Salud en la adopción internacional: ¿Qué debemos saber?


El desconocimiento del estado de salud de los niños previo a la adopción, puede derivar en la detección no esperada por los padres de enfermedades graves a la llegada a España. Nuestro objetivo con esta entrada es brindar información relevante que ayude en la toma de decisiones y guíe en la acogida y mayor bienestar del menor.

A pesar de la disminución del número de adopciones internacionales en los últimos años, en España sigue siendo una opción escogida por muchas familias. Es un proceso largo y no exento de dificultades, en el que el abordaje de ciertas situaciones puede suponer un reto para las familias. Una preocupación frecuente es la salud.
 

  • ¿A qué factores de riesgo se exponen los niños durante el embarazo y los primeros meses de vida?

El embarazo es un periodo fundamental para el desarrollo, sobre todo los tres primeros meses, durante los cuales la exposición a tóxicos como drogas, tabaco o alcohol pueden condicionar enfermedades como el temido Síndrome alcohólico fetal. Un buen control durante el embarazo nos permite detectar malnutrición materna o infecciones que se transmiten al bebé, lo que nos ayuda a prevenir y tratar posibles enfermedades o, en ausencia de tratamiento curativo, disminuir sus efectos.
Además, durante el parto, se pueden producir estados de baja oxigenación que, de no ser asistidos adecuadamente, pueden derivar en falta de desarrollo cerebral. Conviene saber con cuantas semanas de gestación fue el parto, ya que en niños prematuros la maduración del organismo no es la misma que en una gestación de 39 semanas.
En muchos casos, se produce abandono nada más nacer; en algunos casos el niño o niña permanece los primeros meses con sus familiares para luego pasar a instituciones de acogida, donde las condiciones de acogida van a determinar la nutrición y el desarrollo, así como el establecimiento del vínculo de apego con sus cuidadores.
 

  • Durante el proceso de preadopción, ¿cómo sabremos su estado de salud?

Por los motivos que hemos comentado, es vital obtener la mayor cantidad de información posible de los antecedentes de la niña o niño porque nos va a ayudar a detectar sus necesidades y estar más preparados para el momento de la acogida. Por desgracia, en muchos casos se desconoce cómo fue el embarazo y sus primeros meses, mientras que en otros los informes aportados por los organismos del país de origen están incompletos o con datos incorrectos (falta de actualización de las medidas del menor, diagnósticos erróneos, datos ocultos…)
Si ya tenéis el informe médico preadoptivo, deberíais acercaros a vuestro centro de salud a hablar con el futuro pediatra del niño para que valore el informe y resuelva vuestras dudas, o bien acudir a un pediatra especialista en adopción internacional.
En caso de que el informe no esté completo, podéis recopilar los principales datos médicos y sociosanitarios durante la estancia en el país de origen y obtener material audiovisual que será valorado posteriormente. Éste, ha de respetar los derechos del menor y la normativa vigente en ambos países (el de origen y el de acogida).
 

  • Nos vamos de viaje… ¿qué me llevo?

La preparación del viaje probablemente sea, junto con el primer contacto con el pequeño, de los momentos más intensos de esta aventura. La ilusión nos ha de llevar también a ser precavidos y, unas semanas antes del viaje, informarnos de las medidas de precaución y vacunas correspondientes. Hay que tener en cuenta, que la estancia en el país va a ser prolongada. Como tenemos un post específico, os remito a él para su consulta.
Además, conviene llevar un botiquín básico de medicamentos y un kit con lo necesario para el cuidado (tanto de higiene como de alimentación) para el menor durante el periodo que dure la formalización de la adopción y podáis regresar a vuestro país (aunque el proceso continúe y se asegure que la acogida sea la adecuada).
 

  • Hemos aterrizado: primeros pasos

Es imprescindible una valoración médica completa dentro de las dos primeras semanas tras nuestra llegada, preferiblemente en los tres primeros días. En caso de signos de infección (fiebre, vómitos, diarrea, tos…), se deberá acudir a su pediatra en las primeras 24 horas o al servicio de urgencias en caso de no poder concertar cita. Hay que tener en cuenta la posibilidad de transmisión de enfermedades infecciosas a los familiares durante las primeras semanas de contacto.
La mayor parte de los problemas de salud se solucionan o recuperan en los tres primeros años tras la adopción, pero un porcentaje no desdeñable padece trastornos del neurodesarrollo y/o psicopatológicos importantes en los que la recuperación completa no es posible y tendrán secuelas con las que tanto la familia como el menor tendrán que convivir. Es por ello que una detección temprana es fundamental, por lo que tras la primera valoración y solicitud de pruebas (analítica de sangre y orina, cultivo de heces…) deberá acudir a revisiones periódicamente en las que se observará su evolución física y mental.
Entre los problemas más frecuentes se encuentran los retrasos en el crecimiento físico y desarrollo psicomotor, anemias, falta de inmunización (los calendarios vacunales varían de una región a otra y muchos presentan una vacunación incompleta o ausente), lesiones en piel, parasitosis intestinales e infecciones. Con menos frecuencia, nos encontramos con graves trastornos del desarrollo que pueden ser debidos a problemas durante la gestación (infecciones congénitas, malformaciones…), parto o primeros meses de vida, así como infecciones adquiridas y patología neurológica como epilepsia o hidrocefalia (acumulación de exceso de líquido en el cerebro).
La falta de información médica y sociosanitaria del menor puede suponer un obstáculo más en el proceso de adopción, por lo que deberemos esforzarnos en poner un poco de luz en su pasado para poder ofrecerle un futuro mejor.
 
Esperamos haberos ayudado y abajo os dejamos algunos enlaces para que podáis profundizar más en este aspecto:
Fisterra. Portal de Atención Primaria para profesionales y pacientes
-Página web del Dr. Oliván Gonzalvo, pediatra y director del Centro de Pediatría y Adopción Internacional de Zaragoza
-Coordinadora de Asociaciones en defensa de la adopción y el acogimiento (CORA) con una guía de adopción que os podéis descargar 
-Centers for Disease Control and Prevention (en inglés) con recomendaciones sobre vacunaciones para adoptados y sus familiares



REFERENCIAS:

  • “Adopción internacional: manejo en la preadopción” Oliván Gonzalvo G, Guía Fisterra
  •  “Las mejores páginas web en Salud y adopción internacional” Núñez Gaviño P, Buenadicha Huguet JL

 

Paula Docampo Dameá,
Médico de Atención Primaria en CS Alta Sanabria
Miembro del grupo de Inequidades en Salud de la SEMFYC

Revisado: Agosto 2018.

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