Disabilities &
Medical Conditions in Special Needs Adoption

Causes

There are several factors linked to children developing autism, including:  

• Genetics 
• Advanced paternal age 
• Prenatal and perinatal brain injury
• Premature birth

Signs & Symptoms

Children with autism often show symptoms early in life. Some children begin to lose language or social skills (or “regress”) at the age of 1 or 2. Autism looks different in each child. Not every child shows every behavior or sign.

Symptoms of autism may be grouped into two categories.

Social Communication and Social Interaction 

In this case, a child: 

• Doesn’t like to cuddle or hug   
• Likes to play alone 

Under the age of 3

A child: 

• Doesn’t answer to their name   
• Doesn’t want to give, share or show off things they like  
• Doesn’t use motions to communicate  
• Doesn’t understand how others feel   
• Cannot show how they feel  
• Doesn’t understand relationships    
• Has trouble reading and using body language
• Hasn’t spoken a word by 18 months   
• Cannot say two-word phrases by age 2
• Has speech issues 
• Repeats phrases or puts words in the wrong order  
• Can recite information but cannot use it to solve problems or have a conversation   
• Rarely or never makes eye contact   
• Has trouble carrying on a conversation and letting another person speak 

Repetitive Behaviors

In this case, a child: 

• Repeats the same action  
• Focuses on small details  
• Struggles with changes in their routine  
• Organizes or groups toys  
• Gets extremely focused on specific topics or objects

Additionally, children with autism are often sensitive to sounds, lights, textures or smells. This is called sensory processing disorder.    

Complications

A range of physical and mental conditions can be associated with autism. These conditions include: 

• Feeding difficulties, including sensory issues around eating 
• Poor sleep
• Gastrointestinal problems 
• Epilepsy
• Attention-deficit/hyperactivity disorder
• Anxiety and depression 
• Other mental health conditions, such as obsessive-compulsive disorder, schizophrenia and bipolar disorder  

Nutrition & Feeding Implications

Children with autism may experience unique challenges related to their heightened sensory system, motor planning difficulties and strong preferences. This can affect what meals and mealtimes look like for families of children with autism. It may help to keep a food diary, including what, where and when your child eats. This can help you identify any common themes around your child’s needs. 

Some of the challenges related to autism may include:

• Adversity to trying new foods and liquids 
• Severely restricted types of food a child will eat 
• Difficulty managing certain food textures 
• Difficulty with self-feeding 
• Strong preferences for certain eating utensils and dishes 
• Overstuffing their mouth with food to “feel” it in their mouth 
• Frequent digestive problems 
• Restricting foods of a certain color or texture 
• Not eating enough or eating too much 
• Consuming things that are not food (an eating disorder called pica) 
• Coughing or choking while eating 
• Constipation, causing a feeling of fullness when they have not eaten much food 

These feeding challenges can lead to: 

• Limited dietary variety 
• Selective eating habits 
• Behavioral issues during meals 

There are many ways in which children and families can connect and learn during mealtimes. To get started:

• Lead by example, and consume nutritious foods and beverages as a family.
• Eat a variety of fruits and vegetables, pairing them with whole grains and foods that are high in protein, such as eggs, fish, chicken, meats, beans, tofu and nuts or seeds. If a child is selective in their eating, try offering new foods along with those they are comfortable with.  
• Offer plenty of calcium-rich foods and beverages, such as tofu, yogurt, cheese, soy milk and cow’s milk. Other sources of calcium include leafy green vegetables and calcium-fortified products, such as some types of breakfast cereals and 100% fruit juice. 
• Provide nutrient-rich foods, including dried fruit, nuts and nut butters, or smoothies.  
• Encourage plenty of fluids, especially water, to help prevent dehydration and constipation. Avoid sweetened beverages. 
• Children with autism may be at increased risk of experiencing mealtime challenges. Whether these challenges are related to a child’s unique sensory system, oral and fine motor skills, gastrointestinal system or something else, their overall nutrition and growth may inadvertently be affected. Identify a network of support, and ensure that all team members are connected with one another for continuity of care. Your team might include a pediatrician, feeding specialist, dietitian, specialty medical providers and therapists, such as a speech-language pathologist, occupational therapist or physical therapist.
• Change can be hard. Introducing a new food, using a different utensil or cup, or even eating in a different chair or location can all naturally be stressful for children. These changes can often be particularly hard for children with autism. Go slowly and make one change at a time. Taking slow and thoughtful steps when initiating changes at mealtimes can make a huge difference in how a child responds.  
• Some children aren’t ready to try a new food. They need extra time and additional ways to get comfortable with something new. Familiarize your child with new foods outside of the kitchen when there is no pressure for them to eat. Learn about food from a book or a TV show. Explore new foods at the grocery store. In time, you can shift toward other ways to explore these foods, such as touching, smelling, licking and eventually tasting and eating the food. 
• It can take upwards of 20 times for a child to accept a new food! This means it’s important to offer a child many opportunities to explore a food and not to expect them to enjoy it right away. Also, if a child repeatedly refuses a food, consider offering it in a different way. If a child continues to refuse a food after more than 20 offerings, it might just be their individual preference, and that’s okay! Move on to another food to explore. 
• Children with autism may refuse food and liquids for a variety of reasons. These may include sensory aversions (disliking the way a food looks, smells, feels or tastes), difficulty chewing and swallowing a certain texture or consistency, food allergies, or constipation caused by what they’re eating and drinking. Consult first with a pediatrician to rule out any underlying medical condition that may be contributing to a child’s food and liquid selectivity. A pediatrician can then help determine the next best steps, including other possible sources of support, such as a gastrointestinal specialist, allergist, feeding therapist or dietitian. 
• Mealtimes can be inherently challenging for some children, so it’s helpful to avoid adding any extra, unnecessary stress. When children feel pressure to “take a bite,” eat everything on their plate or are force-fed, additional stress can arise. Aim to create a mealtime environment that upholds a positive atmosphere, minimizes the pressure to eat, offers time and space for exploring and eating foods, and follows a child’s individual needs and lead. 
• Parents and caregivers can often feel distress, frustration or worry while supporting a child with autism, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child.

Care & Treatment

Each child with autism has their own unique needs. To support children with autism throughout childhood, it is helpful to seek support early in life.   

Treatment for autism can include: 

• Developmental therapies and supports  
• Family-based therapies and supports  
• Therapy-based supports, including speech-language, occupational, sensory integration and cognitive behavioral therapists 
• Education programs for children with autism, focusing on social skills, speech, language, self-care and job skills  
• Behavioral therapies and supports, focusing on social, movement and cognitive skills
• Complementary and alternative therapies and supports, such as music, art, and play-based and animal-assisted therapies
• Medical therapies and medication. Some children might require medication to manage some of the symptoms of autism. 

Mental health providers can also be a key resource for families of children with autism. These providers can provide parent counseling, social skills training and one-on-one therapy. They can also help find the treatment programs that are best for your child.  

Here are things you can do to care for your child: 

• Keep all appointments with your child’s healthcare provider. 
• Talk with your child’s healthcare provider about other professionals who can be included in your child’s care. Your child may benefit from a team that includes a neurologist, speech-language pathologist, occupational and physical therapist, social worker, psychologist and psychiatrist. Your child’s care team will depend on their needs and the severity of autism symptoms. 
• Tell others about your child’s autism. Work with your child’s healthcare provider and schoolteachers to create a treatment plan. 
• Investigate school resources for your child. Often, a child’s autism can interfere with their ability to manage regular school settings. The Americans with Disabilities Act and Section 504 of the Civil Rights Act help protect children with disabilities and their rights. Talk with your child’s teacher or school principal for more information. 
• Have your child wear a medical alert bracelet or necklace if they wander or have limited communication. Also consider having them carry an emergency form with contact information and communication symbols. 
• Reach out for support from local community services. Parenting a child with autism can be stressful at times. Being in touch with other parents who have a child with autism may be helpful. 
• Take care of yourself and watch for signs of stress in yourself or your family members. The physical and emotional demands of caregiving can be overwhelming. Let family and friends help and provide respite care. A break can be helpful for both you and your child.  

Additional Resources

The following organizations can provide further information about autism. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Autism Society
• Centers for Disease Control and Prevention: Autism Spectrum Disorder
• Cleveland Clinic: Autism Spectrum Disorder

Causes

There is no single cause of ADHD, but children who develop ADHD may have the following risk factors:

• Maternal smoking, alcohol and substance abuse during pregnancy
• Maternal stress during pregnancy
• Low birth weight 
• Exposure to environmental contaminants 
• Exposure to lead

Signs & Symptoms

The following are the most common symptoms of ADHD. However, each child may experience different symptoms.

Inattention 

A child:

• Has difficulty sustaining attention (short attention span for age) 
• Has difficulty listening to others 
• Has difficulty attending to details 
• Is easily distracted 
• Is forgetful
• Has poor organizational skills for age 
• Has poor study skills for age 

Impulsivity

A child:

• Often interrupts others 

• Has difficulty waiting their turn in school and/or social games 

• Tends to blurt out answers instead of waiting to be called upon 

• Takes frequent risks, often without thinking before acting 

Hyperactivity 

A child:

• Seems to be in constant motion — runs or climbs, at times with no apparent goal except motion 
• Has difficulty remaining in their seat even when it is expected 
• Excessively fidgets with their hands or squirms when in their seat
• Talks excessively 
• Has difficulty engaging in quiet activities 
• Loses or forgets things repeatedly and often 
• Is unable to stay on task — shifts from one task to another without bringing any to completion 

Complications

ADHD often occurs with other disorders. Many children with ADHD experience behavior or conduct problems, learning disorders, anxiety and depression, difficult peer relationships and risk of injury.

