Friday, September 05, 2014

ADOPTION: Adopting children from India in the USA, list of things you need to know - A pediatrician's perspective

I just had a call from an NRI couple in USA who are planning to adopt these two beautiful young sisters from a government facility in Panchkula, Haryana, India. They wanted me to examine these children, and that got me thinking about all the things we need to look at as a pediatrician for making sure (as much as possible) regarding the health of these international adoptees.
Here is what I found regarding adopting children from developing countries in to USA, from a pediatrician's perspective.
International Adoption - CDC Travelhealth
Items to consider during medical examination of an adopted child include the following:
  • Temperature (fever requires further investigation)
  • General appearance: alert, interactive
  • Anthropometric measurements: height/age, weight/age, weight/height, head circumference/age
  • Facial features: length of palpebral fissures, philtrum, upper lip (fetal alcohol syndrome: short palpebral fissures, thin upper lip, indistinct philtrum)
  • Hair: texture, color
  • Eyes: jaundice, pallor, strabismus, visual acuity screen
  • Ears: hearing screen
  • Mouth: palate, teeth
  • Neck: thyroid (enlargement secondary to hypothyroidism, iodine deficiency)
  • Heart: murmurs
  • Chest: symmetry, Tanner stage breasts
  • Abdomen: liver or spleen enlargement
  • Skin: Mongolian spots, scars, Bacillus Calmette-GuĂ©rin (BCG) scar
  • Lymph nodes: enlargement suggestive of TB
  • Back: scoliosis and neurocutaneous findings
  • Genitalia: Tanner stage, presence of both testicles
In addition, all children should receive a complete neurodevelopmental examination by a clinician with experience in child development. Further evaluation will depend on the country of origin, the age of the child, previous living conditions, nutritional status, developmental status, and the adoptive family’s specific questions. Concerns raised during the preadoption medical review may dictate further investigation.


The current panel of tests for infectious diseases recommended by the American Academy of Pediatrics (AAP) for screening internationally adopted children is as follows:
  • Hepatitis B virus (HBV) serologic testing (repeat at 6 months if negative)
  • Syphilis serologic testing
  • HIV 1 and 2 serologic testing
  • Complete blood cell count with differential and red blood cell indices
  • Stool examination for ova and parasites (3 specimens)
  • Stool examination for Giardia intestinalis and Cryptosporidium antigen (1 specimen)
  • TST or IGRA (repeat at 6 months if negative)
Additional screening tests may be useful, depending on the child’s country of origin or specific risk factors. These screens include HAV, hepatitis C virus (HCV), and Chagas disease serologic tests; malaria smears; and Helicobacter pylori antigen screening of stool if there is persistent abdominal pain or refractory anemia.

Some other useful resources ...

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