International Adoptions and Medical Needs

In recent years, more and more people are extending their families through international adoption. Understanding the medical, social and developmental issues unique to international adoption can help parents prepare for the special challenges and special needs of these children.

Children who come to the United States from other countries may not be properly immunized and may be at increased risk for infections such as measles and hepatitis A (usually due to living in overcrowded areas). They are also at risk for malnutrition and exposure to other diseases that are not common in the U.S.

Orphanage adoptions

Medical evaluation for international adoptions has become important because of the demographic shift in adoptions in recent years. Currently, a majority of international adoptions are from China, Guatemala, Russia, Ethiopia, South Korea, Vietnam, Ukraine, and Kazakhstan. Medical care is often less developed in these countries, and when children come from an orphanage environment.

Even though the medical issues can be frightening, there are ways of taking precautions prior to international adoption. Prospective parents may want to strongly consider a pre-adoption visit to the country they wish to adopt from. Any type of information, such as medical records, birth history, photos, or videotape can prove helpful for health care providers.

From this material, a child's basic medical condition can often be identified, such as recognizing birth defects, abnormal lab results, or specific growth patterns. Parents should not rely on the material obtained from other countries, however, since it may be somewhat unreliable and it may be impossible for the health care provider to detect all possible disabilities.

Family members who remain at home while waiting for the arrival of a child should be current with their routine immunizations, as advised by the Advisory Committee on Immunization Practices. Those caring for and those who will be around the child should be immunized against hepatitis A and B before the child arrives.

The adopted child should have a medical examination within the first two weeks of arrival to the U.S. If the child has symptoms, such as fever, is not eating well, has diarrhea or vomiting, the visit to the health care provider should be sooner. The physical examination of an adopted child will depend on several other factors, such as:

  • The country of origin

  • The child's age

  • Prior living conditions

  • The number of times the child has been moved from location to location

  • Nutritional status

  • Developmental issues

  • Any specific questions the adoptive family has

Research has estimated that almost half of internationally adopted children have an undiagnosed medical condition, such as gastrointestinal parasites, HIV, malaria, or tuberculosis. Anemia and lead exposure may also be problems on arrival. Often immunizations must be repeated because they may be considered unreliable in a certain country.

Other issues

In addition to assessing a child's possible physical problems, parents must also consider issues of attachment and developmental delays. It's estimated that for every three months a child is placed in an orphanage, he or she will be delayed one month in development. Most parents are understandably anxious about how their children will "make up" these delays in growth and development. The gains made after a child has been in a loving home can be truly miraculous. Typically motor skill delays improve first, then language and social skills. In general, the odds are excellent that children adopted from orphanages will do very well over the long term.

Reactive attachment disorder is a rare but potentially serious disorder that improves with the emotional health of the child, and as bonding with the adoptive parents takes place. With careful medical attention, international adoption can be mutually successful for the child and prospective parents.