Physician: Stress-Causing Issues to Consider Before Adopting

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People tell me that international adoption is easy. I would like to know what issues I should be aware of that may have a stressful impact on my family.

In my experience, a majority of the cases of international adoption that I follow have a happy ending. However, as with any story, there are cases where international adoption may be more than what the family had bargained for.

My pediatric practice is unique because I see families from all walks of life, but my international adoption panel is a special part of my clinical practice. These families are often well educated, financially stable, and career motivated people. These families are often older and sometimes lack the experience of raising a child.

Adoption stress can plague anyone involved in international adoption. The process starts before the adoption actually begins and long before the internationally adopted child even arrives into your home. Issues with infertility, parental age, and the desire to have a child are just the beginning stages of adoption stress.

During the adoption process and difficulties encountered can exaggerate the tension felt by parents. The adoption process itself is a drawn out procedure that can take months to years to complete.

The adoption process is often unpredictable. It can become a long and emotionally draining journey for parents. The financial cost, lifestyle adjustments, and the piles of paperwork of adoption only add to the tension.

Unexpected challenges may arise during the process. Adoption referrals may be withdrawn after you attach to the child, or the country from which you are adopting may suddenly close its adoption program. A prime example of severe adoption stress was created for families when Romania closed its doors to international adoptions. When this occurred, hundreds of families were caught in the pipeline, and their children were condemned to living in an institutional care environment despite the fact that there was a loving family somewhere in the world that had already developed a bond with them. Parents invested a great deal of emotional energy into these children. I know of one particular case of a woman who, even to this date, visits her child in Romania every six months and cares for her from afar. Like these cases, there are still many families waiting to bring these children into their forever homes.

Another cause for adoption stress is when a family loses their referral. I have seen cases where, during the pre-adoption medical records evaluation, the child was assigned as a very low risk for adoption classification. By the time the family contacted their adoption agency in order to accept the referral, the child had been placed with another family domestically because the excellent health conditions of the child.

The opposite type of such a referral would be the high risk adoption. This too can create a significant amount of stress. Because of medical uncertainties and the potential that the child may have serious medical problems, families may refuse this type of referral. Families have related to me that the feeling and emotions that they encounter after refusing an adoption referral are ones of guilt, confusion and the feelings one may encounter with mourning the loss of a child.

In all the above mentioned scenarios, families were forced to deal with a tremendous amount of emotional turmoil, and the child had not even arrived in the United.

The post-adoption period can be the final chapter of the adoption stress story. It has the potential to catapult the stresses experienced in the pre-adoption period spinning out of control, especially if the adoptive child has a serious emotional or medical problem.

Mandatory physician visits, extensive laboratory investigations and subspecialty referral can transform what is supposed to be a happy time to one of extreme tension. This often happens when the adoption medicine physician discovers underlying medical conditions that went undiagnosed, especially if the condition is life altering, such as HIV infection.

Fortunately many of the diagnoses uncovered in the post adoption period are not as serious as is HIV infection, but even a mild case of Giardia intestinal infestation can cause undue stress for the adoptive family.

It is at this point when the adoption stress has reached its peak that is can transform itself into a full blown anxiety or depressive syndrome for the adoptive parent. For some parents, these feeling are difficult to accept because they occur at a time when one is expected to experience joy and happiness and not sadness and despair. After working so hard to achieve the adoption, parents may be reluctant to confess their negative or ambivalent feelings to their spouses, especially if the adoption idea was theirs to begin with. Ignoring these feelings and this delicate situation is never a good idea. The problems will not go away; they will progressively worsen over time.

As you can see, adoption stress can affect almost anybody involved in international adoption. It can affect families with problematic adoptions as well as near perfect adoptions.

In order to prevent discord between the husband, wife, and other members of the family unit, families need to become educated. If one feels that the adoption is not as they planned, or that it is more that they signed up for, seek counseling immediately. All adoptive parents should be prepared to experience some degree of post adoption stress.

I often hear from families make the following statement: “I only want to adopt a normal healthy child.” I can understand their wishes, and I know that there is a parent for every type of child. Adoptive families, however, need to understand that they are not immune from future medical issues. Even in case of biological children, no one can tell you that the child will be healthy. As a parent, all you can do is provide support, love, and a warm family environment to raise your child. They will grow and develop despite our wishes and or plans. There is no perfect road map to raising children, both biological and adoptive. Medical, social and emotional problems can affect anyone. Parents need to be prepared to recognize problems and seek professional help when needed. This is the job of a parent.

by George Rogu, M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit or call 631-499-4114.

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