Medical Examination After Arrival

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The varied geographic origins of internationally adopted infants and children, their unknown backgrounds before adoption (including parental history and living circumstances), and the inadequacy of health care in many developing countries make appropriate medical evaluation of international adoptees a complex and important task.

Usually, an internationally adopted infant or child should be examined within 2 weeks of his or her arrival in the United States. If the infant or child is suffering from an acute illness or has a chronic condition that needs immediate attention, he or she should be examined as soon as possible. Prospective parents might wish to meet with a physician before adoption to review medical records, if available, or to discuss common medical issues involving adopted infants and children. Parents who have not met with a physician before adopting should notify their chosen physician when the infant or child arrives so they can review basic medical issues.

All adopted infants and children should have a complete physical examination and medical history (for many internationally adopted infants and children, previous medical records and histories might be limited or unavailable), and should have age-appropriate screening tests, including evaluation for possible anemia, vision and hearing impairments, and assessment of growth and development. International adoptees frequently have additional medical needs. In studies of internationally adopted infants and children, infectious diseases are among the most common medical diagnoses and have been found in as many as 60% of infants and children, depending on their country of origin. Because many of these infections can be asymptomatic, the diagnosis must be made using screening tests in addition to medical histories and physical examinations. Some infectious diseases occur with sufficient frequency that all international adoptees should be examined for them; for other, less common infectious diseases, screening algorithms should be based on the prevalence of the specific diseases in the infant or child’s country of origin or residence. Other important medical diagnoses include hearing loss and vision abnormalities, growth and developmental retardation, nutrition deficiencies, and congenital anomalies.

A good source of information and recommendations for the medical evaluation of adopted infants and children is the American Academy of Pediatrics (AAP), including the publication "2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition," which has an excellent chapter on infectious disease screening recommendations for international adoptees ("The Medical Evaluation of Internationally Adopted Children for Infectious Diseases"). Another is the AAP policy statement, "Initial Medical Evaluation of an Adopted Child," published in "Pediatrics," Volume 88, Number 3, September 1991.

Internationally adopted infants and children frequently are not immunized or are underimmunized. These infants and children should receive necessary immunizations according to recommended schedules in the United States. Only written documentation should be accepted as evidence of prior immunization. In general, written records can be considered valid if the vaccines, dates of administration, number of doses, intervals between doses, and age of the patient at the time of immunization are comparable to the current U.S. schedule or World Health Organization recommendations. Although some vaccines with inadequate potency have been produced in other countries, most vaccines used worldwide are produced with adequate quality control standards and are reliable. However, immunization records for some internationally adopted infants and children, particularly those from orphanages, might not accurately reflect protection because of inaccurate or unreliable records, lack of vaccine potency, poor nutritional status, or other problems. Existing data are inconclusive as to the existence and extent of the problem among infants and children with recorded doses of vaccines administered abroad, and additional studies using standardized methodologies are planned or in progress. The ACIP is also currently formulating a statement on general recommendations on vaccination for internationally adopted infants and children that will be considered for approval in February 2001. Health care providers may follow one of several approaches if there is a question as to whether vaccines were administered to an international adoptee or were immunogenic. Repeating the vaccinations is an acceptable option. Doing so is generally safe and avoids the need to obtain and interpret serological tests. If there is a desire to avoid unnecessary injections, judicious use of serological testing can be helpful to the health care provider in determining which immunizations might be needed.

Additional Resources:

Credits: Excerpted from "International Adoptions," from the Centers for Disease Control and Prevention (CDC)

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