International Adoption:  Helping parents prepare for travel

Contextual medical information

Sometimes new information about a prospective international adoptee (IA) becomes available once parents arrive in the region. Some families are able to meet the child’s caregiver, the orphanage director or, in some cases, the birth family, as can occur in Haiti and Ethiopia. Parents may be provided with a checklist of important information, including more detailed medical history, in accordance with the following recommendations from the American Academy of Pediatrics.¹ Advise prospective parents that obtaining all the information contained in this list is probably impossible.

Medical history

• Birth records should be obtained whenever possible, particularly for children younger than 6 years of age, including:
  • Prenatal blood and urine test results of biological mother
  • Exposure to medications, illegal substances, alcohol, tobacco
  • Gestational age, birth weight, length, head size; Apgar scores
  • Prenatal concerns, neonatal complications
  • Newborn hearing screening results
  • Results of newborn metabolic screening
• Previous growth points, including head circumference
• History of abuse, physical and sexual; history of neglect
• Reason for placement into adoptive home
  • Voluntary vs. involuntary termination of parental rights
• Nutritional history, particularly with respect to iron, calcium, vitamin D, iodine and other nutrients
  • Assess current dietary habits
  • Determine whether the child has any issues eating textured foods
  • Exercise history
• Developmental milestones, past and present
• Behavioural issues, particularly with respect to socialization, indiscriminate friendliness
• Laboratory test results, radiographic studies, other studies
• Immunizations*
  • School records may suffice, particularly for older children
  • Original records and adequate timing of doses should be verified with antibody titres
  • Children with no records or records that do not appear to be original or accurate should be reimmunized
• Results (if known) of previous testing for tuberculosis, including treatment
• Chronic medical diagnoses
• Allergies (e.g., medication, food, environmental, latex, insect stings)
• Medications (used both acutely and chronically)
• Reports from previous specialists, if seen
  • Consider translating records from other countries
• Family history (when available)
  • Vision, hearing deficits
  • Genetic diseases
  • Concerns related to ethnicity (e.g., sickle cell anemia, thalassemia, Tay Sachs disease, lactose intolerance)
  • Mental health diagnoses
• Environmental risk factors
  • Lead risks
  • Institutionalization
    • Reason and timing, if known, of placement
    • If known, feeding and sleep schedule and environments where feeding and sleep occurred
  • Risks for previous physical, emotional, and sexual abuse
    • Substandard housing, multiple changes in residence
    • Family members using illegal substances or alcohol, or domestic violence
  • Passive tobacco exposure, methamphetamines, other illicit substances in the home environment
  • Other environmental toxins, both in the home and surrounding community
• Number of prior placements, quality of such care

Notes:

• Children who have been adopted internationally may have neurological, hematological, cardiac and metabolic disorders that were previously overdiagnosed, underdiagnosed, or missed completely.
• Medical records from other countries (if available) may be limited in information, inaccurate, or even falsified.
• For children born in Canada or the U.S., there may be issues of confidentiality associated with obtaining records, particularly if the child’s name was changed at the time of the adoption. In all cases, physicians should work with families and adoption workers to obtain complete medical records, while also strictly adhering to laws regarding confidentiality of medical information.

Source: Veronnie F. Jones, American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care. Comprehensive health evaluation of the newly adopted child. Pediatrics 2012;129(1):e214-23.

* More information on immunizations for newcomer children and youth is available in this resource.

Parental health

Most prospective parents will need to travel to meet their child. Exceptional circumstances include Korean and Taiwanese adoptions, or international emergencies such as the 2010 earthquake in Haiti. Some families travel once only for a brief visit that will include cultural events, such as in China; others remain abroad for several weeks or even months (common for adoptions in Russia and the Ukraine) or must travel more than once to see their child and finalize adoption (e.g., in Ethiopia).

