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Internationally Adopted Children
What to consider when adopting a child from a foreign country
By Emmanuel Walter, M.D. and Dennis Clements, MD, PhD, MPH

If you are considering adopting a child from another country, you are not alone.

The number of internationally adopted (IA) children immigrating to the United States each year has tripled since 1990, with current estimates suggesting that there are more than 20,000 IA children arriving each year.

Greater than one-third of IA children are from China, while a substantial number also come from Russia, Guatemala, South Korea, Ukraine, and Kazakhstan. Fewer IA children originate in other countries.

Although each child’s story is different, many IA children come from backgrounds that place them at a higher risk of medical, developmental, and behavioral problems.

IA children may have been abandoned after birth by undernourished or impoverished mothers. In addition, mothers of IA children have frequently abused alcohol or intravenous drugs.

If not in foster care, IA children have often experienced prolonged orphanage stays and may bear the consequences of nutritional deprivation and emotional neglect. IA children also seldom have complete medical histories and many have received inadequate health care.

Preparing for Adoption
When considering international adoption, it is important for prospective parents to seek the advice of a health care professional who is familiar with the needs of IA children.

The best time to seek advice is after your adoption agency has given you a “referral” or has matched what they have learned about you and your family with a child who has been placed for adoption.

Medical information, photographs, and videotapes, when available, should be reviewed by a medical professional to assess whether there are any worrisome health conditions. Special attention should be paid to growth, including height, weight, and head circumference, as it may be the only clue to an undisclosed medical problem.

Before traveling abroad to adopt, prospective parents should also meet with their child’s health care provider to make sure they are ready for the upcoming adoption. Parents need to be prepared to travel with the necessary provisions to care for their new child.

Besides nutritional supplies and appropriately sized clothing, parents should prepare a medication kit including non-prescription medications and a limited number of individually recommended prescription medications. Discuss with a medical provider appropriate administration and dosing of medications for the adopted child.

Prospective parents should also make sure that they have received their own immunizations prior to travel in order to prevent travel related infections.

Medical Tests
After returning to the United States, IA children should be evaluated by a medical practitioner within three weeks of arrival.

In addition to routine blood counts, all IA children should have blood tests for syphilis, HIV-1, HIV-2, and hepatitis B. These tests should be repeated even if they have previously been done abroad.

Children from China, Russia, Europe and Southeast Asia should have blood testing for hepatitis C.

Since children are coming from regions of the world with higher rates of tuberculosis, all children should have a tuberculin skin test performed as well.

Because intestinal parasites are common in IA children, the stool of all IA children should be examined to rule out this type of infection.

Your child’s health care provider may elect to do other laboratory tests such as thyroid function tests, a blood lead test, or a urinalysis, in addition to other individualized blood tests. In many cases hearing and vision screening should be performed as well.

It is important that adopting parents bring any record of immunizations done abroad to the first clinic visit to help assist the provider in determining what immunizations the IA child will need in order to be adequately protected.

Some immunizations routinely recommended for children living in the United States, such as chicken pox vaccine and conjugate pneumococcal vaccine, are not readily available in other countries. These immunizations should be administered as appropriate for the IA child’s age.

For those immunizations that are documented in the immunization record, the provider may elect to assess the validity of IA child’s immunizations by testing the child’s blood to determine if there is any evidence that he or she received the shots that are recorded.

If the IA child does not have any written documentation of receiving recommended immunizations or if blood testing does not confirm prior immunization, vaccination with routine childhood immunizations will need to be restarted according to age specific recommendations.

Behavioral Concerns
After adoption, it is not uncommon for children who have been institutionalized to persist with “orphanage” behaviors that new parents may find concerning.

Behaviors such as rocking, head banging, aggressive acts, over-friendliness, and clinginess may be observed. Some children may have difficulty eating while others may hoard food. Difficulties with sleep are also common.

IA children may experience a sense of grief or loss upon leaving a foster family or others in an orphanage behind. The health care professional should help parents anticipate some of these behaviors and work with parents to develop appropriate responses.

For persistent or extreme worrisome behaviors additional help from a mental health professional may be needed to assist with the transition to the new home.

During the months after adoption your child’s developmental progress including age appropriate milestones and language acquisition should be closely monitored.

If your child is not appropriately acquiring language or other developmental milestones in a timely fashion, intervention by a developmental specialist such as a speech or occupational therapist may be warranted.

The ultimate goal for IA children is for them to form an enduring relationship between themselves and members of their new family.

Attachment to the new family involves deep feelings of trust and security and will only evolve over time after the child has repeatedly had their needs met by loving, nurturing caregivers.

Emmanuel Walter, MD, is head of the section of international adoption and pediatric travel medicine in Duke Children’s Primary Care. Dennis Clements, MD, PhD, MPH, is the chief medical officer of Duke Children's Hospital. For more information, visit www.dukehealth.org

The information presented on this site is intended solely as a general educational aid, and is neither medical nor healthcare advice for any individual problem, nor a substitute for medical or other professional advice and services from a qualified healthcare provider familiar with your unique circumstances. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition and before starting any new treatment.

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