Comprehensive Health Evaluation of the Newly Adopted Child abstract

Children who join families through the process of adoption often have multiple health care needs. After placement in an adoptive home, it is essential that these children have a timely comprehensive health evaluation. This evaluation should include a review of all available medical records and a complete physical examination. Evaluation should also include diagnostic testing based on the findings from the history and physical examination as well as the risks presented by the child’s previous living conditions. Age-appropriate screens should be performed, including, for example, newborn screening panels, hearing, vision, dental, and formal behavioral/developmental screens. The comprehensive assessment can occur at the time of the initial visit to the physician after adoptive placement or can take place over several visits. Adopted children should be referred to other medical specialists as deemed appropriate. The Section on Adoption and Foster Care is a resource within the American Academy of Pediatrics for physicians providing care for children who are being adopted. Pediatrics 2012;129:e214–e223 Increasing numbers of children are joining families through adoption. It is estimated that every year, more than 100 000 children are adopted in the United States. Children can be adopted through the national public welfare system, private agencies, existing relationships, or the international process. Regardless of the route or timing of adoption, these children may have a myriad of special health care needs. Numerous studies have demonstrated that many children who enter the foster care system or children adopted domestically or internationally have an increased incidence of physical, developmental, and mental health concerns. Although these concerns may be addressed before adoption, many of these issues persist and continue to be significant or do not become apparent until after the time of placement in an adoptive home. The number of international adoptions has tripled over the past 15 years, with an average of 22 000 adoptees entering the United States each year for the past 4 years. Most of these children come from China, Guatemala, Russia, Ethiopia, South Korea, Vietnam, Ukraine, and Kazakhstan. Regardless of their countries of origin, many of these children may have concerns related to infectious diseases and developmental delays. Several risk factors have been identified that may account for the aforementioned outcomes, including poverty, little or no prenatal care, malnutrition, perinatal and postnatal exposure to bloodborne and environmental toxins and pathogens, and inadequate Veronnie F. Jones, MD, PhD, MSPH and COMMITTEE ON EARLY CHILDHOOD, ADOPTION, AND DEPENDENT CARE