Initial Medical Evaluation of an Adopted Child

Abstract

Providing health care for adopted children always has been a significant part of pediatric practice, and pediatricians have provided services in different areas of the adoption process for many years. Recent changes in adoption prompt a reevaluation of the pediatrician's role in managing the medical care of adopted children and their families. There has been a gradual shift from viewing adoption as a childless couple's opportunity to find an infant to focusing on the needs of the child first by placing children within families who can help them realize their fullest potential. Increasingly, adoption agencies work with older children and special needs children who have physical handicaps, emotional problems, or chronic medical illness. Private adoptions are often arranged outside of agencies, sometimes with open discussions between birth and adoptive parents. In addition, there are now more than 10 000 international adoptees entering this country each year. The pediatrician must be equipped to evaluate the special needs of all these children and to help their new families integrate them into the family unit. This statement addresses the initial medical evaluation of adoptive children who may have acute and long-term medical, psychological, and developmental problems because of their genetic, emotional, cultural, psychosocial, and/or medical backgrounds. Prior to adoption, or at the time of entry into the family, the pediatrician should begin a careful medical assessment of the child and should counsel the family appropriately regarding adoption issues. Pediatricians should be alert to the following potential problems: