The Health Status of Internationally Adopted Children

Since 1986, American families have adopted more than 260,000 children from other countries. In 2005, more than 22,000 children from around the world arrived in the United States, most commonly from China, Russia, Guatemala, and South Korea. Many internationally adopted children have had perinatal complications and after birth, most reside in orphanages. Thus, these children represent a high-risk group for later complications.

International adoption clinics are a resource for parents with children adopted from abroad. Patients seen in such clinics include newly arrived adopted children, recently arrived children who are being followed for medical or developmental issues, or those who have been home for months or years with newly identified or ongoing problems.

One particularly important service that international adoption clinic staff members can offer is individual pre-adoptive counseling and reviews of medical referrals (the health dossier of an individual child provided to prospective parents by their adoption agency). Short video clips, photos, and other medical information (x-rays, ultrasounds) are often submitted for review via the Internet.

The quality and quantity of available information varies widely, depending on the country of origin. Although a great deal of information can be gleaned even from the most unpromising medical reports, it is important to have realistic goals for the consultation. Most parents are understandably anxious about the health of their prospective child, yet the value and scope of the consultation is constrained by the amount and quality of information provided. Many of the pages offered for review are stamped with the statement "Medical Accuracy and Translation Not Guaranteed," which should give pause to anyone who attempts a review of such material. Even if this statement is not present on a particular report, it is wise to imagine its presence in "invisible ink".

Reports from abroad vary depending on the regions. Reports from Russia and countries of the former Soviet Union frequently include alarming-sounding medical terms such as "Perinatal Encephalopathy," "Hypertensive-hydrocephalic Syndrome," or "Natal Trauma of the Cervical Spine." However, these and many other similar sounding terms are commonly applied to newborns and infants in Russia (and other former Soviet Union countries), and simply do not conform to neurologic diagnoses used in the US. In China, virtually all pre-adopt reports (except for children with designated special needs) describe the physical exam as completely normal (sometimes overlooking significant findings). Reports from Guatemala may include results of DNA testing of the mother and the child, a legal requirement aimed at reducing corrupt adoption practices. South Korean reports tend to be detailed and meticulous - sometimes creating alarm over what turns out to be minor variants.

Some reports are amusing - usually due to garbled translation. For example, one recent report described a child with "Hip Displeasure" (dysplasia).

Although pre-adoptive parents and pediatricians wish otherwise, the value of a pre-adoptive review is clearly limited. For example, it is not possible to predict the child's future language or cognitive abilities, behavior or emotional problems, social skills, or attachment. It is not possible to evaluate the child's risk of learning disabilities or attention deficit disorder, or to make promises about the child's likelihood of "catch-up" growth or development after adoption.

Nonetheless, if the reviewer and parent both have realistic expectations of what the evaluation can provide, a pre-adoptive review can be an opportunity to educate parents about potential medical, developmental, and behavioral risks for children who have had difficult experiences in early life. Parent preparation is key to family adjustment and satisfaction after international adoption.

International adoption clinics can also help treat or otherwise address a child's actual or potential medical or developmental issues post-adoption, as well as ease certain transitions for new families. Many international adoption clinics offer education and support group opportunities in addition to clinical treatments. Sometimes simply connecting with other families who have adopted children internationally can ease some new parents' concerns.

It is also important to remember that even after suffering adversity in early life, most internationally adopted children do extremely well - a tribute to the extraordinary commitment and abounding love of their families and the remarkable resilience of the children...

About Tufts-New England Medical Center and the Floating Hospital for Children
Tufts-New England Medical Center is a world-class academic medical institution that is home to both a full-service hospital for adults and the Floating Hospital for Children. It has long been recognized as a leader in cancer care, cardiology, organ transplantation, neurosciences and pediatrics. Founded in 1796 as the Boston Dispensary to care for sick and needy Bostonians, Tufts-NEMC is the oldest health care facility in New England. The Medical Center is the principal teaching hospital for Tufts University School of Medicine. The Floating Hospital for Children, Tufts-NEMC's full-service children's hospital, began as a hospital ship more than a century ago. The 128-bed Floating Hospital provides comprehensive inpatient and outpatient services in every area of medical specialization. The International Adoption Clinic at the Floating Hospital, established in 1989, is the second clinic of its kind in the United States. Over the past 17 years, the International Adoption Clinic has added many services to meet the changing needs of these children and their families, and has developed an active research program designed to improve the quality of care in Russian orphanages. Clinic staff members also offer bi-monthly seminars for Pre-Adoptive Parents, and review 15-20 pre-adoptive referrals each week. For more information on Tufts-New England Medical Center and the Floating Hospital for Children, visit our web site at www.tufts-nemc.org For more information on the International Adoption Clinic at the Floating Hospital for Children, visit www.tufts-nemc.org/adoption/default.htm .