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medical problems of adopted children

Before adopting a child of any age, adoptive parents should gain as much information as possible about a child's MEDICAL HISTORY and that of his or her birthparents.

If at all possible, parents should locate a physician with a positive attitude about adoption before they adopt a child. If the parents are adopting a child from overseas or from the U.S. foster care system, they should contact adoptive parent groups for recommendations of physicians experienced in treating such children. (Or, if no physicians are available with experience, recommendations should be sought on physicians willing to research and learn about ailments beyond what they usually see.) Infant risks depend on medical factors in both the child and the birthparents. Thus, maternal age, drug or alcohol use and genetic issues are important factors. For the infant, gestational age, birthweight, congenital anomalies and maternal stresses are the most important factors.

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Conditions with a genetic component, such as schizophrenia, hypertension and diabetes, may be discussed with a physician prior to the decision to adopt a child. There are also genetic tests for some conditions such as Huntington's chorea. However, pre-adoption genetic testing is not generally recommended unless there is a direct and immediate benefit to the child, rather than to the adoptive parents.

Even children who seem perfectly healthy may later develop a heart murmur or other medical problem, just as children born into the family sometimes develop health problems. Physicians attempt to screen major health problems and risks, but there are no guarantees, whether one has adopted or a child is born to the family.

Older children who are adopted may have physical, psychological, educational or behavioral problems stemming from abuse, neglect, inadequate medical care or multiple foster care moves.

Children with severe handicaps, such as blindness or cerebral palsy, are often difficult to place, yet there are adoptive parents who are willing and eager to adopt handicapped children.

Probably the hardest categories for whom to find suitable families are children who suffer from FETAL ALCOHOL SYNDROME.

Medical Problems of Children Born Outside the United States

Nearly 16,000 children were adopted by U.S. citizens in intercountry adoptions in fiscal year 1998. Medical information provided to adoptive parents on the child and his genetic ancestry can be ex-tremely sketchy or nonexistent.

Children adopted from other countries are often smaller than U.S. babies, and their growth rates may not track expected growth rates for a U.S. infant. In some cases, the child's age may be underestimated because of size. Bone age and dental X rays can help determine a child's actual age after several months to a year of nutritional rehabilitation occurs. However, they may not be decisive in the case of chronically malnourished and undersized children.

The most common medical problems are easily managed by the pediatrician: malnutrition, rickets, iron deficiency, previously undiagnosed congenital defects and active and chronic diarrhea. The secret lies in a meticulous examination and regular follow-ups.

The American Academy of Pediatrics has established guidelines for tests that should be performed on children adopted from other countries. Colloquially known by pediatricians as the "Red Book," The American Academy of Pediatrics Report on Infectious Diseases has a chapter on recommended tests for children adopted from other countries. The failure to use this recommended screening panel is the most common reason why infectious disease is not diagnosed.

Newly adopted children from lands abroad may be healthy but have difficulty digesting cow's milk because of lactose intolerance; consequently sometimes babies will require a different formula. Parents of infants adopted from other countries may wish to mix American baby formula with formula from the other country, half-and-half, for several weeks.

International Adoptions of Children with Special Needs

Although many children from other lands may have curable problems, some children have more serious ailments that are considered special needs, for example, a child with a cleft palate or club foot. American surgeons may be able to correct or cure many defects and diseases that would go uncured had the child remained in the overseas orphanage.

The child could have a medically controllable form of epilepsy or a delayed development as a result of a variety of conditions. Some ailments cannot be corrected; for example, deafness or blindness may be uncorrectable or correctable, depending on the nature of the problem causing the deafness or blindness. Most experts believe that the most serious "special needs" of children from other countries relate to psychological and developmental issues. Institutional living, abuse and neglect result in children who suffer from such problems. This is also true of children coming from the U.S. foster care system.

Margaret K. Hostetter, M.D., "Adoptive Parents: A Physician's Perspective," OURS, March/April 1989, 20-21.

Margaret K. Hostetter, M.D., Sandra Iver, R. N., Kathryn Dole, O.T.R., and Dana Johnson, M.D., Ph.D., "Unsuspected Infectious Diseases and Other Medical Diagnoses in the Evaluation of Internationally Adopted Children," Pediatrics 83, 4 (April 1989): 559-564.

International Concerns Committee for Children, Report on Foreign Adoption, 1989 (Boulder, Colo.: Internationl Concerns Committee for Children, 1989).

Mary Kathleen Lears, Kathie Judy Guth and Linda Lewandowski, "International Adoption: A Primer for Pediatric Nurses," Pediatric Nursing 24, no. 6 (November-December 1998): 578-586.

"Practical Advice for Parents: Your Doctor and Intercountry Adoption, Adoption/Medical News 5, no. 2 (February 1999).

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