Nutrition & Feeding Implications

There is no evidence to suggest that diet causes ADHD. However, research has found that dietary changes can help improve symptoms in some children. Talk with your child’s doctor or a dietitian before starting any diets for ADHD. Many restrictive diets can lead to nutritional issues. Some doctors may suggest supplements like vitamin D, magnesium or probiotics if vitamin D levels are low.

Children with ADHD may face feeding challenges related to sensory sensitivities, selective eating habits and mealtime behaviors. These challenges can affect their ability to eat a varied and balanced diet, potentially leading to nutritional gaps.

Families can help by creating a supportive mealtime environment, accommodating sensory preferences and addressing any oral motor or swallowing difficulties. Here’s how:

• Lead by example, by consuming nutritious foods and beverages as a family. 
• Eat a variety of fruits and vegetables, pairing them with whole grains and foods that are high in protein, such as eggs, fish, chicken, meats, beans, tofu, nuts and seeds. If a child is selective in their eating, try offering new foods along with those they are comfortable with. 
• Offer plenty of calcium-rich foods and beverages, such as tofu, yogurt, cheese, soy milk and cow’s milk. Other sources of calcium include leafy green vegetables and calcium-fortified products, such as some types of breakfast cereals and 100% fruit juice. 
• Provide nutrient-rich foods including dried fruit, nuts and nut butters, and smoothies.  
• Encourage plenty of fluids, especially water, to help prevent dehydration and constipation. Avoid artificially sweetened beverages. 
• Children with ADHD may demonstrate strong preferences at mealtimes that can have an impact on their ability to receive well-rounded nutrition. Consult with a pediatrician to rule out any underlying medical conditions that may contribute to a child’s food and liquid selectivity. A pediatrician can then help determine the next best steps, including other possible sources of support, such as a gastrointestinal specialist, allergist, feeding therapist or dietitian.
• Children with ADHD often take medications, some of which can cause a loss of appetite and weight loss. A reduced appetite can affect how many nutrients a child consumes, thereby affecting their growth and development. Because of the potential impact of medication on feeding and nutrition, it’s important to have ongoing discussions with, and support from, your child’s medical team. They can offer ways to modify medication use to support your child’s unique nutrition needs (i.e., changing the type of medication and/or when it’s taken, prescribing medication “breaks,” etc.).
• Some children aren’t ready to try a new food. They will need extra time and additional ways to get comfortable with something new. Familiarize your child with new foods outside of the kitchen when there is no pressure for them to eat. Learn about food from a book or TV show. Explore new foods at the grocery store. In time, you can shift toward other ways to explore these foods, such as touching, smelling, licking and eventually tasting and eating the food. 
• It can take upwards of 20 times for a child to accept a new food! This means it’s important to offer a child many opportunities to explore a food and not to expect them to enjoy it right away. Also, if a child repeatedly refuses a food, consider offering it in a different way. If a child continues to refuse a food after more than 20 offerings, it might just be their individual preference, and that’s okay! Move on to another food to explore. 
• Sometimes too many options or too much food or liquid can feel overwhelming for a child with ADHD and have an impact on mealtimes. Offer smaller amounts of food and fewer options at a time. Then, once a child has had ample time, consider introducing more food or liquid or another option.  
• Limit distractions at mealtimes, including the use of electronic devices. Instead, aim to focus your child’s attention on the mealtime experience. 
• Consult with a feeding specialist, such as a speech-language pathologist or occupational therapist, and/or a dietitian for additional support if your child demonstrates a reduced interest in food or liquids, or if there are concerns about their growth and nutrition and mealtimes. 
• Parents and caregivers can often feel distress, frustration or worry while supporting a child with ADHD, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child.  

Care & Treatment

For children with ADHD who are younger than 6, the American Academy of Pediatrics (AAP) recommends that parents receive training in behavior management as the first line of treatment before trying medication with their child. The AAP recommends a treatment plan of both medication and behavior therapy for children 6 years and older. Schools can be part of the treatment plan, by adding behavioral classroom intervention and school support.  

The following suggestions may help a child with ADHD: 

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. 
• Get organized. Encourage your child to put schoolbags, clothing and toys in the same place every day so they will be less likely to lose them. 
• Manage distractions. Turn off the TV, limit noise and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works. 
• Limit choices. To help your child from feeling overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or another. 
• Be clear and specific when talking with your child. Let your child know you are listening by repeating back to them what you heard them say. Use clear, brief directions when they need to do something. 
• Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress. 
• Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic — small steps are important! 
• Discipline effectively. Instead of scolding, yelling or spanking, use effective directions, time-outs or removal of privileges as consequences for inappropriate behavior. 
• Create positive opportunities. Children with ADHD may find certain situations stressful. Finding out and encouraging what your child does well — whether it’s school, sports, art, music or play — can help create positive experiences. 
• Provide a healthy lifestyle. Nutritious food, lots of physical activity and sufficient sleep are important, as they can help keep ADHD symptoms from getting worse. 

Additional Resources

The following organizations can provide further information about ADHD. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Centers for Disease Control and Prevention: What Is ADHD?
• CHADD: Parenting a Child With ADHD
• National Institute of Mental Health: Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need to Know

Causes During Pregnancy

• Genetic conditions  
• Limited blood or oxygen supply to the brain before or during birth  
• Infections  
• Bleeding in the brain  
• Severe jaundice  
• Premature birth, very low birth weight, multiple births (twins, triplets)  
• Maternal smoking, alcohol and/or drug use

Causes During Infancy and Early Childhood 

A small number of children might have brain damage that leads to cerebral palsy during infancy or early childhood. Causes include: 

• Brain infections (bacterial meningitis)  
• Malnutrition  
• Car accident  
• A fall  
• Child abuse  
• Lead poisoning  

Signs & Symptoms

Cerebral palsy is usually detected before a child turns 3. Signs may include: 

• Inability to control muscles in the body; arms and legs might move suddenly and involuntarily  
• Problems with balance and coordination  
• Stiff or tight muscles and exaggerated reflexes  
• Walking with one foot or leg dragging  
• Walking on the toes, a crouched gait or a “scissored” gait  
• Muscle tone that is either too stiff or too floppy  

Complications

For a child with cerebral palsy, poor muscle development and coordination of arms, legs, lips, tongue, jaw and throat can lead to several feeding problems and other complications. If you are caring for a child with cerebral palsy, watch for the following possible problems. 

Care & Treatment

If you are caring for a child with cerebral palsy, discuss a treatment plan with your pediatrician and social worker. The treatment plan should be based on the needs of the child and include:

• Regular follow-ups by a pediatrician, neurologist, breastfeeding counselor or feeding specialist 
• Speech, occupational and/or physical therapy to help develop skills such as walking, sitting, swallowing and using the hands; and to address feeding issues for the infant and child, and speech issues for the child 
• Adaptive equipment, such as specialized bottles, spoons and cups that can improve feeding  
• Training of nurses and caregivers on feeding an infant and child with cerebral palsy using adaptive equipment, daily exercises as recommended by doctors and therapists, and growth monitoring  
• Dental checkups  

Additional Resources

The following organizations can provide further information about cerebral palsy. You can also read more below from one family who adopted a child with cerebral palsy. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• United Cerebral Palsy
• Cerebral Palsy Guide
• Encouragement in the Unknown: A Special Needs Adoption Story

Causes

There are many potential causes of cleft lip and cleft palate such as: 

• Family history of cleft lip or clef palate  
• Exposure to viruses, toxic substances and environmental pollutants 
• Maternal nutritional imbalances 
• Association with several syndromes

Complications

Cleft lip and cleft palate provide no connection or cognitive delays, but they can complicate talking, feeding and eating. If you are caring for a child with a cleft issue, watch for these possible problems: 

• Failure to gain weight  
• Poor growth  
• Feeding problems due to malformation of the face, delayed oral-motor development or behavioral issues 
• Flow of milk through the nose during feeding   
• Dental problems  
• Repeated ear infections that may cause hearing loss  
• Speech difficulties  

Challenges Before Surgery

Before your child undergoes surgery, they may experience the following issues:

• A cleft lip and cleft palate will likely affect bottle feeding and may affect breastfeeding, although infants with a cleft lip or palate can often still successfully breastfeed.   
• An opening in the lip or palate can interfere with the suction or vacuum needed to pull milk from the nipple.    
• Milk may come out of the infant’s nose during a feeding due to the opening in the lip or palate.   
• The infant may swallow too much air while feeding, leading to discomfort and inadequate intake.   
• Longer feedings can make an infant very tired and cause them to burn too many calories.  
• Though a child with a cleft issue has normal sucking and swallowing reflexes, they may need a special bottle to allow milk to flow without suction.   

Challenges After Surgery

A cleft lip or palate can be successfully treated with surgery, especially if corrected soon after birth or in early childhood. Ideally, children with a cleft lip and/or cleft palate should be followed from birth through adolescence by a team that designs an individualized treatment plan. If you are caring for a child with a cleft lip and/or cleft palate, discuss a treatment plan with your pediatrician and other health professionals. The treatment plan should be based on the needs of the child and include:

• Surgery to correct malformation 
• Speech and occupational therapy to address feeding issues for the infant and child, and speech issues for the child 
• Adaptive equipment, such as specialized bottles, spoons and cups that can improve feeding 
• A dental checkup 
• An ear and hearing checkup for children with cleft palate 

Care & Treatment

After the palate is surgically repaired, any problems with mealtimes should be resolved. Sometimes, a small hole may remain or develop in the roof of the mouth at the site of the original cleft. Food or liquid may come through or get lodged in the hole. Most children adapt and clear any liquid or food particles on their own. If leaking or reflux through a fistula is frequent, discuss the concern with your child’s doctor.  

