At Children’s Mercy Kansas City, Shao Jiang, MD coordinates an international adoption program with China for cleft lip/palate surgeries.
The experienced cleft palate/lip and craniofacial team provides comprehensive medical services, with pre-adoption counseling and social workers available for ongoing parental support.
Dr. Jiang is uniquely positioned to not only provide palate/lip and craniofacial care, but also to read Chinese medical records and translate.
Join Dr. Jiang to talk about the Cleft Palate/Craniofacial Clinic and its work with Chinese international adoptions.
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Cleft Palate/Adoption Program
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Learn more about Shao Jiang, MD
Shao Jiang, MD
Shao Jiang, MD, is Director of the Fredrick J. McCoy Cleft and Craniofacial Clinic and the Vice Chair of the Department of Surgery (Informatics) at Children’s Mercy Kansas City. Dr. Jiang received his medical degree from Pennsylvania State University College of Medicine and completed surgery and plastic surgery residencies at Strong Memorial Hospital, University of Rochester, Rochester, NY. In addition, he’s completed a pediatric plastic/craniofacial fellowship with the Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, and a craniofacial fellowship at the Children’s Hospital of Los Angles, University of Southern California Los Angeles, CA. Dr. Jiang is also an Associate Professor of Pediatric Surgery at the University of Missouri-Kansas City School of Medicine.Learn more about Shao Jiang, MD
Transcription:
Cleft Palate/Adoption Program
Dr. Michael Smith (Host): So, our topic today is “Cleft Care in Adopted Chinese Patients: Challenges and Strategies.” My guest is Dr. Shao Jiang. Dr. Jiang is Director of the Fredrick J. McCoy Cleft and Cranial Facial Clinic and the Vice-Chair of the Department of Surgery at Children's Mercy Kansas City. Dr. Jiang, welcome to the show.
Dr. Shao Jiang (Guest): Thank you very much. Thanks for having me.
Dr. Smith: Why don't we start with you telling us a little bit about the cleft lip/palate international adoption program?
Dr. Jiang: So, we have, at Children's Mercy, one of the oldest, comprehensive, multi-disciplinary cleft team in the Midwest. It was started by Dr. Fredrick J. McCoy and it has been continued for the last several decades. This clinic takes care of children with cleft lip and palate differences and a large portion of the kids that are being adopted from China have cleft lip and palate differences that are either not addressed when they're in China, or partially addressed. So, when they come over to this country, then, additional care is needed and we’ve see those kids on a regular basis for the last 20 years or so. So, it is in collaboration with our international adoption program at Children's Mercy along with the staff and the team members of the cleft team that we're able to coordinate a comprehensive cleft care for these internationally adopted children. The large portion of these patients are coming from China and other Asian countries, so we have a large population of these patients that we take care of on a regular basis.
Dr. Smith: So, how is Children's Mercy and your team uniquely equipped to provide this service?
Dr. Jiang: Well, to take care of a kiddo with a cleft lip and palate difference really requires a village and a whole comprehensive multi-disciplinary team that includes not only plastic surgery, but also ENT, dental, social work, nutrition, occupational therapy, speech therapy, hearing. It’s a whole slew of staff members that are going to be participating actively in the care of these patients. So, in that regard, then, we have one of the oldest teams in the Midwest and one of the largest teams in the Midwest because we have four full-time pediatric plastic surgeons that have dedicated our careers in taking care of children with cleft lip and palate and craniofacial differences. In addition to that, I think we're uniquely equipped to deal with the adoptive population mainly because our international adoption clinic is so strong. They see kids after they're being adopted and make sure that they're medically fit to undergo the treatment that they may need to undergo and they also seek the parents before and do pre-adoption consultations to make sure that the parents understand the complexity and the degree of involvement of medical care of these kids that are coming over.
Dr. Smith: You know, I saw a presentation that you did some time back and you presented some information, some data on the number of cases of cleft lip abnormalities in certain regions of China and it was quite impressive, some of the numbers. Why is that case? Why are there so many of these abnormalities in certain regions of China?
Dr. Jiang: Well, it's interesting because the population incidence of cleft lip and palate, in general, all over the world, is about 1 in 500 live birth and 1 in 750 live births. That risk is particularly increased in China to about 1 in 250. So, genetically speaking, folks of Asian descent have higher incidence of cleft and that is something that our genetic counselors are well-versed in addressing and dealing with. So, genetically speaking, the Asian population, particularly the Chinese population, is more prone to have cleft and palate differences.
