What to consider when adopting a child from a foreign country
By Emmanuel Walter, M.D. and Dennis Clements, MD, PhD, MPH
are considering adopting a child from another country, you are not
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
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.
each childs story is different, many IA children come from
backgrounds that place them at a higher risk of medical, developmental,
and behavioral problems.
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.
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.
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.
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.
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.
traveling abroad to adopt, prospective parents should also meet
with their childs 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.
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.
parents should also make sure that they have received their own
immunizations prior to travel in order to prevent travel related
After returning to the United States, IA children should be evaluated
by a medical practitioner within three weeks of arrival.
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.
from China, Russia, Europe and Southeast Asia should have blood
testing for hepatitis C.
children are coming from regions of the world with higher rates
of tuberculosis, all children should have a tuberculin skin test
performed as well.
intestinal parasites are common in IA children, the stool of all
IA children should be examined to rule out this type of infection.
childs 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.
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.
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 childs age.
those immunizations that are documented in the immunization record,
the provider may elect to assess the validity of IA childs
immunizations by testing the childs blood to determine if
there is any evidence that he or she received the shots that are
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.
After adoption, it is not uncommon for children who have been institutionalized
to persist with orphanage behaviors that new parents
may find concerning.
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
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.
persistent or extreme worrisome behaviors additional help from a
mental health professional may be needed to assist with the transition
to the new home.
the months after adoption your childs developmental progress
including age appropriate milestones and language acquisition should
be closely monitored.
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.
ultimate goal for IA children is for them to form an enduring relationship
between themselves and members of their new family.
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.
Walter, MD, is head of the section of international adoption and
pediatric travel medicine in Duke Childrens Primary Care.
Dennis Clements, MD, PhD, MPH, is the chief medical officer of Duke
Children's Hospital. For more information, visit
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.