Medical Considerations in Adoption

What is adoption?

Adoption is the social, emotional and legal process in which children who won’t be raised by their birth parents become members of another family.

There are several forms of adoption, like open or closed adoptions and individual or sibling adoptions. And no two adoptions are the same. In the United States, you may be able to adopt a child through:

• Foster care.
• Private agencies.
• Extended biological or nonbiological family (kinship or stepchild adoption).
• Another country (international adoption).

If you’re planning on adopting a child, you’ll work closely with adoption experts throughout the process, including:

• Legal representatives (like adoption lawyers).
• Local child welfare and/or adoption agencies.
• Social workers.
• Pediatricians.

Pediatricians play a crucial role in helping families with the medical needs of children who go through the adoption process. This includes physical, mental, developmental and emotional care.

What medical issues are related to adoption?

Just like anyone else, children who go through the adoption process can already have or develop any type of health condition. Several studies show that children who go through the adoption process are at an increased risk of physical, developmental and mental health conditions compared to their peers who haven’t been through this process.

These risks are real, but the care, resources and support you provide can help your child grow and thrive despite these health conditions.

Why are adopted children at an increased risk of health conditions?

Early life experiences that may contribute to this increased risk of health conditions include a lack of access to:

• Healthcare before and after birth.
• Nutrition.
• Physical or emotional needs (developmental stimulation).
• Protection from toxins (like substances) or pathogens (like infectious diseases) before or after birth.

Many children also experience adverse childhood experiences (ACEs). ACEs are negative experiences that happen between the ages of 1 and 17 years. These experiences are usually traumatic events. ACEs can affect a person’s health — both mental and physical — throughout their lifetime. Examples of ACEs include:

• Child abuse (physical, emotional or sexual) and neglect.
• Exposure to violence, like domestic violence and community violence.
• Housing insecurity (homelessness, moving frequently or having an unstable home environment).
• Inconsistent caregivers, multiple caregivers or divorce.
• Natural disasters.
• Death of a family member or close loved one.
• Bullying.

Studies show that early traumatic experiences like these can have long-term effects on brain development. Chronic stress from these experiences can have lasting impacts on physical health.

Physical conditions

About 30% to 80% of children in foster care have at least one physical health condition. About 33% of them have a chronic (long-term) health condition. Some of the most common physical health conditions include:

• Growth failure and nutritional deficiencies.
• Asthma.
• Obesity.
• Vision issues.
• Hearing loss.
• Neurological conditions.
• Sexually transmitted infections (STIs).
• Complex chronic conditions.

Children may also be at risk for iron, calcium and vitamin D deficiency due to past malnutrition. Approximately 20% of children in foster care have significant dental issues.

Emotional difficulties

Removal from their first family and all that is familiar is emotionally traumatic for children. Children who experienced several transitions — such as in the foster care system — may have more intense emotional difficulties. It’s important to address — and understand — your child’s adjustment difficulties when they join your home and family.

Your child may:

• Be withdrawn.
• Have temper tantrums.
• Be aggressive or defiant.
• Cry inconsolably.
• Regress in previously obtained skills.
• Have difficulty sleeping.
• Have a lack of interest in enjoyable activities.

Even if transitions into an adoptive home are gradual, most children experience grief with the change in their caregivers, peers, school and home environment. Educate yourself as much as possible about how to ease this transition. Be patient, but don’t hesitate to reach out to your child’s pediatrician or mental health professional for guidance if these emotional issues are severe or long-lasting.

Mental health conditions

Most children with a history of foster care involvement in the U.S. have experienced psychological trauma. This increases their risk of developing mental health conditions. Common mental health diagnoses for children in foster care include:

• Anxiety disorders.
• Eating disorders.
• Mood disorders, including clinical depression and mania.
• Post-traumatic stress disorder (PTSD).

In addition, adolescents in foster care are more likely to have attempted suicide and have a substance use disorder compared to their peers who haven’t been through foster care.

