Adoption: Medical Facts You Need to Know

Are you thinking about adopting a child? Or are you interested in it? However, this is really a very responsible and beautiful thing. But there is a medical aspect to this process that we need to pay special attention to. That is what we are going to talk about today. Simply put, adoption is a social, emotional and legal process in which a child who did not have the opportunity to grow up with his or her birth parents becomes a member of another family, receiving love and care. There are different methods of adoption. For example, there can be open adoptions where the child's birth parents are known and contacted, as well as closed adoptions where there is no such information. It is also possible to adopt a single child or a group of siblings. In fact, no two adoptions are the same. In Sri Lanka, you can adopt a child through the Department of Probation and Child Protection Services or through a court process. Sometimes it is also possible to adopt a child from an extended family member (`kinship adoption`). If you are planning to adopt a child, you will need to work closely with a variety of specialists throughout the process. These include:

• Legal representatives (such as adoption lawyers).
• Local child welfare and/or adoption agencies (Probation Department in Sri Lanka).
• Social workers.
• Pediatricians.

Among these, pediatricians are a crucial group of professionals who help families meet the medical needs of children going through the adoption process. This includes the child's physical, mental, developmental, and emotional care.

Why is it important to think about the health of adopted children?

Now you may be wondering, ‘Why are there so many medical concerns about adopted children?’ In fact, these children can develop any number of illnesses and diseases, just like any other child. However, some studies have shown that adopted children may be at higher risk of developing certain physical, developmental, and mental health problems than other children. These risks are real. But with the love, care, resources, and support you provide, you can help your child thrive and be happy, even with these health conditions.

Why are adopted children at higher risk of health problems?

There could be several reasons for this. Consider that some children may not have received these things in their early years, whether in the womb or shortly after birth:

• Prenatal and postnatal health services.
• Good nutrition.
• Physical or emotional needs (stimulus for development).
• Protection from toxins or pathogens (e.g. infectious diseases), before or after birth.

In addition, many children may have experienced difficult experiences in their early years. We call these Adverse Childhood Experiences (ACEs) . These are usually events that cause a child great trauma. These ACEs can affect a person's mental and physical health throughout their lives. Some examples of ACEs include:

• Child physical, emotional, or sexual abuse and neglect.
• Domestic violence, exposure to violence in society.
• Loss of a permanent home, frequent relocation, or an unstable home environment.
• Caregivers change frequently, have multiple caregivers, or parents divorce.
• Facing natural disasters.
• Death of a family member or loved one.
• Bullying from others.

Studies have shown that early traumatic experiences like these can have long-term effects on brain development. The chronic stress caused by these experiences can also have long-term effects on physical health.

Health problems that may arise in adopted children

Now let's see what are the various health problems these children can have.

Physical health conditions

Between 30% and 80% of children in foster care have at least one physical health condition. About 33% of them have a chronic health condition. Some of the most common physical health conditions include:

• Growth failure and nutritional deficiencies .
• Asthma .
• Obesity .
• Vision problems.
• Hearing impairment.
• Neurological conditions.
• Sexually Transmitted Infections (STIs).
• Complex chronic conditions.

In addition, if there was previous malnutrition, iron, calcium, and vitamin D deficiencies may also develop. It has also been found that about 20% of children in foster care have significant dental problems.

Emotional difficulties

Separating a child from their original family and familiar environment is a real shock to them. Children who have been in foster care, who have been in a constant state of care, and who have had a change of environment, may experience these emotional difficulties even more. It is important to understand the challenges that come with a new addition to your home and family as they adjust to their new environment. Your child may exhibit the following:

• Trying to stay away from others and be alone.
• Sudden outbursts of anger and loud shouting (temper tantrums).
• Being aggressive, being disobedient.
• Crying so much that you can't stop.
• The inability to do things that were previously learned (e.g., eating alone, picking up toys) again.
• Insomnia problems.
• Losing interest in things you used to enjoy.

Even though the child will gradually adjust to the new home, many children will feel sad about losing their previous caregivers, friends, school, and home environment. Be as informed as you can about how you can help your child through this transition. Patience is key. However, if these emotional problems are severe or persistent, do not hesitate to seek advice from your child's pediatrician or a mental health counselor .

Mental health conditions

In countries like the United States, many children who have been through foster care have been exposed to psychological trauma. This puts them at greater risk of developing mental health conditions. Common mental health conditions include:

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

Additionally, young children in foster care are more likely to attempt suicide and develop substance use disorders than other children their age who are not in foster care.

