Health Concerns in International Adoption
How healthy are the children available from other countries?
In general, the children are very healthy. They integrate well into families, and do well throughout their lives. Long-term studies have shown that adopted children do as well or better in life than children in biological families. To be sure, these studies have built-in biases. Adoptive families tend to be relatively affluent and well educated, both great advantages to a child. Still it is clear that most internationally adopted kids do well. We have divided the health risks into three categories. The first is biological - diseases, parasites, and congenital birth defects. The second is environmental damage - changes of caregivers, indifferent or abusive orphanage care, sometimes called the "orphanage effect." Finally, there is the physical and emotional impact of the history of the child's separation from the birth family - poverty, neglect, poor prenatal care, and prenatal exposure to alcohol and other drugs.
What diseases and conditions should we worry about?
The most common serious disease risk for internationally adopted children is Hepatitis B. This is a viral disease that attacks the liver. In most infected children, it will remain relatively inactive for decades, and then can lead to liver failure or cancer in their 40's or 50's. In some cases it can be active, and be immediately life threatening. It is passed by blood or stool contact. Safe, effective immunizations are available for this disease and any caregiver or personnel likely to have close personal contact with an adopted child should be immunized. This is particularly true for older relatives who may help with bathing or diaper changing, or other children who may engage in active play, such as siblings or daycare and pre-school classmates. For comparison, in children adopted from China, the rate of infection among infants is around 2%. Most other countries, including the United States, have rates at least double that of China. While available children from all countries are tested for Hep B, children who have been exposed to the disease can falsely test negative for six months or more after exposure. Some children who have Hep B have been cured of the disease by new drug therapies.
The most feared disease is AIDS. While this disease is considered to be a death sentence, it is also very rare in adoptions. Most children adopted through all of our programs are routinely tested for AIDS. There has never been a child adopted from China who has AIDS. With over 6,000 adoptions per year from China for the past several years, this indicates an AIDS rate of far less than 1%. Our agency has seen more children impacted by tumors and cancer than by AIDS. AIDS rates from our other programs seem to be around a half of a percent. AIDS can also hide from testing for several months after exposure, or after birth from an infected birth mother, so testing is recommended both before and after your adoption.
Most other diseases are readily treatable, and not likely to have long-term effects, but children should certainly be tested for parasites, syphilis, tuberculosis, and anything else your doctor recommends, once you are home with your child. Families should protect themselves from contagion until test results are back, which means precautions like always changing poopy diapers with gloved hands.
It should be noted that these tests and precautions should also be considered for domestic as well as international adoptions. Many of the diseases found in adopted children are associated with drug use and unsafe sexual practices. Both are far more common in the United States than in the rest of the world. Asian women in general, and Chinese women in particular, are culturally unlikely to smoke, drink, or use intravenous drugs.
What kind of an impact does living in an orphanage have on a child?
As you might expect, children do best in loving caring families. Orphanages in developing countries are often under funded and staffed by poorly paid, indifferent staff. Even foster care can be problematic, with families becoming foster parents for purely financial reasons, and having little consideration for some other person's child. This frequently means that children come to adoptive families with developmental delays, repetitive motion syndromes, or challenges in bonding and attachment. Again, China leads the developing world in the care of children. Thanks to their decision to provide better funding of orphanages through international adoption, and a centralized placement system that rewards orphanages for placing healthy children, infants from China have extremely low rates of bonding and attachment problems, and normally bounce back very quickly from any developmental delays.
Ukraine is also benefiting from their centralized adoption process. Orphanages are developing reputations, and competing with each other to provide the healthiest, best cared for children. Among Eastern European systems, they have done a great job. Still, adoptive parents should spend as much time as possible with available children to get a sense of their level of activity, alertness, and bonds to caregivers. Seeing a child and caregiver in a clearly close relationship is a great sign.
How are children impacted by their birth family?
There is no good reason for children to be in an orphanage. It usually means that the birth family has been destroyed, or is under tremendous pressure. Some reasons are less hard on children than others. With most developing countries, severe poverty often coupled with single parenting and/or substance abuse is what frequently brings families to the desperate decisions to relinquish their children. China is the biggest exception to this rule, with most of the available children coming from functioning families who are choosing not to parent for legal and political reasons.
With Asian and South American adoptions, most birth mothers have not used drugs or alcohol to any great degree. The exception can be women from larger cities with significant amounts of prostitution. This means that the biggest concerns for parents adopting from Asia are going to be related to nutrition. Poor prenatal and inadequate early nutrition can impact brain and body development. While most adopted kids will bounce back from their impoverished beginnings, parents will need to be alert for special challenges in learning and development.
The biggest challenge to internationally adopting parents is alcohol use by Eastern European birth families. This problem manifests itself in two ways - First, through Fetal Alcohol Syndrome (FAS). This is significantly damaging to a child, with physical symptoms including facial deformities of the lip, head, teeth, and ears. Families adopting from the United States or Eastern Europe should become familiar with the warning signs. Most studies we have seen suggest that at least 5% of kids in orphanages throughout the region have FAS.
More common, but also more subtle, is Fetal Alcohol Effect/Exposure (FAE). There are normally no outward or testable signs of this condition. Affected children can be indistinguishable from their peers, with symptoms only appearing when a child is several years old. FAE children will frequently have learning disabilities, emotional control problems, or bonding and attachment issues. Probably 15 - 25% of children from all Eastern European countries will have to deal with significant challenges in their lives from their birth parents' use of alcohol. Families adopting from the region need to be particularly alert to the needs of their children.
We do not mean to suggest that FAE children should not be adopted, or will not do well in families. Rather, these children may take more time, effort, care, treatment, and love than children not exposed to alcohol before they were born.
Some adoptive parents place a great deal of importance on knowing the genetic history of the birth family. Most adoption professionals find this concern to be over-emphasized. Aside from the difficulty of verifying the accuracy or reports from birthparents, environment and parenting have a far greater impact on a person's life than genetic makeup. While biology may influence tendencies, it is parenting that establishes values and learning.
How does the health of internationally adopted children compare to other children?
Despite the warnings in this section, it is important to remember that all children come with risks. At least 5% of all kids are born with birth defects. Adoptive parents can choose whether they want to adopt children with certain challenges. A physically active family can choose not to adopt a child with mobility problems. Biological parents do not have that choice. Children adopted domestically are not necessarily healthier than those adopted internationally. Use of alcohol and drugs, from cocaine to heroin to methamphetamines, is much more common in our open, affluent society. The great spreading out of families and lack of close communities, due to inexpensive transportation and housing, has robbed our society of some of its protections for children. Physical and emotional abuse of women and children, with the resultant damage to health, development, and ability to bond, is far too easy and common in anonymous apartments, where "nobody knows your name". The health risks to internationally adopted children are not substantially different from the health risk to any child born to your family, or adopted here in the United States. While every child brings joys and challenges into your home, there are more international adoptions every year because they work for both the kids and the parents.
We strongly recommend that families educate themselves about medical conditions commonly found in internationally adopted children. Several recommended books may be found in our adoption book store. Please take particular note of The Handbook of International Adoption Medicine.