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Section 2. Recommendations for Care of Children in Special Circumstances
MEDICAL EVALUATION OF INTERNATIONALLY ADOPTED CHILDREN FOR INFECTIOUS DISEASES 1
Annually, more than 18 000 children from other countries are adopted by families in the United States. More than 90% of international adoptees are from Asian (China, South Korea, Vietnam, India, and Cambodia), Central and South American (Guatemala and Colombia), and Eastern European countries (Russia, Romania, Ukraine, Kazakhstan, and Bulgaria). Africa and the Middle East remain uncommon origins for international adoptees. The diverse origins of these children, their unknown medical histories before adoption, their previous living circumstances (eg, orphanages and/or foster care), and the limited availability of reliable health care in some developing countries, make the medical evaluation of internationally adopted children a challenging but important task.
Internationally adopted children may differ from refugee children in terms of their medical evaluation and treatment before arrival in the United States and in the frequency of certain infectious diseases. Refugee children may have resided in processing camps for months and may have received medical care and treatment, but the history of access to and quality of medical care for international adoptees can be variable. All internationally adopted and refugee children are required to have a medical examination performed by a physician designated by the US State Department in their country of origin before admission to the United States. However, this examination is limited to completing legal requirements for screening for certain communicable diseases and examination for serious physical or mental defects that would prevent the issue of a permanent residency visa. This evaluation is not a comprehensive assessment of the child’s health. Accompanying health documents for internationally adopted children commonly are out-of-date and may be inaccurate, and there is no simple method of determining whether
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