Congratulations on the adoption of your child! As you begin your new life together, it is important that you help your child have a healthy future.
What You Need to Do
Children adopted internationally are at risk for diseases related to their living conditions, and many being adopted today have very complex special health needs. Because of these factors, a medical examination soon after arriving in the United States is very important. This may be done by your child’s doctor or a specialist in adoption medicine. If your child has special health needs, he or she may also need to see one or more medical specialists — but a general overview visit and a primary healthcare provider to coordinate care between multiple services is a good place to start.
What to Expect During the First Medical Visit
The examination should include a review of your child’s medical history, a physical examination, and laboratory tests. These tests (see “Important Information for Your Child’s Doctor” below) are very important to ensure a healthy start and future for your child. Even if your child appears healthy, some diseases don’t show signs or symptoms until later, when they may be more difficult and complicated to treat.
The following is more information about what your child’s doctor should do. (Remember to bring all your child’s medical records with you, particularly ones you received before the child’s adoption.)
- Review risk factors from your child’s history. This includes drug or alcohol exposure before birth, infectious diseases, any available birth family history, difficult life experiences, and environmental risks.
- Review immunization records. As a part of the medical evaluation for your child to receive a United States visa, you agreed to have your child immunized as soon as possible. It is important for parents and doctors to be aware that vaccines given in orphanages may have been stored incorrectly, inadequately recorded, or given at inappropriate times and intervals in a child’s life. Therefore, vaccine histories should not be accepted as written. Most vaccines may be repeated safely. As another option, your child’s doctor may order blood testing to determine what immunity your child has, then vaccinate as needed.
- Order recommended tests. This includes testing for anemia and lead; developmental, vision and hearing screening; dental and mental health examination. Recommended laboratory tests that were previously done overseas should be repeated. Even if your child does not seem to be sick, the recommended screening tests are important for the health and well-being of your child, your immediate family, and other people with whom your child may have contact.
Again, congratulations on starting a lifelong journey as an adoptive family. Please ensure that this journey will be a healthy one by working closely with your child’s doctor to fully evaluate your child’s medical, developmental, and mental health needs, right from the start.
Important Information for Your Child’s Doctor
Children adopted internationally often have lived in conditions of poverty with limited nutrition, limited stimulation, various traumatic events, and environmental and infectious disease hazards. As such, a comprehensive evaluation is recommended by the American Academy of Pediatrics (AAP) to evaluate for diseases that may be present, with no initial signs or symptoms.
Below is a list of testing that is recommended for children adopted internationally, regardless of the absence of symptoms or test results from the child’s birth country.
Growth and Nutritional Issues
- Measure length, height, weight (unclothed), and head circumference (for ALL children). Use standard CDC or WHO growth charts to determine growth percentiles.
- Growth should be monitored with further work-up done if there is not catch-up growth by 6 months after arrival in the home.
- CBC to evaluate for anemia, blood disorders. Hemoglobin electrophoresis should be done for children at risk for hemoglobinopathies.
- Lead level for environmental risks.
- TSH (in some countries the soil is deficient of iodine).
- Newborn metabolic screen up to 2 years.
- PPD or currently recommended testing for tuberculosis exposure (this should be done even if the child was immunized with the BCG vaccine; please refer to the Red Book for more information)
- Hepatitis B virus serologic testing: Hepatitis B surface antigen (HBsAg)
- Hepatitis C virus serologic testing
- HIV serologic testing
- Testing for tuberculosis, Hepatitis B, Hepatitis C, and HIV should be repeated after the child has been home 6 months. (Some children may not respond initially if the incubation period is inadequate or if they are malnourished.)
- Syphilis serologic testing: RPR or VDRL, and FTA-ABS or TPPA
- Stool examination for ova and parasites (3 recommended, best collected 48 hours apart) with specific request for Giardia and Cryptosporidium testing
- Stool bacterial culture (if diarrhea present)
- Serologic testing for other parasites such as Trypanosoma cruzi, lymphatic filariasis, Strongyloides, Schistosoma species may be indicated for certain children
- Evaluate immunization status by checking antibody titers for vaccines previously given (eg, diphtheria, tetanus, polio neutralizing titers) OR repeat immunizations. (Exceptions may include children from foster homes in Korea.)
Other Recommended Screenings
- Screen of development and behavior, mental health needs, trauma history.
- Assessment of vision and hearing.
- Oral health assessment, with referral to a dentist.
- Referrals for early intervention, speech/OT/PT if indicated.
To obtain more information about medical issues in adoption (or to locate an adoption medical specialist), please visit: www.aap.org/sections/adoption or www.healthychildren.org/adoption
American Academy of Pediatrics. Medical Evaluation of Internationally Adopted Children for Infectious Diseases. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: Report of the Committee on Infectious Diseases, 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012:191-199.
A Healthy Beginning: Important Information for Parents of Internationally Adopted Children