Friday, October 7, 2011

Mongolian Spots

The day after Rose was placed with us she had a really runny diaper. I consequently gave her a bath for the very first time and as I was drying her off I noticed a dark spot on her lower back- right above her bum- which I hadn't noticed when I changed her diapers. At first I thought it might be something left over from her dirty diaper that somehow didn't get rinsed off in her bath. Upon closer inspection I realized it was a nasty-looking bruise. "Oh dear", I thought. "This little baby has already been through enough- not this, too."

I became even more disturbed as I discovered another deep purple looking bruise on her genitals- located in a place which I wouldn't have been able to notice with just a routine diaper change.  I immediately felt sick . . . and angry. I began imagining the worst and thought "How can anyone do something like that to such a small baby?"  

NOTE: Okay, I don't normally go into details about injuries or allegations of the foster children in my care as that is confidential information, but bear with me- I'm sharing this story with the sole purpose of possibly helping any other foster parent or prospective foster parents out there who are ever faced with a similar situation, because, as you'll discover if you keep reading (or if you haven't already figured out by the title of this post) if I had known at the time when I discovered the "bruises" on Rose what I know now I would have been spared a lot of unnecessary worrying.

I showed Rose's caseworker the bruises after she came to our home a couple of hours later for the required 48 hours-after-placement visit. She took a picture of them with her camera to document them.

"Hmmm" she said, sounding puzzled, "I don't think the doctor said anything about those. You'll definitely have to ask about that when you take her to get checked" [She was referring to the fact that a doctor's appointment is typically required within the first couple of days after a child is placed into care]

"You'll also want the doctor to order such-and-such tests" she continued, speaking of some other non-related tests which needed to be done based on the baby's and the baby's parent's medical backgrounds.

I then proceeded to tell the caseworker that I had not yet been given a Medicaid card for Rose (nor had I yet been contacted by the nurse assigned to her case) so I couldn't take her in to see a doctor even if I wanted to right then.

On more than one occasion I've needed to take a foster child to a required check-up or to see a doctor, but their Medicaid Card (a new one is issued monthly) has not yet come in the mail; this is obviously problematic.  It’s just one of the frustrating paperwork aspects of being a foster parent: Since the children in your care are in State custody they qualify for and are covered by Medicaid (unless they happen to be covered by their parent's own private insurance plan, which is, in my experiences, a rarity). So anytime I need to take a foster child to see a doctor or any other medical professional I can't unless I have two forms with me:

1) The Placement Verification Letter from DCFS stating that I am the foster parent and as their  guardian I am responsible for the child yet I should not personally be billed for any treatments, and of course

2) Proof of Insurance (usually Medicaid).

If I don't have those two forms then my foster child can't be seen by a doctor.

Oh, make that three forms if you count the Health Visit Report which must be filled out by the doctor at each visit and comes in triplicate copies- one which the doctor's office keeps, one which I mail in to the nurse assigned to the child’s case, and one which I keep with the child's records.

Back to Rose and her bruises: The other stressful thing about discovering a scratch or bruise or reporting an injury of a foster child is that foster parents run the risk of being accused of child abuse. In some cases, foster parents are viewed suspiciously [thanks to the ones out there who have actually abused the children in their care!] and thought of as guilty until proven innocent [through investigation]. So my first concern about discovering Rose's bruises was for her and as I started jumping to conclusions I found myself hating her parents, whom I had never met, or whomever it was that did this to her.

But then . . . . then I started worrying when I realized that the tables could easily turn- that authorities who don't personally know me or my husband- but only know that we've had a child in our care for less than 24 hours and now we're reporting what could potentially be some serious- and definitely not just "accidental" injuries- could have the same suspicions towards me and my family that I had towards Rose’s family. 

The next morning Rose's caseworker called me and asked/instructed me to take Rose to the Children's Justice Center for further photos and documentation of the bruises. When I met the doctor in charge of the examination she mentioned that after she looked at the initial photos which the caseworker took the day before and, according to her professional experience and opinion, there was a possibility that the bruises might be Mongolian Spots. I had never heard of the term "Mongolian Spots" before but quickly surmised what it meant.  Although she is not of oriental descent, Rose is, after all, a bi-racial child: half-Caucasian and half-Hispanic.

More pictures were taken for documentation & investigation and after a thorough examination the doctor reassured me, once again, that she wouldn't be surprised if they turned out to be Mongolian Spots, but the only way to be certain would be for me to keep an eye on the bruises and watch for any changes in color.

When I got home that afternoon and got Rose fed, burped and down for a nap I went to the computer and Googled "Mongolian Spots". This was one of the images that was brought up:

I also found an excerpt from this article particularly pertinent:

Because Mongolian spots can be easily mistaken for bruises, particularly by well-meaning white people who have no experience with them, they have triggered accusations of child abuse against some adoptive parents. For this reason, it is important to be sure that both your child's pediatrician and the caseworker who completes your post-adoption work record information on the presence of Mongolian spots into their records. You can assist in the documentation of this information by taking snapshots of the spots and providing prints to be included in your child's files. Since you cannot take for granted that everyone will know what Mongolian spots are, it is good advice to have their presence recorded from the start.”

Any other foster or adoptive families out there ever had any experiences with Mongolian spots?


Last Mom said...

I have experienced them a few times from a childcare perspective. Centers have called me very concerned about "bruises" on new babies and have even called in child abuse reports only to find out they are Mongolian spots that the parents have well documented, but didn't think to tell the center about.

Deidra said...

I am really glad you posted about this. I just assumed that everyone knew what mongolian spots were but I am finding this is not the case. People really do need to be educated about this so that false assumptions and accusations are not made.

Our little China baby has them. One day soon after we had gotten home with her, we were at the lake with some friends. I was changing her back into her clothes at the day's end and one of my friends saw her little naked bum. This friend is not afraid to ask people anything so she immediately questioned me about her "bruises". I was surprised but explained they were mongolian spots and not a single person there had ever heard of them.

I guess it's not surprising when you live in a very un-diverse area for people to not be familiar with things that are specific to a particular race or minority.

I asked my pediatrician at a recent visit if we needed to document the spots and he kind of laughed and said no, most people know about them these days. Now, reading this post I am a little more nervous, if your social worker and ped didn't even know what they were! I do have it documented on our camera, I guess that is the best I can do.

Just so people know, there are a lot of races that can have these, black included. I was not aware that hispanics can have them too so that is good information.

Thanks for the post, I think I will have to do a similar one!

Cindy said...

We had this experience with our first foster baby. He was hispanic and had a big mongolian spot on his bum. I thought the same thing, that is was a bruise. I was relieved when I found out what it was!

Shine said...

Huh. Never heard of them. What a learning experience! I gotta say, I'd report it... even a mongolian spot. Better to report it and have it turn out to be a mongolian spot than assuming that's what it is only to find it really was a bruise and caught by a caseworker. That'd be one heckova hot mess!

FootPrints said...

MARY! such a great post!! i forget that these spots are common all around the country! Asian babies also get them quite frequently. our son even had them on his feet and knees!
we once had a foster son (Micronesian) who had them all over his back/butt. we were at the beach and a caucasian lady's eyes nearly popped out when i took his clothes off...we made eye contact and explained where they were...
anyone in their right mind would be freaked by unexpectedly seeing these marks on a child.