Medical Issues in Internationally Adopted Children

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Questions and unknowns are inherent to international adoption. Chief among these unknowns is medical history – both the child’s medical history and the medical history of the child’s birthfamily. It’s only natural to want your child to be healthy – no parent wants their child to be ill. However, if you’re looking for a child who is always perfectly healthy, maybe you should rethink adoption – and parenting in general, for that matter. Remember, there are no guarantees in adoption or in life. Health issues will sometimes appear for no good reason in previously healthy children – both children of adoption and birth children.

Generally, children are placed for international adoption due to abandonment, poverty, illness or death of parents, or severe family dysfunction (such as alcoholism, drug abuse, child abuse, and/or child neglect). All of these reasons bring the possibility of health issues.

Certain health risks are inherent when adopting foreign children. Children from third world countries often come with minor – and sometimes major – health issues. Children being referred for international adoption may have experienced poor prenatal and/or postnatal care, early neglect, and a lack of health care services (including immunizations). Specific health problems of children referred for international adoption vary widely and may include malnutrition, scabies, lice, intestinal parasites, minor congenital defects, developmental delays, tuberculosis, hepatitis (A, B, or C), and HIV/AIDS.

Children also can be affected by living in orphanages during critical developmental periods and/or for long periods of time. Reputable adoption agencies will provide prospective parents with as much information as possible on a child’s background and medical history; however, they cannot guarantee the accuracy or completeness of this information. Medical evaluations (including lab testing) in developing countries do not always match U.S. standards. The birthparents’ medical and genetic histories are not always known, especially for abandoned children.

Don’t panic: The good news is that the vast majority of health issues seen in children placed for international adoption are minor and correctible!

Top Five Health Problems Seen in Children Placed for International Adoption

There are five health issues most commonly seen with internationally adopted children:
  • Hepatitis;
  • HIV;
  • FASD (fetal alcohol spectrum disorder);
  • Reactive attachment disorder; and
  • Sensory integration dysfunction.
Hepatitis & HIV

Blood tests are used to determine if a child has hepatitis or HIV. The vast majority of countries open to international adoption provide the results of these blood tests in your child’s medical history. However, this doesn’t mean that the child won’t be exposed to these diseases after the test was taken – so make sure the date of the blood test is recent.

Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorder (FASD) is a common risk in Eastern Europe and Russia. It is uncommon in Asia, where alcohol consumption is not a societal norm. FASD occurs when the fetus is exposed to alcohol constantly throughout the pregnancy or when the birthmother engages in sporadic episodes of binge drinking. FASD isn’t one specific defect, it is a cluster or pattern of related problems. Signs of FASD include:
  • Small head circumference and brain size (microcephaly);
  • Distinctive facial features including:
  • small eyelid openings
  • a sunken nasal bridge
  • an exceptionally thin upper lip
  • a short, upturned nose, and
  • a smooth skin surface between the nose and upper lip (missing frenulum).
  • Small teeth with faulty enamel;
  • Heart defects;
  • Deformities of joints, limbs, and fingers;
  • Slow physical growth before and after birth;
  • Vision difficulties including nearsightedness (myopia);
  • Mental retardation and delayed development; and
  • Abnormal behavior such as short attention span, hyperactivity, poor impulse control, extreme nervousness, and anxiety.
Physicians at international adoption clinics are constantly on the lookout for telltale signs of fetal alcohol spectrum disorder – yet another reason to have these specialists review any child referral you receive.

Reactive Attachment Disorder

Reactive attachment disorder is a condition in which a child has great difficulty forming lasting, loving relationships. Usually resulting from neglect or abuse, the child has not formed a bond with a parent or primary caregiver and is left unable to sustain a healthy relationship with anyone. Conditions that can damage a child's ability to attach usually occur within the first two to three years of the child's life.
Reactive attachment disorder occurs when a neglected baby fails to bond with a loving adult caretaker. The results of this disorder can leave a devastating legacy of a life lived without feeling love. There is some good news, however: Medical experts now believe that once a child bonds with someone (usually someone in a caretaker role), the child can (and will) transfer that bond to a new parent.

The risk of reactive attachment disorder is minimized if the ratio of caregivers to children is low. (A good ratio is 1 caregiver for every 3 or 4 kids; a bad ratio is 1 caregiver for every 20 kids.) Different orphanages within the same country can have different ratios – some good and some bad. If you get a video with your child referral packet, be sure you (and your international adoption physician) look for evidence on the video of how the child interacts with other people.

Sensory Integration Dysfunction

Sensory integration dysfunction is the brain’s inability to correctly process information brought in by the senses. For example the nervous system can overreact to heat and cold or repetitive noises, bringing out hostility, withdrawal, and/or clumsiness in the child.

Sensory integration dysfunction can result when babies are unable to explore their surroundings and are left alone in their cribs for long periods of time and do not receive the loving touch of a caretaker. As a result, the body’s senses interpret information inappropriately. It is very hard to tell from a video if a child has a sensory integration dysfunction.

Sensory integration dysfunction can be treated through therapy. Occupational therapists familiar with sensory integration can be very helpful in deducing what stimulations are comforting and what stimulations need to be avoided – and how to go about avoiding those “bad” stimuli.

The Moral of the Medical Story

As you can see from just this brief discussion, children available for international adoption may be the victims of a wide variety of potential health problems. The good news is that most of the health problems faced by internationally adopted children can be easily and effectively treated with modern medicine. The bad news is that you may not know your child has a health problem until you have him home.

The moral of the story is this: Even if the medical history in the child’s referral file looks fine to you, it would be wise to have it evaluated by a pediatrician who specializes in international adoption medicine.

Additional Resources:

Credits: Excerpted from "International Adoption Guidebook," Mary M. Strickert, 2004

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