Behavioral conditions

About 50% to 75% of children who go through foster care have difficulty with behavioral or social skills that require care from health services. Common diagnoses include oppositional defiant disorder and conduct disorder.

Childhood trauma, adversity and toxic stress, which children in foster care often experience, correlate with the following behaviors:

• Poor emotional regulation.
• Aggression.
• Hyperactivity.
• Inattention.
• Impulsivity.

These outcomes can increase their risk of behavioral conditions and difficulties.

Developmental conditions

About 46% to 60% of children younger than six in foster care have a developmental disability. These can include:

• Speech delays.
• Fine motor delays.
• Gross motor delays.
• Learning inabilities or intellectual disabilities.
• Social-emotional dysregulation.

These conditions begin during child development. They may impact day-to-day functioning and usually last throughout a person’s lifetime.

Speech and language developmental delays are especially common. Examples include:

• Auditory processing disorder (APD).
• Aphasia.
• Childhood apraxia of speech.
• Dysarthria.

Attention-deficit/hyperactivity disorder (ADHD) is also a common neurodevelopmental diagnosis for children in foster care.

Health considerations for international adoptions

Children who go through international adoption are highly likely to have physical health needs and developmental delays.

Infectious diseases and nutritional deficiencies are among the most common medical diagnoses healthcare providers identify after a child arrives in the United States. Children adopted internationally nearly always have delays in at least one area of development, with nearly half having global delays.

It can be especially difficult to get medical records of children from other countries. And the records may be sparse or inaccurate. Many countries follow different immunization schedules than the U.S. If a child coming from another country got their vaccines, it’s important you review these records with their pediatrician in order to make sure they aren’t missing any immunizations recommended in the U.S. If you’re planning to adopt a child from another country, talk to experts about what you can expect and how you can prepare for their health needs. They may have medical guidance based on the specific country of origin. 

Health concerns for other family members

When you add another member to your family, it’s important to consider the health and well-being of existing family members. Talk to adoption experts about how family members can positively adapt to this big change. Ask about warning signs to look out for with things like sibling rivalry or jealousy. Be sure to give attention or have one-on-one time with existing family members when you can to help with this.

It’s also common for parents to experience caregiver burnout when they go through the adoption process. This is a state of physical, emotional and mental exhaustion that can happen when you dedicate time and energy to manage the health and safety of someone else.

Consider joining a support group and seeing a mental health professional to help you and your family through challenging times. It’s also essential to lean on loved ones you trust for support.

What should I know about a child’s health before I adopt?

Before — or shortly after — you adopt, try to gather as much health information as possible. You’ll likely work with several people and groups to get this information, including:

• The adoption agency or foster care system.
• Your adoption lawyer.
• Your child’s birth parents and/or family.
• Hospital systems and your child’s previous or existing healthcare providers.
• Your child’s past and/or current school.

Health information you should try to get includes:

• Any physical, mental health, developmental or behavioral conditions your child has or had. This includes any hospitalizations and surgeries as well.
• Birth record information, like their gestational age, birth weight, length, head size and any complications during pregnancy or immediately after birth.
• Your child’s growth chart, including their weight, height and head circumference.
• Documentation of developmental milestones.
• Known allergies
• Current medications.
• Immunization records 
• Infectious disease exposures.
• Eye and dental records.
• Any history of malnutrition or feeding difficulties.
• The results of any medical tests (like imaging or blood tests) they’ve had.
• Any reports of physical, sexual or emotional abuse or neglect of your child.
• School history and performance.
• Relationship history, like important ongoing relationships (including with biological family members, foster parents and/or friends) and significant relationship losses.
• Medical history of your child’s first-degree relatives (biological parents and siblings).
• Medical conditions that run in your child’s extended biological family.