Additional Resources

The following organizations can provide further information about cleft lip and cleft palate. You can also read more below from families who adopted children with clefts. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• American Cleft Palate Craniofacial Association
• Mayo Clinic: Cleft Lip and Cleft Palate
• Cleft Lip and Palate: Before and After

Signs & Symptoms

Signs and symptoms of CHD depend on the type and severity of the illness. Contact your doctor if your child: 

• Has bluish-tinted nails, lips or tongue  
• Has fast or difficulty breathing  
• Sweats, especially during feeding  
• Tires easily when feeding  
• Is very sleepy  

CHF can affect either the right or left side of the heart. Right-sided CHF is the most common in children with CHD. The child may show different signs and symptoms based on the side affected:

Complications 

Children diagnosed with CHD are at nutritional risk and often demonstrate slow growth, which becomes apparent early in life. Depending on cardiac status, many factors may cause poor growth and malnutrition.

 CAUSES OF POOR GROWTH AND MALNUTRITION IN CHILDREN WITH CHD

• Poor appetite
• Fatigue during feeding
• Oral feeding challenges
• Food and oral aversions
• Suboptimal hunger cues
• Early fullness
• Nausea and vomiting
• Reflux
• Fluid restriction

Possible outcome:

Decreased food intake

• Increased metabolism
• Heart working hard to pump blood
• Increased susceptibility to infection
• Frequent illnesses

Possible outcome:

Increased energy and protein needs

• Impaired nutrition absorption in the gut
• Medications

Possible outcome:

Decreased nutrient utilization

Care & Treatment

Infants diagnosed with CHD can receive corrective surgery in the first days to months of life. Good nutritional status is important before surgery, as some infants will not be able to receive an operation until they are at a healthy weight. If you are caring for a child with CHD, discuss a treatment plan with your doctor. The treatment plan should be based on the needs of the child and include:   

• Regular follow-ups by a pediatrician   
• Follow-ups by a pediatric cardiologist as needed 
• Speech and/or occupational therapy, or breastfeeding counseling to address feeding issues  
• Training of nurses and caregivers on feeding an infant and child with CHD  
• Training of nurses, caregivers and cooks on measurement of liquids and limiting salt in cooking in case of fluid and salt restrictions   

Additional Resources

The following organizations can provide further information about CHD. You can also read more below from families who adopted children with CHD. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• American Heart Association
• The Children’s Heart Foundation
• The Five Most Common Heart Conditions Among Children Who Need Adoptive Families

Causes

Down syndrome is a condition in which a baby is born with an extra chromosome. The extra chromosome is associated with delays in the child’s mental and physical development, as well as an increased risk for health problems. The exact cause of why this happens is unknown. Women who become pregnant after the age of 35 have a significantly higher risk of having a child diagnosed with Down syndrome.   

Signs & Symptoms

Common physical features include: 

• Flat facial profile  
• An upward slant to the eyes  
• Small ears  
• A protruding tongue  
• Excessive drooling  
• Low muscle tone (babies in particular may seem especially “floppy”)  

Complications

Infants:

• Slower growth rate  
• Difficulty sleeping  
• Sucking and feeding problems  
• Constipation  
• Delayed developmental milestones (sitting up, crawling and walking)  

Toddlers and Older Children:

• Difficulty learning  
• Delays in speech  
• Delays in self-care skills (feeding, dressing, use of toilet)  
• Slow metabolism that may result in being overweight  
• Thyroid problems  
• Seizure disorders  
• Respiratory problems  
• Vision or hearing problems  
• Problems with the heart and lungs  
• Increased susceptibility to infections  

Low tone can, and often does, improve over time. Most children diagnosed with Down syndrome typically reach developmental milestones later than other kids. Children diagnosed with Down syndrome are capable of learning and developing skills throughout their lives. They simply reach goals at a different pace, which is why it is important not to compare a child with Down syndrome to a child without Down syndrome.

Care & Treatment

If you are caring for a child with Down syndrome or a condition characterized by low tone, discuss a treatment plan with your pediatrician and social worker. The treatment plan should be based on the needs of the child and should include:   

• Regular follow-ups by a pediatrician. Ask the doctor about developmental milestones you should watch for and how to encourage the development of those skills.  
• Evaluation by a cardiologist, eye doctor and ear, nose and throat specialist 
• Speech, physical and/or occupational therapy or breastfeeding counseling to address feeding issues for the infant and child, as well as speech and feeding issues for toddlers and older children  
• Training of caregivers on feeding an infant and child with Down syndrome   

Additional Resources

The following organizations can provide further information about Down syndrome. You can also read more below from families who adopted a child with Down syndrome. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• National Down Syndrome Congress
• Global Down Syndrome Foundation
• What It Means to Adopt a Child With Down Syndrome

Causes

For many children, the cause of epilepsy is unknown. But epilepsy may occur as a result of abnormal electrical discharges in the central nervous system, inflammation or oxidative stress (an imbalance between free radicals and antioxidants in the body). Half of diagnosed cases of epilepsy result from unknown causes, and epilepsy is considered a spectrum disorder. 

Some known potential causes include: 

• Infections 
• Head trauma 
• Injury or drug exposure during fetal development 
• Blood vessel conditions 
• Genetic factors  
• Metabolic issues 
• Immune system issues 
• Congenital conditions 

Signs & Symptoms

Children with epilepsy may show a range of signs and symptoms. Some of the most common include:

• Periods of rapid eye blinking and staring 
• Feeling lightheaded 
• Jerking movements of extremities 
• Stiffening of the body 
• Loss of consciousness 
• Breathing difficulty or cessation 
• Loss of bowel or bladder control 
• Unresponsiveness  
• Appearing confused or disoriented 
• Vision difficulties 
• Headaches 
• Dizziness 

Complications

If a child loses consciousness as a result of an epileptic seizure, they can be at risk of physical injury from falling or hitting objects nearby. You can help your child by laying them down during a seizure. Talk to your doctor about the best way to support your child during such an episode.

Other complications of epilepsy can include: 

• Disrupted sleep 
• Anxiety and depression 
• Trouble concentrating 
• Behavior changes 
• Mood changes 

Nutrition & Feeding Implications

Micronutrient deficiencies may contribute to a child’s having seizures. That’s why it’s important to make sure your child is consuming enough vitamins and minerals, including thiamine, pyridoxine (a form of vitamin B6), vitamin D, calcium, magnesium and carnitine (a substance that helps the body turn fat into energy). If there are concerns about your child’s nutritional intake, speak to a dietitian about ways to improve your child’s diet or options for supplementation. 

In addition: 

• Some epilepsy treatments and medications can have side effects, such as causing an upset stomach or changes in appetite. If your child is on epilepsy medication, be mindful of their nutritional intake and ask a doctor or dietitian about how you can ensure your child is receiving enough nutrition. 
• Children with epilepsy may be at an increased risk for oral and dental health issues. These types of issues can lead to pain or discomfort in the mouth, gums and teeth, which can impact a child’s capacity or desire to eat and drink. Support and encourage good oral and dental hygiene, including regular dental visits (every 6 months) with a dentist who is aware of a child’s epilepsy diagnosis and the associated implications. 
• Children with epilepsy often take medications that come with side effects that can have an affect on feeding and nutrition, such as vomiting, diarrhea, decreased appetite, lethargy, lack of coordination and gum hypertrophy. Some medications may taste unpleasant and lead to a general resistance to all foods and liquids. Because of the potential impacts of medication on feeding and nutrition, it’s important to have ongoing support from your child’s medical team.
• Some children are treated using a ketogenic diet, which requires adhering to a strict high-fat food diet. This can sometimes be unappetizing or restrictive, leading to mealtime challenges. High-fat meals can also feel very satiating, meaning your child will feel full right away. With this in mind, it sometimes helps to offer smaller, more frequent nutrient-dense meals throughout the day.
• Because of the underlying neurological nature of epilepsy, its complexity and its potential impacts on feeding and nutrition, it’s strongly encouraged to have an integrated team of medical support for your child. The team might include a pediatrician, neurologist, feeding specialist and dietitian as well as other medical providers, such as a speech-language pathologist, occupational therapist or physical therapist.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with epilepsy, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Some dietary modifications may help children with epilepsy manage symptoms.  

• A diet with a focus on foods that are high in antioxidants — such as the Mediterranean diet, for example — helps to increase consumption of vegetables, lean proteins and healthy fats, including omega-3s, oleic acid, vitamin E, carotene and flavonoids.
• Other diets, such as a ketogenic diet, may help manage seizures. This diet can benefit children who have had a limited response to antiseizure medication. But because of the strictness of the diet, micronutrient deficiencies can occur due to a lack of certain vitamins and minerals. 

Additional Resources

The following organizations can provide further information about epilepsy. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Epilepsy Foundation
• Mayo Clinic: Epilepsy
• Nationwide Children’s: Epilepsy

Causes

FASD is caused by the consumption of alcohol during pregnancy. Alcohol damages the baby’s cells and has an impact on development. There is no cure for FASD. Its associated problems must be managed throughout a child’s life. However, early intervention can improve a child’s growth, development and well-being.   