Behavioral conditions

Between 50% and 75% of children in foster care have behavioral or social skills problems that require medical attention. The most commonly diagnosed conditions are oppositional defiant disorder and conduct disorder. Childhood trauma, adverse experiences, and toxic stress can be associated with the following behaviors:

• Weaknesses in controlling emotions.
• Aggression.
• Hyperactivity.
• Lack of attention.
• Arbitrariness.

These conditions increase their risk of developing behavioral problems.

Developmental statuses

Between 46% and 60% of children in foster care under the age of six have some kind of developmental disability. These can include:

• Speech delays.
• Fine motor delays (e.g., difficulty buttoning, holding a pencil).
• Gross motor delays (e.g., difficulty running, jumping, catching a ball).
• Learning disabilities or intellectual disabilities.
• Social-emotional dysregulation.

These conditions begin during a child's development. They can affect daily functioning and can last a lifetime. Delays in speech and language development are especially common. For example:

• Auditory processing disorder (APD) (difficulty understanding what is heard).
• Aphasia (difficulty using or understanding language).
• Childhood apraxia of speech (a problem with the coordination of the muscles needed to speak).
• Dysarthria (inability to pronounce words clearly due to muscle weakness during speech).

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition commonly seen among children in foster care.

Health considerations in international adoptions

If a child is adopted from another country (international adoption), the child is more likely to have physical health problems and developmental delays. Infectious diseases and nutritional deficiencies are often the main things doctors find when a child arrives in the country. Children who are adopted internationally almost always have delays in at least one area of ​​development, and about half of the children may have delays in all areas (global delays). Finding medical records for children in other countries can sometimes be very difficult. Also, those records may be incomplete or contain incorrect information. Many countries follow different immunization schedules. Therefore, if a child coming from another country has been vaccinated, it is very important to review those records with their pediatrician to make sure that they have not missed any recommended vaccines. If you are planning to adopt a child from another country, ask experts about the health needs that the child may have depending on the country they come from and how you can prepare for them.

Think about the health of other family members too.

When you add a new member to your family, you also need to consider the health and well-being of the rest of your existing family. Talk to adoption experts about how to help your family adjust positively to this big change. Ask them what signs to watch for, such as sibling rivalry and jealousy. Give your existing family members attention and spend time with them one-on-one whenever possible. Similarly, parents can experience a condition called caregiver burnout while going through the adoption process. Simply put, this is the physical, emotional, and mental exhaustion that comes from dedicating time and effort to the health and safety of another person. Consider joining a support group or seeing a mental health counselor to help you and your family get through this challenging time. It's also essential to seek help from loved ones you trust.

What should you know about a child's health before adopting him/her?

Before you adopt a child – or as soon as possible after adoption – try to gather as much health information about them as possible. You will need to work with many people to get this information:

• Adoption agency or foster care system (in Sri Lanka, the Probation Department).
• Your adoption lawyer.
• The child's birth parents and/or family (if possible).
• Hospital systems and the child's previous or current healthcare providers.
• The child's previous and/or current school.

The health information you should try to find is:

• Find out about any physical, mental, developmental, or behavioral conditions the child has or has had in the past, as well as any hospitalizations or surgeries.
• Birth record information, for example, gestational age, birth weight, length, head size, and complications during pregnancy or birth.
• Child's growth chart (weight, height, head circumference).
• Documentation of developmental milestones.
• Known allergies.
• Current medications.
• Immunization records.
• Infectious disease exposures.
• Reports on eyes and teeth.
• A history of malnutrition or eating disorders.
• Results of medical tests that have been performed (e.g. imaging tests, blood tests).
• Reports of physical, sexual, or emotional abuse or neglect of the child.
• School history and talents.
• Relationship history, meaning important, ongoing relationships (with biological parents, foster parents, friends) and the loss of important relationships.
• Medical history of the child's closest relatives (biological parents and siblings).
• Hereditary diseases in the child's biological family.

If you are adopting a baby or young child, it is also helpful to know the child's birth history and information about the mother's pregnancy. This should include:

• Did the mother use drugs during pregnancy, for example, alcohol, tobacco, marijuana, or opioids?
• Did you use any prescription or over-the-counter medications during pregnancy?
• Did you have sexually transmitted infections (STIs) or other infectious diseases during pregnancy?
• Were there any complications during pregnancy, labor, or delivery?

