The medical evaluation of an internationally adopted child should not begin with the arrival of the child. A family who is adopting from abroad should begin their process months before travel and arrival. Parents need to consult with their primary care physician, travel physician, infectious diseases specialist, or an adoption medicine specialist for health guidelines about travel abroad and immunizations for themselves.

Preparing for Travel

A primary care pediatrician or an adoption medicine specialist can prepare a family for travel abroad either over the phone, or in an individualized or group session. Parents can learn about the possible medical conditions that their child might present when first adopted out of the country. Many adoptive parents are becoming parents for the first time and need to be instructed about very basic health issues of childhood, which include teething, constipation, and minor illnesses. Children often have upper respiratory infections, ear infections, diarrhea, vomiting, scabies, diaper rash, feeding problems, failure to thrive, rickets, and transitional depression when their parent first meet them overseas. The travel preparation session should give a practical guide on how to handle these common medical problems and, most important, prepare parents for what to expect from the child's possible initial behavior and appearance.

The phone numbers of the pediatrician in the U.S. should also accompany the family, so if there is a need for consultation while abroad, the arrangements will have been made well in advance. Phone numbers of medical facilities in the destination country can also be provided.

Once the child has arrived home, an initial visit to the doctor should ideally occur within 10 to 14 days, except in the case of an acute illness — then a sick visit is obviously imperative within 24 hours. Once the family knows their travel dates, they can schedule the adoption consultation appointment long in advance, since the initial visit should take at least an hour or more.

Recommended Screening Tests and Evaluations

Adoption medicine specialists recommend the following screening tests be performed on every child adopted from abroad initially. Physicians can also consult the 2000 Redbook of Pediatric Infectious Diseases, from the American Academy of Pediatrics, as a guideline.

• Complete blood count
• Hemoglobin electrophoresis
• Urinalysis
• Three stools for ova and parasites, Giardia antigen
• Stool for bacterial culture
• Hepatitis B surface antibody
• Hepatitis B surface antigen
• Hepatitis B core antibody (IgG total)
• Hepatitis C antibody
• Repeat Hepatitis B, C serology six months after arrival
• Syphilis serology
• HIV 1, 2 ELISA (repeat in six months)
• Thyroid function tests
• State newborn screen for infants less than 6 months (sometimes includes thyroid, HIV, and hemoglobin electrophoresis, which lessens cost and amount of blood)
• Lead
• PPD (to be checked by healthcare professional in person after 48 to 72 hours)
• Use 10mm of induration as the cut-off for chest x-ray and preventive therapy
• Repeat PPD in 6 months
• Hearing screening
• Ophthalmologic evaluation
• Dental visit
• Developmental assessments (serial Denver developmental screening tests over first few months after arrival), or early intervention assessment if the child is over one year or displays delays more than the expected transitional delays, or if there is any parental anxiety
• Sub-specialty consultations based on medical information found in medical abstract from country of origin or based on medical findings in the initial visit (such as heart murmur/cardiology, features of FAS/genetic/dysmorphology)

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This article was originally written for and published in Pediatric Annals Vol. 29, No. 4, April 2000 as "Medical Evaluation and Infectious Considerations on Arrival."

If your primary care pediatrician is unfamiliar with the issues mentioned here, or if you would like to get in touch with the author, call SPARK Child Development for Adoptive Families, 212-360-0259 for a referral.