Complications

Damage to the fetus can result in physical and mental complications. These problems can affect each child in different ways and can range from mild to severe. They may include:

Care & Treatment

If you are caring for a child with FASD, discuss a treatment plan with your pediatrician and social worker. The treatment plan should be based on the needs of the child and include:   

• Regular follow-ups with a pediatrician. Ask the doctor about developmental milestones you should watch for and how to encourage the development of those skills. 
• Speech, physical and/or occupational therapy to address feeding issues for the infant and child, as well as speech and language issues for the child 
• Training of nurses and caregivers on feeding an infant and child with FASD 

Additional Resources

The following organizations can provide further information about FASD. Below, we also link to a video interview with two siblings who have FASD and their adoptive family. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• FASD United
• Centers for Disease Control and Prevention: FASDs – Information for Families
• Siblings With Fetal Alcohol Syndrome (An Adoption Story)

Causes

Causes of GDD can include: 

• Trauma 
• Neglect 
• Residing in institution-based care 
• Genetic conditions 
• Lack of attentive or engaged caregiving 
• Environmental factors 
• Issues during prenatal, perinatal and/or postnatal developmental periods of childhood 
• Premature birth 
• Prenatal drug exposure 
• Lead exposure 
• Poor nutrition 

Signs & Symptoms

Many of the signs and symptoms of GDD are experienced in other neurological and developmental disorders or intellectual disabilities, making it sometimes difficult to diagnose. To assess whether your child has GDD, a pediatrician will analyze your child’s growth chart, perform hearing and vision assessments, conduct genetic tests or blood tests and more.  

The most common signs and symptoms of GDD are:  

• Delays in rolling over, sitting up, crawling and walking 
• Trouble with fine motor and gross motor skills 
• Difficulties understanding what others say 
• Challenges with problem-solving 
• Delayed social skills 
• Problems talking  
• Delayed language skills 
• Memory difficulties 
• Difficulty connecting actions with consequences 
• Feeding difficulties

Complications

Children with GDD may acquire skills at a slower pace than their peers and may therefore require specialized services and support both at home and at school.    

Some complications of GDD can include: 

• Malnutrition 
• Poor growth  
• Fatigue 
• Speech and language delays, due to inadequate skill development during the key language-learning period of birth to 5

Nutrition & Feeding Implications

Childhood malnutrition may contribute to a child’s developing GDD, particularly if they are deficient in nutrients such as iron, folate, calcium, vitamin C and vitamin D. If you are concerned that your child’s diet may be lacking in key nutrients, talk to their pediatrician or a dietitian about testing or supplementation.

In addition:

• Children with GDD may have feeding issues that mirror other areas of their development. Newborns, for instance, may have problems sucking and swallowing. Children with GDD may also be susceptible to respiratory infections, esophagitis (inflammation of the esophagus), recurrent vomiting and choking. If your child experiences any of these difficulties, they’ll need assistance at feeding times.  
• Support children with a graduate progression in skill development and provide opportunities for practicing skills. For example, if you want to teach your child to use an open cup, start by using a sippy cup or straw cup, while allowing them opportunities to practice using (or even playing with!) an open cup.
• To prevent constipation, make sure your child has adequate hydration, fiber in their diet and physical activity. Also, make sure their diet includes an adequate intake of protein, vitamins and minerals. For variety, offer your child new foods, along with those that are familiar, but remember it can take more than 20 times for a child to accept a new food! This means it’s important to offer a child many opportunities to explore a food and not to expect them to enjoy it right away. Also, if a child repeatedly refuses a food, consider offering it in a different way. If a child continues to refuse a food after more than 20 offerings, it might just be their individual preference, and that’s okay! Move on to another food to explore. 
• Because children with GDD often have multiple needs, it’s important that every member of their care team is connected. Eating and drinking are complex processes and often require an integrated approach of support involving a team that may include a pediatrician, developmental specialist, feeding specialist, dietitian and other medical providers, such as a speech-language pathologist, occupational therapist or physical therapist.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with GDD, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Early intervention can be crucial to the success and development of a child with GDD. Families have many opportunities to engage with their children to support their overall development, while working in tandem with specialists like speech therapists, occupational therapists, physical therapists and psychologists/certified behavior analysts.

For example, parents can engage in skill-development play activities with their children, read with children to support language skills, reduce screen time and create routines and schedules for the family. Social and verbal play activities can help develop communication, social and emotional skills. Positive relationships and attuned caregiving can have a beneficial impact on a child’s development. As such, many children will see catch-up gains in their development post adoption.

Additional Resources

The following organizations can provide further information about developmental delays in children. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Cleveland Clinic: Developmental Delay in Children
• University of Minnesota Adoption Medicine Clinic: Health Topics for Preadoptive Parents

Causes

HIV is caused by the human immunodeficiency virus which attacks the body’s immune system. If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS). Mother–to-child transmission of HIV is the most common cause of HIV infection among children. Mother-to-child transmission can occur during pregnancy, labor, delivery or breastfeeding. 

Signs & Symptoms

Children with HIV can experience a wide range of symptoms related to the virus or to their antiretroviral therapy (ART) medications. With treatment, however, symptoms can be managed. Most children adhering to treatment will not have any HIV-related symptoms. 

However, children with undiagnosed HIV, or with advanced stages of HIV infection, may experience the following: 

• Malnutrition, which can result in stunting, wasting/underweight and micronutrient deficiencies   
• Acute or persistent diarrhea  
• Chronic intestinal inflammation 
• Anemia  
• Swollen lymph and salivary glands 
• Enlarged spleen or liver 
• Frequent infections 
• Nausea or vomiting 

Complications

There are many complications related to untreated HIV, but for children on ART, many of the following complications are avoidable and treatable:

• Malnutrition, including anemia
• Learning and developmental challenges, which often improve or resolve for children after starting therapies 
• Infections 
• Asthma-like conditions
• Weight gain
• Increased risk of chronic kidney disease
• Depression
• Insomnia

It’s important to note that ART medications can have some side effects in children, including nausea, fatigue or difficulty sleeping. Some medications can also put children at risk for high cholesterol in adulthood. But in recent years, improvements in medications have reduced these side effects, and some symptoms can resolve over time. What’s more, the benefits of ART medications still far outweigh the side effects in children with HIV.

On another note, stigma can still be quite an issue for children with HIV. A child’s HIV status does not need to be disclosed to day care providers, schools or sports teams, so it is up to the child and their family as to whether or not they want to share this information. Parents should also provide children with emotional and mental health support as they deal with their diagnosis and related social stigmas.   

Nutrition & Feeding Implications

Since children with HIV experience impaired immune function and increased intestinal inflammation, they will have additional nutritional needs to support their normal growth. 

• If your child has been diagnosed as HIV positive, it’s important to work with your pediatric HIV specialist to ensure your child is not malnourished, experiencing anemia or deficient in essential nutrients in their diet.
• Dehydration can be an issue for children with HIV, so you’ll want to offer fluids frequently throughout the day. If you have a young child, track their wet diapers to help monitor their hydration status.   
• Oral and dental diseases can make eating difficult and reduce your child’s nutritional intake. Support and encourage healthy oral and dental hygiene practices, and schedule visits every 6 months with a dentist who is aware of your child’s HIV diagnosis and the associated implications. 
• High cholesterol can be a side effect of some HIV medications. Working to manage your child’s cholesterol by encouraging regular physical activity, choosing foods low in saturated fats and eliminating those high in artificial trans fats will help decrease the risk of heart disease.  
• If a child is experiencing nausea, try offering small, frequent meals or avoiding foods, such as spicy foods, that might worsen their nausea.
• Consider giving your child prebiotic and probiotic supplements to treat persistent diarrhea. 
• Children with HIV often have a reduced appetite, which may be related to medication, pain, depression, stress, fatigue or a general reaction to their illness. Because of the potential impact of medication on feeding and nutrition, it’s important to have ongoing support from your child’s medical team, including dietitians.
• Smaller, more frequent nutrient-rich meals can be helpful for a child with a reduced appetite, fatigue, discomfort or pain. Smaller portions of bland foods may help a child who is experiencing nausea or vomiting. Soft, moist foods might be helpful for a child who has pain, fatigue or challenges with eating and swallowing.
• Offer foods that are high in nutrients without increasing the amount. Adding extra ingredients —instead of increasing quantity — can provide much more “bang for the buck” for a child who is eating small amounts. Extra ingredients might include yogurt, nut butters, cheese and bananas. 
• Consult with a feeding specialist, such as a speech-language pathologist or occupational therapist, for additional individualized support if your child is experiencing any difficulties that may be affecting their mealtimes and/or growth and development.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with HIV, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so they can best support their child. 

Care & Treatment

Children should ideally begin taking ART medications in the first few months of life and maintain this treatment throughout their lives. Discuss with your doctor any possible interactions between ART medicines and others your child may be taking.

Additional Resources

The following organizations can provide further information about HIV. You can also read more below from one family who adopted a child with HIV. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Medline Plus: HIV/AIDS in Pregnant Women and Infants
• National Institutes of Health: Nutrition for HIV-Infected Infants and Children
• University of Minnesota Adoption Medicine Clinic: Health Topics for Preadoptive Parents
• Hearts Created Equal

Causes

Some causes of hydrocephalus are unknown. But others, of a genetic or environmental nature, may include:

• Meningitis 
• Head injuries 
• Brain malformations 
• Spina bifida 
• Brain bleeding 
• Issues during fetal development 
• Infections 
• Tumors 

Signs & Symptoms

A child’s head is enlarged as a result of excess cerebrospinal fluid buildup in the brain due to either overproduction, decreased absorption or obstructed flow through the ventricular system. A child may exhibit a thin, glistening scalp or visually prominent veins in the scalp as well.

Infants with hydrocephalus may have the following symptoms:

• Vomiting 
• Sleepiness 
• Irritability 
• Seizures/epilepsy 
• Downward gaze or the baby’s eyes appear to be “stuck” looking down 

Children and adolescents may show these symptoms:

• Nausea and vomiting 
• Swelling of the optic disc or papilledema 
• Blurred or double vision 
• Balance and gait abnormalities 
• Slowing or loss of developmental progress 
• Changes in personality 
• Inability to concentrate 
• Seizures 
• Poor appetite 
• Urinary incontinence 

Complications

Children with hydrocephalus may experience a variety of complications and delays. Their prognosis — and range of difficulties — will depend on the age of the child and severity of the illness at the time they were diagnosed.

Some complications may include:

• Neurological and cognitive delays, including learning difficulties at school
• Developmental delays, including delays in speech/language and fine and gross motor skills, particularly in young children
• Feeding difficulties
• Increased risk of infection due to surgery and shunt placement
• Potential failure of the shunt. Most shunts will have some failures as a child grows up for a number of reasons. Extra attention to how a shunt functions should be tracked in the first year of placement. Shunt malfunction or failure can result in symptoms such as vomiting, irritability and fatigue.  

Nutrition & Feeding Implications

It’s important for children with hydrocephalus to maintain a healthy nutrient- and protein-rich diet, particularly since they’ll likely require multiple surgeries to manage their condition over time. Undernutrition can have an impact on a child’s recovery from these surgeries.

• A diet rich in micronutrients, protein and antioxidants can support immune health as well as brain and nerve function. Aim for foods that contain omega-3 fatty acids, vitamin C, vitamin A, vitamin K and zinc. Such foods include nuts, seeds, seafood, fruits and vegetables.

• As a child ages, they may experience feeding difficulties related to their developmental challenges. These challenges may result in:
  • Sensory issues; i.e., a child may refuse to eat foods with certain textures
  • Difficulty chewing and/or swallowing
  • Eye-hand coordination (possibly due to visual-spatial impairment), making it difficult for a child to feed themselves
  • Gross and fine motor developmental delays
  • Excessive fatigue
  • Reduced appetite
• Some children with hydrocephalus are on medications whose side effects, such as vomiting, diarrhea, decreased appetite and lethargy, may impact feeding and nutrition. Some medications may taste unpleasant and lead to a generalized resistance to all foods and liquids. Because of the potential impact of medications on feeding and nutrition, it’s important to consult with, and have ongoing support, from a child’s medical team.
• Consider offering smaller, more frequent nutrient- and calorie-rich meals throughout the day to support a child’s reduced appetite or potential issues with weakness and fatigue.
• Because of the underlying neurological nature of this diagnosis, its complexity and the potential impact on feeding, nutrition and overall development, an integrated approach of support is strongly encouraged. Your child’s medical team may include a pediatrician, neurologist, feeding specialist, dietitian and other medical specialist or therapist, such as a speech-language pathologist, occupational therapist or physical therapist.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with hydrocephalus, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Children with hydrocephalus will need ongoing care. If they have not already had a shunt placed in their brain, they may need one to relieve pressure. The longer the pressure remains, the more serious the damage to the brain. In addition, a physical therapist, speech-language pathologist and occupational therapist can help a child reach their developmental milestones as they grow.  

Additional Resources

The following resources can provide further information about hydrocephalus. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• American Association of Neurological Surgeons
• Holt International’s Feeding and Positioning Manual
• Hydrocephalus Association
• National Institute of Neurological Disorders and Stroke
• University of Minnesota Adoption Medicine Clinic: Health Topics for Preadoptive Parents

Causes

The causes of intellectual disability are often unknown, but some may include:

• Injury 
• Diseases 
• Problems in the brain 
• Genetic conditions 
• Birth defects or injury during birth 
• Premature birth 
• Stroke

Signs & Symptoms

There are many signs that indicate that a child has intellectual disability. For example, they may:

• Sit up, crawl or walk later than other children 
• Learn to talk later or have difficulty speaking 
• Find it hard to remember things 
• Have trouble understanding social rules 
• Have trouble seeing the results of their actions 
• Have difficulty solving problems

The more severe the intellectual disability, the earlier the signs can be noticed. However, it still might be hard to tell how young children will be affected later in life. 

Complications

Some children with intellectual disability have an increased risk of other medical problems, including seizure disorders, sensory impairments (particularly visual deficits), cerebral palsy, feeding problems and failure to thrive. 

Nutrition & Feeding Implications

Feeding a child with an intellectual disability such as cerebral palsy can come with added mealtime challenges. More than 80%-90% of children with developmental disabilities may have feeding disorders. The more severe the intellectual disability, the greater the feeding challenges.

Some challenges can include:

• Problems with chewing and swallowing. Many children with intellectual disability struggle with effective chewing and swallowing, leading to a risk of choking. Food may need to be cut into small pieces or pureed for safer consumption. Parents or caregivers may need to make other modifications in terms of food, liquid, utensils, positioning or the pace of eating as well. Consult with a feeding specialist, such as a speech-language pathologist or occupational therapist, for additional support if a child is experiencing any difficulties that may affect their mealtimes and/or growth and development.
• Obesity. Children with learning or intellectual disabilities are at high risk for becoming overweight or obese due to a mix of environmental, behavioral and biological factors. Regular exercise and exposure to nutritious foods, especially fruits, vegetables and legumes, can help children maintain a healthy weight. 
•  Being underweight. Some children with intellectual disability may also have conditions that result in higher calorie needs or impaired nutrient absorption. A dietitian or doctor may recommend supplements for your child if necessary.
• Acid reflux. Children with intellectual disability may experience acid reflux during feeding, leading to heartburn, vomiting and poor weight gain. Proper positioning during feeding and medication times may help alleviate symptoms. Foods like citrus fruits, fatty and fried foods, tomato sauce and carbonated drinks can exacerbate acid reflux, so consider limiting these foods if your child is experiencing symptoms.
• Constipation. Children with intellectual disability are at greater risk of constipation if they are dehydrated, do not get enough fiber in their diet or have mobility challenges. Children don’t always recognize if they are thirsty or constipated, so you can use a calendar to track your child’s bowel movements if you have any concerns. To prevent dehydration, regularly offer your child fluids, especially during warm weather, and limit sweetened beverages. 
• Poor appetite. Children with intellectual disability may lack interest in food for various reasons. Offering children a variety of foods in different flavors and textures can help stimulate their appetite.
  • It’s also important to establish routines and provide a balanced diet with a focus on fresh fruits, vegetables and whole grains to help address feeding challenges and support a child’s health and nutritional needs. Lead by example, by consuming nutritious foods and beverages as a family. If a child is selective in their eating, try offering new foods alongside foods they are comfortable with.
  • Also offer plenty of calcium-rich foods and beverages such as tofu, yogurt, cheese, soy milk and cow’s milk. Other sources of calcium include leafy green vegetables and calcium-fortified products, such as some types of breakfast cereals and 100% fruit juice.
• Because children with intellectual disability often have multiple needs, it’s important to ensure every member of their care team is connected. Eating and drinking is a complex process and often requires an integrated approach of support by a feeding team that might include a pediatrician, feeding specialist, dietitian and other medical specialist or therapist, such as a speech-language pathologist, occupational therapist or physical therapist.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with intellectual disability, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child.   

Care & Treatment

Early intervention and consistent support can help your child thrive. There are many programs and services in your community and at your child’s school that can help your child learn at their own speed and gain the skills they need to lead a full life. 

Additional Resources

The following organizations can provide further information about intellectual disability. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Centers for Disease Control and Prevention: Facts About Intellectual Disability
• CerebralPalsy.org: Cognitive Impairment
• Cleveland Clinic: Intellectual Disability
• Holt International’s Feeding and Positioning Manual

Causes

Kidney disease or impairment may be caused by:

• Genetics 
• Birth defects 
• Systemic diseases, such as systemic lupus or systemic sclerosis
• Nephrotic syndrome, a kidney disorder that causes the body to excrete too much protein in the urine
• Surgery 
• Injuries  
• Dehydration 
• Issues with the urethra or bladder 
• Infections 

Signs & Symptoms

Children with kidney impairment may have these symptoms:

• Increased or decreased urination and urinary incontinence 
• Difficulty concentrating and learning 
• Delayed motor and language skills
• Edema, or swelling caused by too much fluid trapped in the body’s tissues
• Proteinuria, or elevated protein in the urine 
• Fatigue 
• High blood pressure 
• Nausea and vomiting 
• Infections, including urinary tract infections  
• Diarrhea 

Complications

Kidney impairment may lead to these complications:

• Heart disease or cardiovascular disease 
• Cognitive difficulties  
• Urinary incontinence  
• High blood pressure and hypertension  
• Increased risk of infection 
• Impaired growth  
• Mental health issues, such as depression and anxiety 
• Anemia 

Nutrition & Feeding Implications

Children with kidney impairment will require special attention to nutrition and feeding.

