Loving a Child Has No Boundaries

“Loving a Child has no Boundaries”

SPECIAL NEEDS CONSIDERATON CHECKLIST

The China Waiting Child Program is an amazing program which allows children with medical special needs to be matched and processed for adoption as quickly as possible. The majority of these children have medical conditions which can be corrected with surgery and/or rehabilitation therapy. However, these are needs that are viewed as significant in China. There are also children who have no medical needs at all but are included in the Waiting Child program due to their age. We at CHI take the responsibility to advocate for each of these children and find their families very seriously. Please, open your hearts and your minds to the potential of these children!

The following is a list of special needs that are most common to children in the China Waiting Child program. The special need can be mild, moderate, or severe in scope. Please check the special needs that you would be willing to consider. For further information on the individual needs, please go to http://www.childrenshouseinternational.com/ and click on the medical resources link.

Family Name: ______

Gender of child willing to consider: ______Male ______Female ______Both

Age of child willing to consider: ______

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BLOOD CONDITIONS

_____ Anemia

_____ Hemophilia

_____ Thalassemia ____alpha ___beta

CRANIO-FACIAL CONDITIONS

_____ Cleft lip ____ unrepaired _____ repaired

_____ Cleft palate __ unrepaired ____ repaired

_____ Cleft lip and palate

_____ unrepaired _____ repaired

_____ Goldenhar Syndrome (congenital birth defect which involves deformities of the face)

_____Hemifacial Microsomia (uneven development of one side of the face)

_____ Microcephaly (small head size)

_____ Plagiocephaly (flattened head)

_____ Port Wine Stain (may or may not include Sturge-Weber Syndrome)

_____ Tumors

DEVELOPMENTAL CONDITIONS

_____ Developmental delay (this can be emotional, physical, social or mental delays in comparison to other children their age. The child may or may not catch up)

__mild __moderate __severe

_____ Autism

_____ Down’s Syndrome

_____ Hyperactivity __mild __moderate __severe

_____ Learning Difference

__mild __moderate __severe

_____ Speech delay

__mild __moderate __severe

_____ Non-verbal

DIGESTIVE CONDITIONS

_____Anal Atresia/Imperforate Anus (rectum is malformed or closed)

_____ Cyclic Vomiting Syndrome (cycles of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days)

_____ Hernia (umbilical and/or inguinal)

EAR AND/OR HEARING CONDITIONS

_____ Atresia (lack of ear opening)

_____ Microtia (exernal ear not fully formed)

_____ Deaf

_____ Hard of Hearing ____mild ___moderate

EYE AND/OR VISION CONDITIONS

_____ Amblyopia (lazy eye)

_____ Blindness (complete)

_____ Blindness in one eye

_____ Congenital Cataracts

_____ Glaucoma

_____ Nystagmus (rapid involuntary movements of the eyes)

_____ Missing or small eyeball __one ___both

_____ Poor vision

_____ Ptosis (droopy eyelid)

_____ Strabismus (crossed eyes)

HEART CONDITIONS

_____ Atrial Septum Defect (valve does not fully close)

_____ Coarctation of the Aorta (a pinched aorta)

_____ Patent Ductus Arteriosus (blood bypasses the lungs preventing oxygen to circulate throughout the body)

_____ Tetralogy of Fallot (four different heart defects that occur together)

_____ Transposition of the Great Vessels (blood from the left side of the heart and right side of the heart intermix because the large artery connections are incorrect)

_____ Ventricular Septal Defect (valve does not fully close)

INFECTIOUS DISEASES

_____ Hepatitis B Positive

_____ Hepatitis C Positive

_____ Tuberculosis

CENTRAL NERVOUS SYSTEM

_____ Agenesis of the Corpus Callosum (an abnormality of brain structure, that is characterized by partial or complete absence of the corpus callosum. The corpus callosum is a bundle of nerve fibers that connects the two hemispheres (halves) of the brain and allows information to pass back and forth between both sides. Children may have no outward symptoms or in more severe cases intellectual delay)

_____ Arachnoid cysts (fluid filled cysts found in the brain or on the spinal cord)

_____ Cerebral Palsy (non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement)

__mild __moderate ___ severe

_____ Hemiparesis (weakening of one side of the body)

_____ History of encephalitis, meningitis or other brain infections

_____ Hydrocephaly (abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain which may require surgery)

__repaired ___unrepaired

_____ Macrocephaly (abnormal largeness of the head)

_____ Neurofibromatosis (a genetic disorder that causes tumors to grow on nerve tissue, producing skin and bone abnormalities)