Depending on the situation, you may only be able to find some of this information. Sometimes, you may not find anything at all. Try to find as many answers as possible. The best thing to do is to take this information and show it to a pediatrician before your child joins your family. The doctor can then educate you about the care your child may need and give you general guidance on what to expect. They can also provide referrals to specialists or community support services. This can help your family make this transition easier. If you are unable to get medical advice in this way before the adoption, take your child to a pediatrician as soon as possible after the child joins the family.

What is the role of pediatricians in the adoption process?

Pediatricians play a very important role in the adoption process. They will work with you to help you identify the health needs of your child. They can also provide emotional support to families going through the adoption process. Adoption and foster care medicine is a growing subspecialty within pediatrics. You can ask your social worker or pediatrician for a referral to a pediatrician who has experience in this field. Pediatricians' roles include:

• Helping to obtain the child's medical records and history.
• Providing complete medical evaluations, well-child care, and follow-up visits.
• Providing continuous care for the child and their health needs.
• Referral to medical specialists, for example, child psychologists, pediatric cardiologists, or speech-language pathologists.
• Recommending resources that can help the child and family in the long term.
• Advising families on adjustment issues that may arise after adoption.
• Recommend strategies to promote strong, healthy bonds within your family.
• If necessary, help prepare documentation for the child's Individualized Educational Program (IEP) and/or 504 Plan for the school.

What can you expect at your adopted child's first doctor's appointment?

As soon as your child joins your family and home (ideally within 30 days), you should take him or her to a pediatrician for a complete health evaluation. This evaluation can help you start treating known health problems and identify any new ones. These ``initial evaluation visits`` are more in-depth than regular ``well-child visits.`` Your child's pediatrician will want to give you as much medical history (such as medical records) as possible. Depending on your child's overall health and age, a single visit may be necessary, or multiple visits may be recommended for a complete evaluation. These ``evaluation(s)`` will often include:

• Confirming and clarifying existing medical diagnoses.
• A complete physical exam.
• A neurological exam.
• Age-appropriate tests, for example, newborn screening panels, hearing, vision, dental, and behavioral and/or developmental tests.
• Assessing for previously undiagnosed medical problems.
• Discussing any developmental and behavioral issues.
• Assessing the child's vaccination status.
• Referrals to other healthcare providers and specialists.

Testing

Your child's pediatrician may recommend some diagnostic tests based on their evaluation. These may include blood tests, urine tests, and/or imaging tests. Your pediatrician may also recommend some blood tests to check if your child has received the appropriate vaccinations for their age.

Mental health evaluation

Experts recommend that a child in foster care receive a mental health evaluation within 30 days of joining your family. It's best to do this with a child mental health counselor trained in trauma-informed care.

How to prepare for adoption?

The adoption process requires a lot of preparation and many steps. Before you decide to adopt a child, it's important to understand what it really means to add a child to your family, especially what to consider when it comes to their health and well-being. Here are some questions you should ask yourself:

• What are your reasons for adopting a child? Are you truly ready for this lifelong decision and commitment?
• Can you provide a loving, nurturing, and stable environment for a child?
• Do you have access to adequate support services and health services that the child may need?
• Are you willing to advocate for the health and well-being of children in various settings (such as schools, hospital systems)?
• Would you and your family like to be as aware as possible about your child's special physical, mental, developmental, and emotional health needs?
• Do you have a strong support system of friends and relatives you can trust and are willing to help?

Like anything in life, it’s impossible to predict the future or what life will be like with a new family member. However, by being realistic about what adoption entails and being as prepared as possible, you can manage your expectations and create a safe and supportive environment for your family. Adoption is a complex, personal, and emotional process for everyone involved. A big part of adopting is considering and preparing for the special health needs of your new addition to your family. Your child’s pediatrician is a very important part of your family’s adoption support team. Remember, they are there to give your child the best care possible – and to help you provide that care.

What message do we want to take home from this story?

Adopting a child is a truly noble and important responsibility. It is essential to pay special attention to the child's health during this journey.

• Be aware: Be well-informed about the specific health, mental, behavioral, and developmental issues that may arise in adopted children.
• Gather information: Gather as much information as possible about the child's medical history and family background.
• Pediatrician's support: Get the support of a skilled, experienced pediatrician from the very beginning. He or she will be your biggest supporter.
• Patience and love: Give your child time to adjust to the new environment and new family. Be patient, loving, and understanding.
• Think about yourself too: Take care of your mental and physical health during this journey. Get help if you need it.

Remember, it is the love, care, and support you give that will heal the lives of these children and help them build a beautiful future.

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