• If your child has anemia, offer them iron-rich foods like leafy green vegetables, meat, tofu or eggs. Vitamin C-rich foods can also help to increase the absorption of iron in the body. In addition, have your child regularly tested for anemia, as your child’s doctor or dietitian may recommend iron supplements with folate and/or vitamin B12 if necessary. 
• Some children with kidney difficulties need to eat a moderate or reduced amount of protein, as guided by their dietitian or doctors. If this is the case for your child, make sure the protein sources they consume (e.g., fish or eggs) contain more of the essential amino acids they need to grow.
• Some children with kidney issues need to reduce the amount of sodium, potassium or phosphorus in their diet, while others need to add more of these nutrients. Your child’s dietitian/nutritionist can help you plan meals and find food options that will meet your child’s needs for adequate growth.
• Many children with kidney problems also need to have their fluid intake monitored. Discuss this issue with your child’s doctor if you see any swelling in their body, or if your child’s urine production increases or decreases.
• Children with kidney impairment or chronic kidney disease often have a reduced appetite, small oral intakes and difficulty meeting their nutritional requirements. Consider offering smaller, more frequent nutrient- and calorie-rich meals throughout the day to make sure your child receives their proper nutrition.
• Exercise and physical activity can help your child feel better, so it’s best to reduce children’s screen time and opt for active playtime. Your child’s doctor should be able to guide you toward the types of physical activity that are appropriate for a child with kidney impairment.
• Because children with kidney impairment often have multiple needs, it’s important that every member of their cmeare team be connected. Children and their families benefit from an integrated support team that can include a pediatrician, kidney specialist, dietitian, feeding specialist and other medical specialists or therapists, such as a speech-language pathologist, occupational therapist or physical therapist.  
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with kidney issues, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child.  

Care & Treatment

Early intervention and treatment of kidney issues can help children live full lives. Many of the complications with the kidneys can be managed with medical treatment and nutrition therapy.

Additional Resources

The following organizations can provide further information about kidney impairment. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Health Topics for Preadoptive Parents
• National Institute of Diabetes and Digestive and Kidney Diseases: Kidney Disease in Children
• National Institute of Diabetes and Digestive and Kidney Diseases: Helping Your Child Adapt to Life With Chronic Kidney Disease
• National Institute of Diabetes and Digestive and Kidney Diseases: Nutrition for Children With Chronic Kidney Disease

Causes

Complications

Care & Treatment

Additional Resources

The following resources can provide more information about low birth weight babies. If you’d like to talk to someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• March of Dimes
• Stanford Medicine Children’s Health: Low Birth Weight
• University of Minnesota Adoption Medicine Clinic: Health Topics for Preadoptive Parents

Causes

Common causes of microcephaly include: 

• Genetic factors
• Exposure to external or environmental factors during pregnancy that affect the development and integrity of the fetal brain, including:
  • Prenatal and postnatal infections of the central nervous system
  • Prenatal exposure to drugs or toxic substances 
  • Maternal diseases and perinatal factors 

Signs & Symptoms

Children with microcephaly typically have:

• A small head
• A small brain

Complications

Complications associated with microcephaly can vary widely from one child to another. Early diagnosis, intervention and appropriate medical and therapeutic support are essential for addressing these challenges and improving a child’s quality of life.

Health complications may include:

• Brain disorders. Microcephaly can result in brain development abnormalities, which may be caused by factors like chromosomal abnormalities or gene mutations. This can lead to intellectual disabilities or learning difficulties. 
• Intellectual disabilities. Children with microcephaly often face intellectual disabilities, with IQ levels below 70. This can manifest in different ways, including speech delays, social difficulties, memory problems, limited problem-solving skills and a need for increased assistance with self-care tasks. 
• Physical development. Some children with microcephaly may have difficulty with coordination, moving or balance. These difficulties have an impact on a child’s daily activities such as holding their head upright, sitting on their own, crawling, standing and walking independently.
• Dwarfism. Microcephaly can lead to short stature or dwarfism in some children, often due to genetic factors.
• Hearing and vision problems. Underdeveloped brain structures can affect the development of hearing and vision, leading to sensory impairments.
• Facial distortions or malformations. Microcephaly may cause distortions in facial features or joint and facial malformations. 
• Seizures. Incomplete brain development can increase the risk of seizures. 

Nutrition & Feeding Implications

Children with microcephaly will require special attention to nutrition and feeding.

• Babies with microcephaly may struggle with proper feeding, causing them to make high-pitched crying sounds. Some may experience swallowing problems. 
• Children with microcephaly may have problems eating, drinking and swallowing. In addition, they may have increased challenges at mealtimes that require individualized adaptations to foods, liquids, utensils, positioning, pacing of meals and more. In such cases, parents can work with a feeding specialist, such as a speech-language pathologist or occupational therapist, to manage feeding difficulties and identify techniques to support oral motor skills, swallowing function and feeding skill development.  
• Difficulty with feeding can affect a child’s caloric intake. To ensure that your child receives sufficient calories for growth and development, provide a variety of fruits and vegetables, and pair them with whole grains and foods high in protein, such as eggs, fish, chicken, meats, beans, tofu, nuts and seeds.  
• In some cases, children with microcephaly may require specialized diets tailored to their specific needs. This could involve modifications to texture and consistency to accommodate swallowing difficulties or sensory needs related to food. Children may also require alternative forms of nutrition, such as a feeding tube, to support their nutritional growth.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with microcephaly, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Microcephaly is a lifelong condition, with no known cure or standard treatment. Because symptoms range from mild to severe, treatment options vary as well. Babies with mild microcephaly often experience no other problems other than small head size. These babies will need routine checkups to monitor their growth and development.

For more severe microcephaly, babies will need care and treatment focused on managing other health complications. Developmental services early in life will often help babies with microcephaly to improve and maximize their physical and intellectual abilities. These services known as early intervention can include speech, occupational and physical therapies. Sometimes medications are also needed to treat seizures or other symptoms. Older children can receive support from a team of healthcare professionals, including a pediatrician, neurologist and therapists.

Additional Resources

The following organizations can provide further information about microcephaly. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Centers for Disease Control and Prevention: Facts About Microcephaly
• Johns Hopkins Medicine: Microcephaly
• Stanford Medicine: Microcephaly in Children

Causes

There are a number of factors that cause babies to be born early. They include:  

• Multiple births  
• Infections 
• Maternal stress  
• Other maternal risk factors, including age, substance abuse, malnutrition, poor care during pregnancy, etc.
• Preterm labor caused by conditions such as inflammation, hemorrhage and uterine overdistension 

Signs & Symptoms

Premature babies may exhibit the following signs and symptoms:

• Small size, often weighing less than 5 pounds, 8 ounces 
• Thin, shiny, pink or red skin, with veins sometimes visible through the skin 
• Little body fat 
• Little scalp hair, although the baby may have lots of soft body hair, known as lanugo 
• Weak cry 
• Low muscle tone 
• Genitals that are small and not yet fully developed 
• Sleep challenges  
• Delays in all areas of development due to being born early 
• Behavior challenges or learning difficulties  
• Other health issues, including hearing and vision problems, asthma or breathing difficulties, reflux, etc.  
• Sensitive sensory systems  
• Increased fussiness and difficulty becoming calm  
• Lengthy or frequent hospitalizations  
• Digestion issues or lack of appetite 

Complications

Premature babies are born before their bodies and organ systems have completely matured. They are smaller than they would have been if they were born at full term. Therefore, they may need help breathing, eating, fighting infections and staying warm.

Extremely premature babies, those born before 28 weeks, are at the greatest risk for health concerns. Their organs and body systems may be underdeveloped.  

Some of the challenges premature babies experience may include: 

• Keeping their body temperature steady or staying warm 
• Breathing problems, including serious short- and long-term issues
• Blood problems, including low red blood cell counts (anemia), yellow color to the skin from breaking down old red blood cells (jaundice) or low blood sugar levels (hypoglycemia) 
• Kidney problems
• Nervous system problems, including bleeding in the brain or seizures 
• Increased risk of infections 
• Increased risk of disabilities, such as cerebral palsy, visual or hearing impairments, ADHD and poor growth  
• Learning difficulties that often require additional early intervention or education services 
• Increased risk of chronic diseases in adulthood, such as heart disease, asthma, hypertension and diabetes  
•  Digestive problems, including trouble feeding and poor digestion

Nutrition & Feeding Implications

When babies are born prematurely, their digestive systems may not be fully developed. As a result, many of these infants experience feeding difficulties, such as: 

• Problems establishing nipple feedings, at breast or with the bottle
• Gastroesophageal reflux
• Abdominal distension, or an abnormal enlargement or swelling of the stomach
• Fatigue or increased sleepiness, which may lead to falling asleep during feedings or make it difficult to wake for feedings 
• Reduced endurance for feedings, leading to reduced intake of nutrients
• Inability to eat an entire meal, or the need to eat small frequent meals throughout the day and night
• Feedings that can take more than 30 minutes   
• Difficulty maintaining a stable position for safe feedings and eating
• Heightened sensory systems and difficulty calming down or being soothed 
• Apnea, or episodes where babies stop breathing, and respiratory compromise
• Episodes of bradycardia, or slow heartbeat that can cause oxygen levels to drop
• Immature feeding pattern, in which babies suck, swallow and breathe incorrectly or out of order
• Risk of aspiration, or breathing in milk or formula

Children who are born prematurely can benefit from good nutrition, an active lifestyle and healthy habits. To help them thrive:

