Are you considering adoption, or perhaps just curious about the process? Regardless, it is a profoundly beautiful and significant responsibility. However, there is a vital medical aspect to this journey that deserves your careful attention. Simply put, adoption is a social, emotional, and legal process that allows a child who cannot be raised by their birth parents to become a member of a new family, providing them with the love and security they deserve.
There are many ways to adopt. For example, there are "open adoptions," where you have contact with the birth parents, and "closed adoptions," where no information is shared. You might adopt a single child or a group of siblings; truly, no two adoptions are identical. In Sri Lanka, you typically pursue adoption through the Department of Probation and Child Care Services or via a court process. In some instances, a child may be adopted by an extended family member, known as "kinship adoption."
If you are planning to adopt, you will work closely with a variety of specialists throughout the process, including:
- Legal representatives (such as adoption attorneys).
- Local child welfare or adoption agencies (such as the Probation Department in Sri Lanka).
- Social workers.
- Pediatricians.
Among these, pediatricians are essential partners who help families navigate the specific medical needs of children being adopted, addressing their physical, developmental, and emotional health.
Why should you pay special attention to the health of adopted children?
You might wonder, "Why emphasize the medical side for adopted children?" While all children can face health challenges, some studies indicate that adopted children may have a higher risk for certain physical, developmental, and mental health issues compared to their peers.
While these risks are real, the love, resources, and support you provide can empower your child to thrive and flourish, regardless of their medical background.
Why is the risk for health issues higher for some adopted children?
There are several reasons for this. Consider that some children may not have had access to adequate care during their early development—whether in the womb or in their early years—such as:
- Prenatal and postnatal healthcare.
- Proper nutrition.
- Physical or emotional needs (developmental stimulation).
- Protection from toxins or pathogens (e.g., infectious diseases) before or after birth.
Additionally, many children may have experienced trauma early in life, known as Adverse Childhood Experiences (ACEs). These are significantly distressing events that can impact a child’s long-term mental and physical health. Examples of ACEs include:
- Physical, emotional, or sexual abuse and neglect.
- Exposure to domestic or community violence.
- Homelessness, frequent relocation, or an unstable home environment.
- Inconsistent caregivers, having multiple caregivers, or parental separation or divorce.
- Living through natural disasters.
- The death of a family member or someone close.
- Being subjected to bullying.
Research suggests that these early traumatic experiences can have lasting effects on brain development, and the resulting chronic stress can impact long-term physical health as well.
Potential health challenges for adopted children
Let's look at the various health challenges these children may face.
Physical health conditions
Between 30% and 80% of children in foster care have at least one physical health condition, with about 33% living with a chronic health condition. Common physical health issues include:
- Growth delays and nutritional deficiencies.
- Asthma.
- Obesity.
- Vision problems.
- Hearing impairments.
- Neurological conditions.
- Sexually Transmitted Infections (STIs).
- Complex chronic conditions.
Furthermore, if there was previous malnutrition, your child might have deficiencies in iron, calcium, and vitamin D. It is also found that roughly 20% of children in foster care have significant dental issues.
Emotional difficulties
Separating a child from their original family and familiar environment is deeply traumatic. This is especially true for children in foster care who may have experienced frequent changes in caregivers and surroundings. As your child integrates into your home, understanding these emotional challenges is vital.
Your child may exhibit:
- Social withdrawal or isolation.
- Sudden temper tantrums or emotional outbursts.
- Aggressive or defiant behavior.
- Inconsolable crying.
- Regression in previously learned skills (e.g., self-feeding or cleaning up).
- Sleep disturbances.
- Loss of interest in previously enjoyed activities.
While adjustment takes time, remember that many children mourn the loss of previous caregivers, friends, and their familiar home. Stay informed on how to support your child through this transition. Patience is paramount. However, if these emotional challenges are severe or persistent, do not hesitate to seek guidance from your pediatrician or a mental health counselor.
Mental health conditions
Many children who have been in foster care have faced significant psychological trauma, increasing their risk for mental health conditions, such as:
- Anxiety disorders.
- Eating disorders.
- Mood disorders, such as clinical depression and mania.
- Post-traumatic stress disorder (PTSD).
Additionally, youth who have been in foster care are at a higher risk for suicidal ideation and substance use disorders compared to their peers who have not been in that system.
Behavioral conditions
Approximately 50% to 75% of children in foster care experience behavioral or social skill challenges that require professional medical support. The most frequently identified conditions include oppositional defiant disorder (ODD) and conduct disorder.
