When I traveled to adopt my children, I witnessed firsthand the conditions in which they spent their early lives. As a mom, I saw the caretakers' love. As a pediatrician, I saw crowded living quarters and lack of sanitary conditions. Before we came home, I treated lice and scabies passed to my daughter from her caretakers. But by the time of her first doctor's visit in the United States, my daughter was clean and free of skin diseases and had begun to adjust to her new surroundings.
Most pediatricians treating newly adopted children can't judge potential risk factors based on firsthand observation. They must rely on what parents tell them about their children's early lives. After a child's placement in an adoptive home — whether via a domestic or an international adoption — there should be a review of all medical records, a complete physical examination and diagnostic testing, all taking into consideration the child's past. Because children change between the time of adoption and the first medical evaluation, health-care workers need to be reminded about the child's previous home and circumstances.
With these in mind, be sure your health-care take the following steps:
Evaluate birth history and past medical history.
- Check for blood-borne pathogens and sexually transmitted diseases, including syphilis, hepatitis B, hepatitis C and HIV.
- Children who have been significantly malnourished, have been in institutional care or have lived in northern latitudes (where they might not have been exposed to much sunshine) should be tested for rickets.
- Repeat testing for children adopted domestically at birth if records are unavailable or unreliable, and for all children adopted from another country.
Assess risk for diseases.
- Children from orphanages or institutional care should be tested for tuberculosis.
- Any child who has been adopted abroad should be evaluated for giardia and other stool parasites.
- A complete blood count should be done to check for anemia. Non-Caucasian children should have a hemoglobin electrophoresis to evaluate abnormalities in the structure of the blood hemoglobin.
- All children beyond the newborn stage should also have a test done for lead toxicity.
- A urinalysis can detect kidney disorders and urinary tract infections.