Dr. Smith: What are some of the initial exams that a patient may go through when they come to you clinic? What are some of the exams that are typically recommended?
Dr. Jiang: Oh, okay. So, actually the initial examination begins with just examining the records, so even before the parents go over, we have the ability to look at the adoption documentation and the description of medical procedures and conditions that are contained within the adoption report to give the parents a basic understanding of what's going to happen once their child gets here. When they're over there, if they should encounter any difficulties, particularly with cleft lip and palate kids that are being adopted, the number one complaint is feeding difficulties. We're able to counsel them via Telemedicine or call or email to sort of help them through that initial phase. And then, once they get here, they are evaluated by our international adoption clinic first, get all their vaccinations, and titers, and lab works drawn, and then we see them two to three weeks after they have been seen by our international adoption clinic to start the assessment of their cleft lip and palate difference. In that examination, we examine the kids; we delineate what surgeries they had and what surgery they may need; we talk to the parents about the pre-operative care, the post-operative care and the expected outcome of surgery. Then our nutritionists and our occupational therapists will help us get the kids feeding in the correct manner and get the caloric intake increased to where their malnutrition is starting to resolve and things like that. So, that's the initial consultation. It begins even before they go over to other parts of the world to pick up their kiddos.
Dr. Smith: How many children and families have benefited from the program?
Dr. Jiang: Oh, quite a bit. So, starting in the late 1990's and early 2000's, we saw a gradual increase in the number of kids that we're treating here. On average, we see somewhere between 20 to 30 adoptive families a year now. So, it's actually quite a bit.
Dr. Smith: What are some of the considerations for primary care physicians, or even parents, considering the best referral for a newly-adopted child with cleft lip or palate? What are some of the things they need to think about in the work up?
Dr. Jiang: I think the thing to think about is to focus less on the cleft lip and palate difference and more on the whole well-being of the child. You know, as a surgeon, we obviously want to operate, but we can't operate on a kid that is malnourished, that has other concomitant medical conditions that may prevent us from doing a successful surgery. So, we want the parents to not focus on the cleft lip and palate difference. We want the parents to focus on the overall well-being of the child. The cleft lip and palate will be taken care of in a timely and expertly manner once everything else is settled. That is the same message for the primary care physician, as well.
Dr. Smith: Right. Very good message. Where can people go for more information?
Dr. Jiang: They can go to our Children's Mercy website and under “Services,” there will be the “Cleft Lip and Palate Craniofacial Clinic” tab and they could look for our contact information there.
Dr. Smith: Very good. Dr. Jiang, thank you for the work that you're doing and thanks for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Thanks for listening.
Cleft Palate/Adoption Program
Dr. Michael Smith (Host): So, our topic today is “Cleft Care in Adopted Chinese Patients: Challenges and Strategies.” My guest is Dr. Shao Jiang. Dr. Jiang is Director of the Fredrick J. McCoy Cleft and Cranial Facial Clinic and the Vice-Chair of the Department of Surgery at Children's Mercy Kansas City. Dr. Jiang, welcome to the show.
Dr. Shao Jiang (Guest): Thank you very much. Thanks for having me.
Dr. Smith: Why don't we start with you telling us a little bit about the cleft lip/palate international adoption program?
Dr. Jiang: So, we have, at Children's Mercy, one of the oldest, comprehensive, multi-disciplinary cleft team in the Midwest. It was started by Dr. Fredrick J. McCoy and it has been continued for the last several decades. This clinic takes care of children with cleft lip and palate differences and a large portion of the kids that are being adopted from China have cleft lip and palate differences that are either not addressed when they're in China, or partially addressed. So, when they come over to this country, then, additional care is needed and we’ve see those kids on a regular basis for the last 20 years or so. So, it is in collaboration with our international adoption program at Children's Mercy along with the staff and the team members of the cleft team that we're able to coordinate a comprehensive cleft care for these internationally adopted children. The large portion of these patients are coming from China and other Asian countries, so we have a large population of these patients that we take care of on a regular basis.
Dr. Smith: So, how is Children's Mercy and your team uniquely equipped to provide this service?
Dr. Jiang: Well, to take care of a kiddo with a cleft lip and palate difference really requires a village and a whole comprehensive multi-disciplinary team that includes not only plastic surgery, but also ENT, dental, social work, nutrition, occupational therapy, speech therapy, hearing. It’s a whole slew of staff members that are going to be participating actively in the care of these patients. So, in that regard, then, we have one of the oldest teams in the Midwest and one of the largest teams in the Midwest because we have four full-time pediatric plastic surgeons that have dedicated our careers in taking care of children with cleft lip and palate and craniofacial differences. In addition to that, I think we're uniquely equipped to deal with the adoptive population mainly because our international adoption clinic is so strong. They see kids after they're being adopted and make sure that they're medically fit to undergo the treatment that they may need to undergo and they also seek the parents before and do pre-adoption consultations to make sure that the parents understand the complexity and the degree of involvement of medical care of these kids that are coming over.
Dr. Smith: You know, I saw a presentation that you did some time back and you presented some information, some data on the number of cases of cleft lip abnormalities in certain regions of China and it was quite impressive, some of the numbers. Why is that case? Why are there so many of these abnormalities in certain regions of China?
Dr. Jiang: Well, it's interesting because the population incidence of cleft lip and palate, in general, all over the world, is about 1 in 500 live birth and 1 in 750 live births. That risk is particularly increased in China to about 1 in 250. So, genetically speaking, folks of Asian descent have higher incidence of cleft and that is something that our genetic counselors are well-versed in addressing and dealing with. So, genetically speaking, the Asian population, particularly the Chinese population, is more prone to have cleft and palate differences.
Dr. Smith: What are some of the initial exams that a patient may go through when they come to you clinic? What are some of the exams that are typically recommended?
Dr. Jiang: Oh, okay. So, actually the initial examination begins with just examining the records, so even before the parents go over, we have the ability to look at the adoption documentation and the description of medical procedures and conditions that are contained within the adoption report to give the parents a basic understanding of what's going to happen once their child gets here. When they're over there, if they should encounter any difficulties, particularly with cleft lip and palate kids that are being adopted, the number one complaint is feeding difficulties. We're able to counsel them via Telemedicine or call or email to sort of help them through that initial phase. And then, once they get here, they are evaluated by our international adoption clinic first, get all their vaccinations, and titers, and lab works drawn, and then we see them two to three weeks after they have been seen by our international adoption clinic to start the assessment of their cleft lip and palate difference. In that examination, we examine the kids; we delineate what surgeries they had and what surgery they may need; we talk to the parents about the pre-operative care, the post-operative care and the expected outcome of surgery. Then our nutritionists and our occupational therapists will help us get the kids feeding in the correct manner and get the caloric intake increased to where their malnutrition is starting to resolve and things like that. So, that's the initial consultation. It begins even before they go over to other parts of the world to pick up their kiddos.
Dr. Smith: How many children and families have benefited from the program?
Dr. Jiang: Oh, quite a bit. So, starting in the late 1990's and early 2000's, we saw a gradual increase in the number of kids that we're treating here. On average, we see somewhere between 20 to 30 adoptive families a year now. So, it's actually quite a bit.
Dr. Smith: What are some of the considerations for primary care physicians, or even parents, considering the best referral for a newly-adopted child with cleft lip or palate? What are some of the things they need to think about in the work up?
Dr. Jiang: I think the thing to think about is to focus less on the cleft lip and palate difference and more on the whole well-being of the child. You know, as a surgeon, we obviously want to operate, but we can't operate on a kid that is malnourished, that has other concomitant medical conditions that may prevent us from doing a successful surgery. So, we want the parents to not focus on the cleft lip and palate difference. We want the parents to focus on the overall well-being of the child. The cleft lip and palate will be taken care of in a timely and expertly manner once everything else is settled. That is the same message for the primary care physician, as well.
Dr. Smith: Right. Very good message. Where can people go for more information?
Dr. Jiang: They can go to our Children's Mercy website and under “Services,” there will be the “Cleft Lip and Palate Craniofacial Clinic” tab and they could look for our contact information there.
Dr. Smith: Very good. Dr. Jiang, thank you for the work that you're doing and thanks for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Thanks for listening.