_____ Nerve damage to limbs

_____ Post Polio__mild __moderate __severe

_____ Spina Bifida (a birth defect that involves the incomplete development of the spinal cord or its coverings)

__repaired ___unrepaired

_____ Seizure Disorder (brain disorder which causes disruptions in the electrical activity in the brain ) __mild __moderate __severe

_____ Tethered Spinal Cord (spinal cord is tugged between the lower back and the brain stem. Because the vertebral column grows more quickly than the nerves that make up the spinal cord, tethering will cause increased tension on the cord as a child grows)

ORTHOPEDIC CONDITIONS

_____ Amniotic banding (results in malformed or missing limbs)

_____ Arthogryposis (persistent flexure/contracture of a joint)

_____ Congenital talipes equinovarus (clubbed feet) ___one foot ___two feet

_____ Developmental Dysplasia of the Hip (abnormal formation of the hip joint often requiring surgery or casting)

_____ Ectodactaly (congenital defect involving a complete or partial absence of one or more digits)

_____ Limb Length Difference (arms or legs are of different lengths)

_____ Macrodactaly (uncommon birth defect in which toes or fingers are abnormally large due to overgrowth of underlying bone and soft tissue-particularly the nerves, fat and skin of the involved digit or digits.)

_____ Polydactyly (extra digits)

_____ Syndactyly (a condition where two or more digits are fused together)

_____ Osteogenesis Imperfecta (genetic bone disorder with defective connective tissue, or inability to make connective tissue, usually because of a deficiency of Type-I collagen)

_____ Radial Club Hand (an anomaly in which the wrist is deviated on the thumb side towards the arm, due to deficiency or absence of the radius)

_____ Rickets (softening of the bones most often due to lack of vitamin D or calcium)

_____ Scoliosis (lateral curvature in the normally straight vertical line of the spine.)

_____ Tibial or Fibular Hemimelia (congenital absence or shortening of the tibia or fibula. Can also result in malformed foot and missing toes. Amputation or leg lengthening surgery often required)

_____ Torticollis (stiffening of the head and/or chest muscles)

_____ Wheelchair bound (any condition requiring the continued use of a wheelchair)

SKELETOMUSCULAR CONDITIONS

_____ Congenital myopathy (any muscle disorder present at birth)

_____ Dwarfism (genetic condition resulting in small stature)

_____ Growth Delay (cause may or may not been known)

_____ Hypotonia (disorder that causes low muscle tone often involving reduced muscle strength)

SKIN CONDITIONS

_____ Albinism __mild __moderate __severe

_____ Birthmarks ___on face __ on other parts of the body

_____ Burns __mild __moderate __severe

_____ Café Au Lait Spots (hyperpigmented lesions that may vary in color from light brown to dark brown, the borders may be smooth or irregular)

_____ Eczema, Psoriasis, and other chronic skin conditions in their most serious form

_____ Icthyosis (genetic skin disorders which result in dry, thickened, scaly or flaky skin)

_____ Hemangioma __on face __on other parts of the body

_____ Nevus (benign chronic lesions on the skin which may be raised or discolored.)

_____ Teratoma (type of encapsulated tumor present at birth. Most teratomas are benign, but some can become malignant, especially if they are located in the testes.)

UROGENITAL CONDITIONS

_____ Ambiguous Genitalia (a birth defect of the sex organs that makes it unclear whether an affected newborn is a girl or boy. Causes include genetic abnormalities and hormonal problems)

_____ Hypospadia (male birth defect in which the opening of the tube (urethra) that carries urine from the body develops abnormally, usually on the underside of the penis.)

_____ Incontinence (involuntary leakage of urine or feces due to an underlying medical condition)

_____ Renal Agensis (absence of kidney)

_____ Vaginal Fistula (abnormal passages connecting the vagina to other organs)

_____ Undescended Testicles (one or both testicles are missing from the scrotum and are lodged instead in the groin or inside the lower abdomen)

OTHER CONDITIONS

______Medically healthy children (are considered special needs due to their age. Generally there are boys over the age of 7 and girls over the age of 10.)

IF THERE ARE ADDITIONAL SPECIAL NEEDS YOU WILL CONSIDER THAT ARE NOT ON THE CHECKLIST, PLEASE ADD THEM BELOW:

______

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