What are the health issues in international adoption?
Experts in international adoption medicine stress that the child’s country of origin is less important than the individual child’s circumstances. Children with disastrous, life-long problems can be born to healthy couples in wealthy countries; perfectly healthy babies can emerge from chaos and poverty. However, our adoptive families recommend that, while you are deciding on a sending country, you investigate the most common problems among its adoptees. The Centers for Disease Control is a good source of information about diseases in sending countries. For information more specific to adoptees, join the online support groups for each country you are considering, and search the message archives for references to medical issues. TB? Attachment disorders? Intestinal parasites? Fetal alcohol syndrome? If any medical problem appears common there, find out as much about it as you can, and think hard about how you would cope if your child came home with that problem.
What tests should be done once we get back to the U.S.?
No matter how healthy your internationally adopted child appears, he or she should see your physician within the first few weeks after his or her arrival—or sooner if there appear to be problems. The first doctor’s visit in the U.S. can be scary and stressful for a newly adopted child, especially one who has seen death and disease up close. If you can, recruit someone who speaks the child’s language to translate and reassure.
The following tests are recommended by our adoption pediatricians and by the American Academy of Pediatrics. Many (like the tests for HIV, TB, and syphilis) will probably have been done in the sending country to qualify for the orphan visa, but they should be repeated, so that your child’s medical file is complete. Even if your child came with immunization records, they may be incomplete and/or inaccurate; vaccinations may have been given at too young an age to ensure immunity; or a child may have received out-of-date or unrefrigerated vaccines. Blood tests for antibodies (also known as titers) will determine the child’s current immunity status, and can be used in place of vaccination records for schools in the U.S.
- Hepatitis B profile, to include HBsAg, anti-HBs, and anti-HBc
- Stool examination for ova and parasites
- Mantoux (intradermal PPD) skin test for TB with candida control
- HIV-1 and HIV-2 testing
- RPR or VDRL for syphilis
- A complete blood count, with erythrocyte (RBC) indices and a dipstick urinalysis
- A developmental exam, especially for those who have been institutionalized
- Children from Eastern Europe, Russia, and China should have their lead level and antibodies to hepatitis C checked.
- Children from China should be screened for hypothyroidism, because of the high incidence of dietary iodine deficiency.
- Vision and hearing screening
- Testing for antibodies to infectious diseases—polio, hepatitis A and B, measles/mumps/rubella (MMR), and diphtheria/tetanus/pertussis (DTaP)
Dr. Dana Johnson, director of the International Adoption Clinic at the University of Minnesota, warns that your regular pediatrician or family physician may be reluctant to perform all of the recommended tests. “Unfortunately, physicians tend to look at the parents, not the child,” he says. “The parents come from a middle-class suburb; they don’t have TB, syphilis, or HIV, therefore the child doesn’t either. Physicians don’t feel they need to do the screening tests. However, if the birth parents had walked in with the child, the physician would probably have ordered even more tests. So parents may have to remind their physician to consider the child’s country of origin and the diseases that are endemic in that country that can’t be diagnosed solely through a physical examination.”