It’s also helpful to know your child’s birth history and information about their birthing parent’s pregnancy, especially if you’re adopting a baby or young child. This includes if the birthing parent:

• Used substances during pregnancy, like alcohol, tobacco (like smoking), marijuana or opioids (for example).
• Took any prescription or over-the-counter medications during pregnancy.
• Had any sexually transmitted infections (STIs) or other infectious diseases during pregnancy.
• Had any complications during pregnancy, labor or delivery.

Depending on the situation, you may only be able to get some of this information. In some cases, you might not be able to get any of it. Try your best to get the answers you can.

In an ideal situation, you’d take this information to a pediatrician for review before your child joins your family. This way, they can help you plan for the care your child might need and give you general guidance on what to expect. They can also provide referrals to specialists or certain services, like community support services. This can help ease the transition for your family.

If it’s not possible to do this review before the adoption, you’ll take your child to a pediatric appointment shortly after they join your family.

What is the role of pediatricians in the adoption process?

Pediatricians play an important role in the adoption process. They’ll work with you to identify your child’s health needs. They can also provide emotional support to help families through the adoption process.

Adoption and foster care medicine is an evolving subspecialty within the field of pediatrics. You may want to ask your social worker or pediatrician if they have a referral for a pediatrician who has experience in this area.

Roles of pediatricians include:

• Assisting in getting the medical records and history of your child.
• Providing thorough medical evaluations, well-child care and follow-up visits.
• Providing ongoing care for your child and their health needs.
• Making referrals for medical specialists, like child psychologists, pediatric cardiologists or speech-language pathologists, for example.
• Recommending resources that can help your child and family in the long term.
• Counseling families about potential adjustment issues after adoption.
• Recommending strategies to promote strong, healthy attachments within your family unit.
• Helping with documentation for your child’s Individualized Educational Program (IEP) and/or 504 Plan for school, if necessary.

What can I expect at my adopted child’s first health appointment?

Shortly after your child joins your family and home (ideally within 30 days), they should have a comprehensive health evaluation with a pediatrician. This evaluation can establish care for known health issues and identify any new ones. These initial evaluation visits are much more in-depth than regular well-child visits.

Your child’s pediatrician will need as much information about their medical history (like medical records) as you can provide. Depending on your child’s overall health and age, one visit may be enough, or their pediatrician may recommend several visits to complete a thorough assessment.

The evaluation(s) will likely include:

• Confirming and clarifying existing medical diagnoses.
• Thorough physical exam.
• Neurological exam.
• Age-appropriate screenings, like newborn screening panels, hearing, vision, dental and behavioral and/or developmental screenings.
• Assessing for any previously unrecognized medical issues.
• Discussing any developmental and behavioral concerns.
• Assessing your child’s vaccination status.
• Making any referrals to other healthcare providers and specialists.

Testing

Your child’s pediatrician may recommend certain diagnostic tests depending on their evaluation. These may be blood, urine (pee) and/or imaging tests.

Your child’s pediatrician may also recommend certain blood tests that can check if your child received the vaccines appropriate for their age. 

Mental health evaluation

Experts recommend that a child in foster care should have a mental health evaluation within 30 days of joining your family. Ideally, this would be with a child mental health professional trained in trauma-informed care.

How can I prepare for adoption?

The adoption process requires an immense amount of preparation and steps. Before you decide to adopt, it’s important to understand what bringing a child into your family entails, especially the considerations related to their health and well-being.

Questions to consider include:

• What are your motivations for adopting? Are you ready for this lifelong decision and commitment?
• Are you able to provide a caring, nurturing and stable environment for your child?
• Do you have access to adequate support services and healthcare your child may need?
• Are you willing to advocate for your child’s health and well-being in various settings (like at school and in hospital systems)?
• Are you willing to educate yourself and your family as much as possible about the special physical, mental, developmental and emotional health needs of your child?
• Do you have a strong support system of friends and family to lean on?

Like anything in life, it’s impossible to predict the future and what life with your newest family member will be like. But the more you can prepare and think realistically about what adoption brings, the more you can manage your expectations and provide a secure and supportive environment for your family.