Early childhood trauma, adverse experiences, and chronic toxic stress can often manifest in the following ways:
- Difficulty regulating emotions.
- Aggressive behavior.
- Hyperactivity.
- Inattention.
- Impulsivity.
These factors significantly increase a child's risk for ongoing behavioral challenges.
Developmental Conditions
Between 46% and 60% of children in foster care under the age of six experience some form of developmental disability. These may include:
- Speech delays.
- Fine motor delays (e.g., difficulty buttoning shirts or gripping a pencil).
- Gross motor delays (e.g., challenges with running, jumping, or catching a ball).
- Learning disabilities or intellectual impairments.
- Social-emotional dysregulation.
These conditions often emerge during early development and can impact daily functioning, sometimes persisting throughout a child’s life.
Speech and language development delays are particularly common, such as:
- Auditory processing disorder (APD): Difficulty interpreting sounds.
- Aphasia: Challenges with using or understanding language.
- Childhood apraxia of speech: A motor planning difficulty affecting the muscles required for speech.
- Dysarthria: Speech impairment due to muscle weakness, leading to unclear articulation.
Attention-deficit/hyperactivity disorder (ADHD) is also a frequently diagnosed neurodevelopmental condition among children in foster care.
Medical Considerations for International Adoptions
If you are pursuing an international adoption, be aware that children may face a higher likelihood of physical health issues and developmental delays. Infectious diseases and nutritional deficiencies are often the primary concerns addressed by physicians once the child arrives. Almost all internationally adopted children experience at least one developmental delay, with approximately half exhibiting global developmental delays.
Obtaining medical records from other countries can be challenging, as documentation may be incomplete or inaccurate. Since many countries follow different immunization schedules, it is vital to review these records with your pediatrician to determine if any vaccinations are missing. If you are planning an international adoption, consult with specialists regarding the specific health needs and risks associated with the child's country of origin so you can prepare accordingly.
Considering Family Well-being
As you welcome a new member into your home, consider the health and well-being of your existing family. Speak with adoption experts about how to help your family adjust positively. Ask about the signs of sibling rivalry or jealousy and ensure you dedicate individual time to each of your children.
Additionally, as you navigate the adoption process, you may experience caregiver burnout—the physical, emotional, and mental exhaustion that occurs when you dedicate your energy to the health and safety of others. To help your family navigate this transition, consider joining a support group or speaking with a mental health counselor. Do not hesitate to lean on trusted loved ones for support.
What Should You Know About a Child's Health Before Adoption?
Before—or as soon as possible after—adopting, strive to gather as much medical information as you can. You may need to coordinate with:
- Your adoption agency or the foster care system.
- Your adoption attorney.
- The child's birth parents or family (if possible).
- Hospital systems and the child’s previous or current healthcare providers.
- The child's current or former school.
Key information you should seek includes:
- Current or past physical, mental, developmental, or behavioral conditions, including hospitalizations and surgeries.
- Birth records, such as gestational age, birth weight, height, head circumference, and any complications during pregnancy or birth.
- Growth charts (weight, height, head circumference).
- Documentation of developmental milestones.
- Known allergies.
- Current medications.
- Immunization records.
- Exposure to infectious diseases.
- Vision and dental records.
- History of malnutrition or feeding difficulties.
- Results of medical exams (e.g., imaging tests, blood tests).
- Reports regarding any history of physical, sexual, or emotional abuse, or neglect.
- School history and academic performance.
- Relationship history, including significant ongoing bonds or loss of important attachments.
- Medical history of the child's biological relatives.
- Hereditary conditions within the biological family.
If you are adopting an infant or young child, obtaining their birth history and information regarding the pregnancy is highly beneficial, including:
- Maternal substance use, such as alcohol, tobacco, marijuana, or opioids.
- Use of prescription or over-the-counter medications during pregnancy.
- Presence of sexually transmitted infections (STIs) or other infectious diseases during pregnancy.
- Complications during pregnancy, labor, or delivery.
Depending on the circumstances, you may only obtain some of this information, or in some cases, very little. Always strive to find as many answers as possible.
Ideally, present this information to a pediatrician before the child joins your family for professional guidance. Your doctor can inform you about the care the child may require and guide you on what to expect. They can also provide referrals to specialists or community support services to ease the transition for your family. If you cannot consult a physician prior to the adoption, schedule an appointment as soon as the child arrives home.
