrition affects more than 200 million children worldwide and many internationally adopted children are malnourished. A person is said to be suffering from malnutrition if they have not consumed the appropriate amount, kind or quality of nutrients comprising a healthy diet for an extended period of time.

Adopted children may experience malnutrition for a number of reasons: inadequate prenatal care; impoverished or neglectful birth families; insufficiently varied diet in institutions; illness; poor appetite; inadequate feeding techniques. Poor feeding practices may lead to oral aversion which can affect eating practices after adoption.

Malnutrition has broad effects on growth, development, cognition, behavior and immune function. Adopted children tend to have growth delays and reduced head circumference. The effect of early malnutrition may not appear until years later. School age children may have poor attention spans, poorer memories, distractability, and difficulty in forming peer relationships.

Most adopted children quickly catch-up growth once they begin eating a balanced, nutrient-rich diet, although some children may remain permanently smaller and lighter. Children who do not have rapid growth recovery after arrival should be carefully evaluated.

The pediatrician should prescribe vitamin or mineral supplements if necessary, and should discuss feeding practices with the family. Many malnourished children have an ambivalent relationship with food. Some seem to have no appetite, even when presented with desirable foods, while others may gorge themselves and be unable to determine when they’ve eaten enough.

Internationally adopted children are at risk for micronutrient deficiencies because of inadequate pre- and postnatal care and an excessive use of bottle feeding in institutions, resulting in impaired growth and development, and long-term health and behavior problems.

Iron: Internationally adopted children are very susceptible to iron deficiency. Lack of iron can delay language, vocalization, and comprehension, and may have long term-effects on cognition. Iron-fortified cereals and formulas, and iron-rich foods are the best treatment.

Iodine: Iodine deficiency reduces IQ and is the world’s most common cause of preventable mental retardation. A thyroid test will usually indicate problems, and a diet which includes iodized salt is usually sufficient.

Zinc: Zinc deficiency is associated with increased susceptibility to infections, limited growth, and cognitive delays. Children with zinc deficiency may be more prone to ear infections or parasitic infections. Zinc deficiency is difficult to diagnose – signs include diarrhea, skin rashes, hair loss, and thin, peeling fingernails. Treatment is a high-protein diet and multivitamins.

Vitamin A: Vitamin A is important to vision, bone and skin development. Vitamin A deficiency can cause night blindness, xerophthalmia (eye fails to produce tears) poor growth, and susceptibility to measles and respiratory diseases. A diet rich in green, leafy vegetables and dietary supplements is recommended.

Rickets is a disease of bone growth caused by a calcium and vitamin D deficiency. Rickets is prevalent in children worldwide due to inadequate nutrition and lack of exposure to sunlight. Children in the northern latitudes are at the greatest risk. It is particularly common in orphanages in China, Romania and the former Soviet Union.

Children with rickets may have skeletal deformities; dental deformities; impaired growth; decreased muscle tone and a tendency toward bone fractures. X-rays are the best method for diagnosis.

Most adopted children recover from rickets with an adequate diet and vitamin supplements. Physical exercise will improve muscle tone. Children with physical impairments may benefit from seeing an orthopedist. A child who has had a diagnosis of rickets should see a dentist to determine any short or long term effects to the teeth.

Lactose intolerance is the inability to digest and absorb lactose, the major sugar in milk. It is commonly found in those of Asian, African, Native American, and Mediterranean descent, but less often found in those of European origin. Onset of symptoms varies from infancy to seven or eight years. The condition often persists into adulthood.

Symptoms of lactose intolerance begin 30 minutes to two hours after eating or drinking foods containing lactose. They range from the mild to the severe, and may include abdominal pain, cramps, abdominal distention, nausea, flatulence, diarrhea and vomiting.

Lactose intolerance may be a temporary condition if it appears associated with an intestinal infection. A physician should obtain a comprehensive dietary history and conduct a complete medical evaluation before making a diagnosis.

Treatment for lactose intolerance involves controlling the amount of lactose in the diet. Some people are more able to tolerate dairy products more easily than others. Lactose-reduced products are available, as are lactase drops or tablets, which help make lactose more digestible. A variety of other milks are available such as goat, soy, and almond but be aware that one can have soy intolerance as well. Talk to your doctor before eliminating dairy from your child’s diet.

Older children often self regulate their diet and it is important to ensure that a lactose intolerant child gets enough calcium if he is eating little or no dairy products. Foods that are high in calcium, like dark green vegetables can be substituted. However, it is advisable to check with a physician to determine if dietary supplements are advisable.