• Lead by example, by consuming nutritious foods and beverages as a family. Eat a variety of fruits and vegetables, pairing them with whole grains and high-protein foods, such as eggs, fish, chicken, meats, beans, tofu, nuts and seeds. If a child is selective in their eating, try offering new foods with foods they are comfortable with.
• Offer plenty of calcium-rich foods and beverages such as tofu, yogurt, cheese, soy milk and cow’s milk. Other sources of calcium include leafy green vegetables and calcium-fortified products, such as some types of breakfast cereals and 100% fruit juice.
• Provide nutrient-rich foods including dried fruit, nuts, seeds, nut butters and smoothies.  
• Encourage plenty of fluids, especially water, to help prevent dehydration and constipation. Avoid sweetened beverages. 
• Modify the feeding environment to best support an infant’s extremely sensitive and underdeveloped sensory system. Reduce lights, sounds, movements, touch and other forms of stimulation for an overly fussy baby, or increase them for an infant who is more prone to being fatigued and sleepy.
• Modify how and when you feed a premature baby. This might include shortening feedings to include only the times when the infant is most awake, alert and most effectively feeding, and offering more frequent feedings.
• Encourage pleasurable oral experiences for a premature child, including sucking on a finger, hand, pacifier or developmentally appropriate toys. You can also offer other pleasant forms of touch to their face, lips and mouth if your child is receptive to those forms of touch.
• Consult with a pediatrician to evaluate oxygen saturation if drowsiness, lethargy and difficulty maintaining arousal persists and has an impact on feeding routines. 
• Consult with a feeding specialist, such as a speech-language pathologist or occupational therapist, if your child is experiencing any difficulties that may affect their mealtimes and/or growth and development. Infants who are born prematurely may have difficulty sucking, swallowing, eating and drinking. As these children age, they may have increased challenges at mealtimes that require individualized adaptations to foods, liquids, utensils, positioning, pacing of meals and more.
•  Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child who was born prematurely, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Premature babies often need time to catch up both developmentally and in terms of their growth, and will need support for their feeding difficulties. Occupational therapists or speech-language pathologists with a specialization in feeding should be able to help children with these issues. Early intervention and screening for other medical issues will help children born prematurely reach their full potential.

Additional Resources

The following organizations can provide further information about prematurity. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Centers for Disease Control and Prevention: Preterm Birth
• Cleveland Clinic Journal of Medicine: Long-Term Consequences of Prematurity
• Holt International’s Feeding and Positioning Manual
• Mayo Clinic: Premature Birth

Causes

As a fetus grows and develops in the womb, it derives nourishment from the mother via the placenta. It also may absorb toxins in the mother’s system if she has taken drugs or consumed alcohol or tobacco while pregnant. These toxins may cause damage to the developing fetal organs. A baby may also become dependent on substances used by the mother.

Signs & Symptoms

Many children who have prenatal substance exposure experience issues with intellectual, emotional and physical development. Children’s symptoms can range in severity but may include:  

• Premature birth, intrauterine growth restriction and low birth weight
• Birth defects and organ damage
• Smaller head circumference
• Behavioral issues and delayed intellectual development   
• Distinctive facial features, including an increased chance of oral clefts or cleft palate
• High-pitched crying among infants, with the inability to be consoled  
• Abnormal muscle tone 
• Impulsivity
• Feeding difficulties  
• Neonatal Abstinence Syndrome or Neonatal Opioid Withdrawal Syndrome (withdrawal symptoms include decreased sleep, tremors, seizures, sweating and fever) 

Complications

Children with prenatal substance exposure can have lifelong challenges. If you are caring for a child with this condition, they may experience some of the following challenges: 

• Cognitive, motor and sensory deficits and delays in development. Children with in utero exposure are more likely to be diagnosed with learning disabilities. 
• Difficulty managing behaviors or feelings 
• Sensory system difficulties  
• Impaired memory and attention span 
• Gastrointestinal dysfunction 
• Medical issues in adulthood, such as obesity, hypertension, diabetes, cardiovascular disease and dyslipidemia (abnormally elevated cholesterol or fats in the blood), as well as an increased risk of Opioid Use Disorder

Nutrition & Feeding Implications

Children with prenatal substance exposure will require special attention to nutrition and feeding.

• Some infants can be fussy or irritable, which may affect many routines, including feeding. Often, this behavior is related to their extremely sensitive and underdeveloped sensory systems. To best support an infant’s sensory system, modify the environment for feedings by reducing lights, sounds, movements, touch and other forms of stimulation for an overly fussy baby, or increasing them for an infant who is more prone to being fatigued and sleepy. 
• Offer shorter, more frequent and smaller feedings for an infant or child who is prone to getting tired easily, falling asleep or becoming easily distracted during mealtimes.
• Establish a routine. By maintaining consistent feeding, sleeping and awake interaction times each day, a baby will gradually learn what to expect from their day. This helps them regulate their bodies and experience more success at mealtimes.
• Encourage pleasurable oral experiences for a premature child, including sucking on a finger, hand, pacifier or developmentally appropriate toys. You can also offer other pleasant forms of touch to their face, lips and mouth if your child is receptive to these forms of touch.
• Constipation can be a challenge for children who have had prenatal substance exposure. Offer plenty of fluids, especially water, to help prevent dehydration and constipation. Avoid sweetened beverages. 
• Distinctive facial features, such as cleft palate or oral clefts, can result in difficulty eating or the need for surgeries. Surgeries will increase the calories and protein a child needs to support healing.  
• To ensure your child is getting an adequate amount of nutrients to meet their daily needs, offer a variety of fruits and vegetables, pairing them with whole grains and high-protein foods, such as eggs, fish, chicken, meats, beans, tofu, nuts and seeds. Children may be malnourished due to a number of challenges, including feeding difficulties, premature birth or low birth weight, cleft palate, surgeries, maternal malnutrition or frequent illnesses related to prenatal substance exposure.
• If your child is experiencing feeding difficulties, a speech-language pathologist or occupational therapist may be able to help you work through their challenges.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with prenatal substance exposure, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Early intervention and therapy for children with prenatal substance exposure can provide them with the support and resources they need to overcome some of their challenges. Your child’s doctor and a feeding specialist can also address some of their unique needs. Some children will benefit from sensory reductions or stimuli by limiting noise and bright lights. Others may require medical or surgical interventions and other long-term therapies.

Additional Resources

The following organizations can provide further information about prenatal substance exposure. You can also read more below from families who adopted a child with this condition. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• American Academy of Pediatrics: Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus
• National Library of Medicine: Infant of a Substance-Using Mother
• The American College of Obstetricians and Gynecologists: Opioid Use and Opioid Use Disorder in Pregnancy
• Alcohol Exposure: What Does It Mean?

Causes

Sickle cell disease is caused by a mutation in the HBB gene. Both biological parents must be carriers of this gene in order for a child to develop sickle cell disease. If only one biological parent has the defective gene, the child will be a carrier but not have the illness.

Signs & Symptoms

Most children with sickle cell disease begin to have symptoms in the first year of life, often around 5 months of age. Children’s symptoms may vary in severity and include:

• Anemia, the most common symptom. Children with sickle cell anemia — the most serious form of sickle cell disease — have fewer red blood cells. Anemia can cause children to be pale, tired, irritable and lethargic.  
• Jaundice, a common symptom characterized by a yellowing of the skin, eyes and mouth. Sickle cells don’t live as long as normal red blood cells, and they die faster than the liver can filter them out. The yellow color is caused by a substance (bilirubin) that is released when the red blood cells die. 
• Pain crisis, or sickle crisis. When sickle cells get stuck in small blood vessels, the flow of blood is blocked and children experience pain. This sudden pain can happen anywhere in the body, but it most often occurs in the chest, arms and legs. Babies and young children may have painful swelling in their fingers and toes.
• Acute chest syndrome. This can occur when sickle cells stick together and block the flow of oxygen in the tiny vessels of the lungs. Acute chest syndrome often happens suddenly, when the body is under stress from infection, fever or loss of fluid (dehydration). It can appear as though a child has pneumonia, with symptoms that include fever, pain and a violent cough. 
• Splenic sequestration. When sickle cells get stuck in the spleen, the spleen becomes enlarged and fewer blood cells circulate.

Complications

Advances in preventive care and new medicines have reduced the life-threatening complications of sickle cell disease, but it is still a chronic illness. If you are caring for a child with this condition, watch for the following possible problems: 

• Long-term anemia. This may lead to delayed healing and delayed growth and development. 
• Pain crisis, or sickle crisis. In severe cases, your child may need treatment in a hospital.
• Acute chest syndrome. Over time, many episodes of acute chest syndrome can cause permanent lung damage.
• Splenic sequestration. The spleen can become damaged and scarred after many episodes of splenic sequestration. By age 8, many children with sickle cell disease have had their spleen removed. The risk for infection is a major concern for children without a functioning spleen. 
• Stroke. If the blood vessels to the brain are blocked, a stroke can occur, resulting in serious long-term problems. A child who has had one stroke is more likely to have another.
• Infections. Babies and children with sickle cell disease have a higher risk of infection. 

Nutrition & Feeding Implications

Children with sickle cell disease require special attention to nutrition and feeding.