Importantly, parents need to attend to their own health. Encourage prospective families to attend a travel clinic to make sure all immunizations are up-to-date and to eliminate the risk of transmitting illnesses such as measles, hepatitis A and hepatitis B. There have been reports of measles outbreaks among new family members and close contacts connected with children adopted in China.^2,3 Hepatitis A has been found in children newly adopted from Ethiopia, Panama and the Philippines and in their contacts, including non-travelling contacts and contacts of contacts.^4,5 The risk of hepatitis A transmission is significant in any country where access to clean water is a problem.  Recommendations for immunizing families of IAs now include hepatitis A vaccine for close contacts within 60 days of the new child’s arrival.^6,7

Recommendations for vaccinating families of IAs are readily available in print ⁸ and online for country-specific locations.⁹

Suggestions for further reading are provided under Selected Resources.

Medical supplies to travel with

Prospective parents should pack the supplies when travelling to visit a child. The following list is adapted from the Committee to Advise on Tropical Medicine’s Statement on International Adoption:¹⁰

• Adhesive plaster/band aids
• Alcohol wipes
• Antibacterial wipes
• Antibiotic ointment
• Antihistamine
• Antipyretic
• Antifungal diaper cream
• Diaper rash cream/zinc oxide cream
• Oral rehydration solution
• Hand sanitizer
• Insect repellant containing DEET
• Non-perfumed moisturizer
• Petroleum jelly/Vaseline
• Mosquito nets
• Sun block
• Thermometer
• Nasal spray
• Scabicide
• Milk substitutes (with and without lactose)

The Canadian Medical Protective Association does not support the prescribing of medication(s) before a child is seen and examined in Canada. They advise parents to contact the nearest Canadian embassy or consulate for advice on local medical resources.¹¹

Selected Resources

• Howard CR, Chandy CJ. International travel with infants and children. In: Centers for Disease Control and Prevention, 2014. Yellow Book http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-7-international-travel-infants-children/international-adoption
• Other web resources, handouts and further reading on international adoption.

References

1. Jones VF, AAP Committee on Early Childhood, Adoption, and Dependent Care. Comprehensive health evaluation of the newly adopted child. Pediatrics 2012;129(1):e214-23.
2. Centers for Disease Control and Prevention. Measles outbreak among internationally adopted children arriving in the United States, February-March 2001. JAMA 2003;289(4):417-8.
3. Centers for Disease Control and Prevention. Multistate investigation of measles among adoptees from China. United States 2004. MMWR Morb Mortal Wkly Rep 2004;53(14):309-10. Update;53(15):323-4.
4. Fischer GE, Teshale EH, Miller C, et al. Hepatitis A among international adoptees and their contacts. Clin Infect Dis 2008; 47(6):812-4.
5. Sweet K, Sutherland W, Ehresmann K, et al. Hepatitis A infection in recent international adoptees and their contacts in Minnesota, 2007-2009. Pediatrics 2011;128(2):e333-8.
6. Centres for Disease Control and Prevention. Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. MMWR Morb Mortal Wkly Rep 2009; 58(36):1006-7.
7. American Academy of Paediatrics, Committee on Infectious Diseases. Recommendations for administering hepatitis A vaccine to contacts of international adoptees. Pediatrics 2011;128(4): 803-4.
8. Chen LH, Barnett ED, Wilson ME. Preventing infectious disease during and after international adoption. Ann Intern Med 2003;139(5 Pt 1):371-8.
9. Centers for Disease Control and Prevention. Travelers’ health: Vaccines, medicine, advice: wwwnc.cdc.gov/travel
10. Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on International Adoption. Vol. 36; ACS-15 (December 2010): www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-15/index-eng.php#a10
11. Canadian Medical Protective Association, December 2012. International adoptions-- Assisting parents and managing the risks. Ottawa: W12-009-E: www.cmpa-acpm.ca/cmpapd04/docs/resource_files/web_sheets/2012/com_w12_009-e.cfm