What is the Role of Pediatricians in the Adoption Process?
Pediatricians play a crucial, supportive role in the adoption process. They partner with you to identify your child’s unique health needs while providing the essential emotional support that families navigating adoption journeys often require.
Adoption and foster care medicine is a specialized, evolving field within pediatrics. You can ask your social worker or primary physician for a referral to a pediatrician who has specific experience in adoption-related medical care.
Key responsibilities of your pediatrician include:
- Assisting in gathering and interpreting your child’s medical records and history.
- Providing comprehensive medical evaluations, well-child care, and necessary follow-up visits.
- Ensuring continuous, coordinated care tailored to your child’s health needs.
- Facilitating referrals to medical specialists, such as child psychologists, pediatric cardiologists, or speech-language pathologists.
- Recommending long-term resources to support both your child and your family.
- Offering guidance on potential adjustment challenges that may arise post-adoption.
- Recommending strategies to foster strong, healthy, and secure attachments within your family.
- Assisting with the documentation for an Individualized Educational Program (IEP) or 504 Plan for your child’s school, if required.
What to Expect at Your Child’s First Medical Visit
Once your child has joined your family, it is recommended that they receive a comprehensive health assessment within 30 days. This evaluation allows you to begin addressing known health issues and identify any previously undiagnosed concerns. These initial evaluation visits are significantly more detailed than standard well-child check-ups.
Please provide your pediatrician with as much of the child's medical history as possible. Depending on your child's age and overall health, your doctor may conduct this assessment in a single visit or recommend a series of appointments to complete the full evaluation.
These evaluations typically include:
- Verification and explanation of existing medical diagnoses.
- A thorough physical exam.
- A neurological assessment.
- Age-appropriate screenings, such as newborn screening panels, hearing, vision, dental, and behavioral or developmental assessments.
- Screening for previously undetected medical issues.
- Discussions regarding any developmental or behavioral concerns.
- A review of your child’s immunization status.
- Referrals to other healthcare providers and specialists as needed.
Testing
Based on their initial evaluation, your pediatrician may recommend specific diagnostic tests. These could include blood tests, urine tests, or imaging studies. Your doctor may also order blood work to verify your child’s immunity levels or to ensure they are up to date with necessary vaccinations.
Mental Health Evaluation
Experts recommend that children in foster care undergo a mental health evaluation within 30 days of joining your home. Ideally, this should be conducted by a child mental health professional who is specifically trained in trauma-informed care.
How Do You Prepare for Adoption?
The adoption process involves extensive preparation and several steps. Before deciding to adopt, it is vital to understand the reality of bringing a child into your family, particularly regarding the health and well-being considerations involved.
Consider asking yourself these important questions:
- What are your motivations for adopting? Are you truly prepared for this lifelong commitment?
- Can you provide a loving, nurturing, and stable environment for a child?
- Do you have access to the necessary support services and healthcare systems?
- Are you prepared to advocate for your child’s health and well-being in various settings, such as schools or healthcare systems?
- Are you and your family willing to learn about your child's specific physical, mental, and developmental needs?
- Do you have a strong support system of friends and family you can rely on?
As with anything in life, you cannot predict the future or know exactly how life will unfold with a new family member. However, by maintaining realistic expectations and preparing as thoroughly as possible, you can effectively manage your transition and build a secure, supportive environment for your family.
Adoption is a complex, personal, and deeply emotional journey for everyone involved. A vital part of this process is acknowledging and preparing for the unique health needs of your newest family member. Remember that your child’s pediatrician is a cornerstone of your adoption support team, and they are there to help you provide the best possible care for your child—and for yourself.
Key Takeaways
Adopting a child is a noble and profound responsibility. Prioritizing your child’s health is an essential part of this commitment.
- Stay informed: Learn about the specific health, mental, behavioral, and developmental concerns that may affect adopted children.
- Gather information: Collect as much information as possible regarding your child’s medical and family history.
- Utilize pediatrician support: Build a relationship with a skilled, experienced pediatrician from the start; they will be one of your greatest advocates.
- Patience and love: Give your child time to adjust to their new environment and family. Lead with patience, love, and understanding.
- Take care of yourself: Your own physical and mental health matters during this journey. Seek help whenever you need it.
Remember, the love, care, and support you provide are the foundations upon which your child’s future and healing are built.
Nirogi Lanka: adoption, child health, medical information, pediatric care, mental health, developmental issues