• Lead by example, and consume nutritious foods and beverages as a family. Offer your child a variety of fruits and vegetables, pairing them with whole grains and foods high in protein, such as eggs, fish, chicken, meat, beans, tofu, nuts and seeds. 
• Provide plenty of calcium-rich foods and beverages, such as tofu, yogurt, cheese, soy milk and cow’s milk. Other sources of calcium include leafy green vegetables and calcium-fortified products, such as some types of breakfast cereals and 100% fruit juice. 
• Children with sickle cell disease use more energy because they break down red blood cells faster than other children, so they’ll need a diet rich in protein, vitamins and minerals. High-calorie foods or extra snacks can be helpful.
• Nutrient-rich, high-energy foods may include dried fruit, nuts, nut butters and smoothies. Sauces, gravies and sources of fat may also be added to meals and snacks for extra calories. It’s common for children with sickle cell disease to be shorter and thinner than their peers, but they often are able to catch up if their energy needs are met.
• Children with sickle cell disease may experience a reduced or suppressed appetite, as well as chronic fatigue and pain, which will have an impact on how much they can eat and drink. Children may also be at risk of experiencing dysphagia, or difficulties eating, drinking and swallowing. These difficulties may become more severe during sickle cell crises. Consider offering smaller, more frequent nutrient- and calorie-rich meals throughout the day to support a child’s reduced appetite and potential fatigue and pain issues. 
• Children with sickle cell disease may be at risk for oral and dental health issues, such as cavities, infections and periodontal diseases. These types of issues can lead to pain or discomfort in the mouth, gums and teeth, and can affect a child’s capacity or desire to eat and drink. Support and encourage good oral and dental hygiene practices, beginning when a child’s first tooth appears. Have your child brush at least twice a day, floss and, every 6 months, visit a dentist who is aware of their diagnosis and the associated implications.
• Children with sickle cell disease often have problems with their kidneys and fluid retention, so it’s important that they get enough fluids. Good hydration can also prevent constipation as well as red blood cells from sticking, potentially providing some pain relief. Encourage plenty of fluids, especially water, and avoid sweetened beverages. 
• Children are also at a higher risk for nutrient deficiencies, especially vitamin D, omega 3, vitamin C, folic acid and zinc. Your child’s doctor may recommend vitamin and mineral supplements, such as folic acid, which helps in the production of red blood cells. Your healthcare provider may also test your child for a deficiency in vitamin D. While sun exposure, fatty fish, fortified milk and some cereals provide vitamin D, it often is difficult to replenish vitamin D with food alone.
• Discuss any supplementation use with a dietitian or doctor as some supplements can be an issue for children with sickle cell disease.
• Consult with a feeding specialist, such as a speech-language pathologist or occupational therapist, for additional support if your child is experiencing any difficulties with eating, drinking or swallowing that may have an impact on their mealtimes and/or growth and development.  
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with sickle cell disease, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child. 

Care & Treatment

Caring for children with sickle cell disease involves a comprehensive approach that addresses both the acute and chronic aspects of the condition. Here are some of the key components of care:

• Infants who have sickle cell disease may see a pediatric hematologist, a doctor who specializes in blood diseases, making their first visit before 8 weeks of age. 
• In general, children should see their healthcare provider regularly, typically every 3 to 12 months. 
• After an early diagnosis, your child’s healthcare provider may recommend medication or blood transfusions to manage complications, such as chronic pain.  A bone marrow transplant is currently the only cure for some patients with sickle cell disease.
• Childhood vaccinations can help reduce some of the complications or risks associated with sickle cell disease, including pneumonia and meningococcal disease, a serious bacterial illness.
• Establish a pain action plan with your child’s healthcare provider ahead of time. Also, avoid situations that may set off a pain crisis in your child, such as extreme heat or cold. For example, when going swimming, have your child ease into the water rather than jumping in.  
• Help children adopt a healthy lifestyle by getting enough good quality sleep, eating a healthy, balanced diet and enjoying regular physical activities. 
• If your child attends day care, preschool or school, speak to their teacher about what they need to know to support your child. 

Additional Resources

The following organizations can provide further information about sickle cell disease. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• National Heart, Lung, and Blood Institute: What Is Sickle Cell Disease?
• Nemours Children’s Health: Eating Well With Sickle Cell
• Stanford Medicine: Sickle Cell Disease in Children

Causes

Complications

Care & Treatment

Additional Resources

The following organizations can provide further information about thalassemia. You can also read more below from families who adopted children with thalassemia. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Cooley’s Anemia Foundation: Leading the Fight Against Thalassemia
• Centers for Disease Control and Prevention: Thalassemia
• Changing the Face of Thalassemia

Causes

Some common causes of vision impairment include: 

• Genetic conditions 
• Neurological conditions 
• Illness 
• Infections  
• Physical damage 
• Improper eye development
• Diabetes 
• Vitamin A deficiency. In low- and middle-income countries, children and pregnant women might be more susceptible to vision impairment due to vitamin A deficiency. This can occur from the inadequate intake of vitamin A, absorption issues, chronic diarrhea, celiac disease, liver disorders, fat malabsorption, cystic fibrosis, pancreatic and bile duct deficiencies, and a zinc or iron deficiency.
• Trachoma, a contagious microorganism that causes inflammation in the eye. This condition is primarily found in low- and middle-income countries with limited access to good sanitation and clean drinking water.   

Signs & Symptoms

If a baby is not yet tracking or following faces or objects at 8 weeks, this might indicate a vision problem. Other signs of vision impairment in a baby or young child include: 

• Discolored pupils 
• No reaction to bright lights 
• Eyes that cross or drift apart 
• Abnormal eye movement 

Older children might have vision impairment if they appear clumsy, struggle to see at night, or hold things closer or tilt their head to see better. They might also appear tired after activities that rely on vision, like reading. 

If the vision impairment is related to vitamin A deficiency, children might experience:

• Vision issues   
• Scaly, itchy skin  
• Stunting or delayed growth  
• Night blindness, or trouble seeing in dim or dark settings  
• Respiratory infection, due to a compromised immune system 

Complications

Vision impairment and blindness can affect a child’s development in many areas.

• Experiencing vision impairment or blindness can limit childhood experiences that contribute to overall development, and therefore have an impact on a child’s cognitive, physical, emotional and/or neurological growth.  
• It is common for children with vision impairment, especially those with severe impairment, to also have a developmental disability.
• Vision impairment can be related to feeding difficulties.

Nutrition & Feeding Implications

Impaired vision can affect how children develop mealtime skills. Some feeding challenges include: 

• Sensory sensitivities and food aversions 
  • Becoming overwhelmed by the touch and feel of foods, preferring some over others
  • Avoiding feedings or requiring more time when being fed
• Oral motor challenges  
  • Having difficulty with certain textures, due to delayed oral motor skills 
• Physical challenges  
  • Experiencing spatial awareness issues, making it difficult to maintain a feeding position and locate foods
• Nutritional deficiencies can also impact eye health. That’s why it’s important to offer a balanced diet rich in fruits, vegetables and proteins. Vitamin-A rich foods include leafy green vegetables, fish oils, mangos, eggs, bell peppers, carrots, pumpkins, squash and broccoli. Encourage plenty of fluids, especially water, to help prevent dehydration. 
• Children with visual impairments and blindness need to find — or be offered — ways to prepare themselves for eating since they can’t rely on their sight. To support them:
  • Keep a consistent mealtime routine
  • Talk with your child about mealtimes. Let them know when and where they’re happening (and with whom), what will be served, when a bite of food is coming, etc.
  • Let your child control the pace of the meal
  • Offer your child the chance to help out as much as possible in ways that feel comfortable for them. All children want to be part of the mealtime process and can benefit from touching, smelling and exploring foods, as well as handling items such as utensils, cups and bowls. Offering visually impaired children the chance to truly explore and participate in mealtimes is a valuable way for them to grow and develop.
• Change is inherently hard for most children, but navigating changes with a child with visual impairment or blindness can be even more difficult. Introducing a new food, with its own taste, texture, temperature and smell, using a different utensil, cup or chair, or even eating in a different location can naturally be stressful for these children. To help them, go slowly and make one change at a time. Let your child know that something new or different is coming their way. Take slow and thoughtful steps at mealtimes that prepare a child in advance and make a huge difference.
• Because of the complexity of visual impairments and blindness, and the potential impact on feeding, nutrition and overall development, it’s strongly encouraged that your child have an integrated team of healthcare providers. The team may include their pediatrician, a vision specialist, a feeding specialist such as a speech-language pathologist or occupational therapist, a dietitian and/or a physical therapist.
• Parents and caregivers can often feel distress, frustration or worry while supporting an infant or child with a vision impairment or blindness, and particularly when there are difficulties surrounding feeding and nutrition. Feeding is inherently relational, and when it is challenging, it can challenge important relationships. Finding support from a licensed mental health provider can be one of the best ways a parent or caregiver can support themselves so that they can best support their child.     

Care & Treatment

If you are concerned that your child has an undiagnosed vision impairment, talk with your child’s pediatrician about having their vision checked. Children should have their vision checked annually (or more frequently if they are younger children), even if they are not experiencing vision problems.

For children with vision impairment, early intervention is key. A pediatrician might refer your child to a pediatric eye specialist, who can determine the root cause of the impairment and help determine the appropriate next steps.

Vision impairment can affect many other skills like communication, social interaction, mobility, eating, reading and writing. The best approach for supporting a child with vision loss is recognizing these barriers, working with your child’s healthcare providers and providing loving attention, interaction and play every day. 

Additional Resources

The following organizations can provide further information about vision impairment. If you’d like to speak with someone at Holt about adopting a child with special needs, please email one of our adoption specialists to learn more.

• Centers for Disease Control and Prevention: Facts About Vision Loss in Children
• Cleveland Clinic: Vitamin A Deficiency
• Holt International’s Feeding and Positioning Manual
• Prevent Blindness: Your Child’s Sight
• World Health Organization: Blindness and Visual Impairment