International Adoptions Guide

If possible, you may also be able to arrange a preadoption review of a child's medical records. This is especially useful if it includes a videotape of his activity, so that his growth and developmental status can be assessed. It is important to keep in mind that these medical records are often incomplete or contain misleading or even false information. A physician (especially in Russia) may diagnose a child with a problem because it is the only way that the government will let the child be adopted outside the country.

Once you have brought your adopted child home, you should arrange a visit with your Pediatrician for a complete examination. This exam should be done within two weeks of your arrival home and it will help to establish the child's baseline of growth and development and will look for common medical conditions found in children that are adopted from foreign countries. It is also a good time to begin immunizations.

Medical conditions that are commonly found in internationally adopted children include chronic diarrhea, tuberculosis, hepatitis, HIV, scabies, lice, rickets, iron deficiency anemia and chronic ear infections. Because many of these infections do not produce symptoms (asymptomatic infections), your doctor may do some testing to look for these medical problems. These screening tests will usually include testing for Hepatitis B (HBsAg), HIV, Hepatitis C, and syphilis (RPR or VDRL); a PPD to test for tuberculosis (receiving the BCG vaccine is not a contraindication to getting a PPD); examination of the stool for parasites; and a complete blood count to test for anemia (low blood counts). Although your child may have been tested before leaving his country of origin, these tests are usually considered unreliable and should be repeated. Your physician may also consider repeating testing in 6 months to evaluate for infections that were in the incubation phase on your child's arrival. Other tests that may be considered including a urinalysis, hemoglobin electrophoresis, thyroid function tests, and a lead level.

If your child is having symptoms when he is brought home or shortly afterwards, especially fever or diarrhea, then more extensive testing may be done.

Unless details of immunizations are recorded, including the name of the vaccine, date of administration and interval between doses, then you may need to repeat any that were given prior to adoption. While some vaccines are adequate and can count to their recommended immunization schedule, others are not, because of unreliable records or lack of potency of the vaccine that was given. If in doubt, it is usually better to just repeat them, or it is possible to check titers to see if he has immunity.

Your Pediatrician will also exam your child's growth and development, including screening for vision and hearing problems. Depending on the child's age, family history, past medical history and the type of environment he was in prior to adoption (foster care vs. institutionalization and caregiver to child ratios), in addition to the medical problems described above, he may have problems with developmental delays, especially language delays, poor growth, emotional and/or behavioral problems and difficulty feeding.

Although many children adopted internationally have growth delays, with their initial growth plotted below the 5% for their weight, height and head circumference, with proper nutrition, most of these children will catch-up and begin to grow normally. If this catch-up growth does not occur, then a thorough medical evaluation to look for medical reasons of poor growth is indicated.

In addition to rapid catch-up in their growth, most children also have a rapid catch-up in their developmental delays. As with their growth, if there is a severe developmental delay, or a child does not have rapid catch-up, then a more throrough evaluation will be necessary, with possible treatment with speech, occupational, and/or physical therapy. Other children with behavioral or attachment problems may need to be evaluated by a child psychologist.

In my own Pediatric's practice, I have parents who have adopted children from Mexico, the Marshall Islands, China, Romania, and Russia and they have all done very well.

• Although many children who are adopted from abroad initially have problems with poor growth and developmental delays, many of these children, especially if they were adopted at a young age and do not have any chronic illnesses, have a quick catch-up in their growth and meeting their developmental milestones.
• It is important that screening tests (especially a PPD and testing for hepatitis) and appropriate medical treatments be performed upon arrival home.
• Seek additional help and treatments if your adopted child does not have a rapid catch-up in their growth or meeting their developmental milestones or if you are having a lot of behavioral and emotional problems. For children who arrive with severe delays, and early referral to your local early childhood intervention program may be beneficial.
• Remember to remind your Pediatrician that your child was adopted from a foreign country if he develops any chronic illness in the first few months to a year after being adopted, so that appropriate testing can be considered.

International Adoption Links:

• Comeunity - Adoption Parenting Support: 'a volunteer website from our family for your family. With the motto "Come Together in Unity," our goal is to benefit children by building diverse communities and providing family centered support.'
• Initial Medical Evaluation of an Adopted Child: policy statement from the American Academy of Pediatrics.
• Adoption Resources: Medline Plus guide to adoption with links to other sites with info about coping, specific conditions/aspects, directories, law and policy, organizations, statistics, children, teenagers, and resources in Spanish.
• Adoption International: provides parents contemplating international adoption with the best pre-adoption medical advice and consultation, as well as with similar services after the arrival of the adopted children to their final destination.
• Joint Council on International Children's Services: the oldest and largest affiliation of licensed, nonprofit international adoption agencies in the world. JCICS membership also includes parent groups, advocacy organizations, and individuals who have an interest in intercountry adoption
• Eastern European Adoption Coalition:. a nonprofit organization which serves the needs of families adopting children from Eastern Europe.
• Rainbow Kids: an on-line magazine for parents of children adopted internationally.  Every month you will find new stories, features, process-updates, and information on adopting children from all over the world.  It is always free.
• Adoptive Families: The Award-Winning National Magazine & How To Adopt Resource.
• National Adoption Information Clearinghouse: a comprehensive resource on all aspects of adoption, including infant, intercountry, and special needs adoption
• International Adoption Guide: US Dept of State resources concerning international adoption, including country specific contact information and procedures.

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