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The Informed Parent

Concerns For The Out-of-Country Adoption

by Peter W. Welty, M.D., F.A.A.P.
Published on Feb. 18, 2002

More and more children are being adopted from other countries each year. Children coming from Asian nations accounted for 90% of international adoptees in the year 1997. Many others came from Eastern Europe, the Caribbean, Africa and the Middle East. Often times the adopted child comes with sketchy health information. Family backgrounds are virtually unknown, and there is no recorded prenatal history. The health status of the birth family may be unclear, and there may be partial information about the child’s early development. All of these factors combine to make the ongoing health and emotional care of the adopted child an important one.

Before an immigrant visa can be issued all internationally adopted children are supposed to have a physical examination by a physician designated by the United States Embassy or consulate in the country of origin. Usually this examination is limited to gross physical defects, and the child is checked for communicable diseases. The child’s overall health status is not thoroughly examined at this time.

A personal physician’s examination of this internationally adopted child does not need to occur immediately, but should occur soon after this child arrives to his new home. Depending on his country of origin, the child should be screened for a variety of disorders. These may include hepatitis, intestinal parasites, tuberculosis, HIV, and CMV. One should be aware of specifics on these and other disorders.

The adoptive parents should also pay close attention to their child’s developmental and emotional status during this early adjustment time, and beyond. It is very important to be attuned to the tremendous series of changes this child has experienced, and will continue to experience. One may note regression in his developmental milestones, such as tantrums, bedwetting or bowel incontinence. Sleep or appetite changes may occur. All of these changes could be considered entirely normal and may eventually pass with time. Discussing any particular concerns with the child’s doctor is of utmost importance, to determine if any behaviors need a follow-up with a pediatric specialist.

The child may also benefit from a developmental screening. Developmental milestones can be grouped into the following areas: gross motor skills (running, riding a bike), fine motor skills (writing with a pencil or crayon, using eating utensils), speed skills (use of language in the child’s mother tongue or in English), and socialization skills (getting along with others in an age-appropriate way). Some delays may be temporary, and improve rapidly with the parent’s individual attention. Other delays may represent emotional or intellectual concerns, and benefit from a specialist’s evaluation.

If there were other children in the family they need to be well prepared prior to the new family member’s arrival. Ongoing vigilance to the other children’s emotional well being is essential. The other children may feel left out or slighted if they feel a parent’s lack of attention or concern. Keeping them involved in the new child’s life is important in integrating everyone into the family. Adopting a child, as a newborn or as an older child, whether from this country or from another, is a tremendous endeavor, full of rewards and challenges.

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