Pediatricians are in an ideal position to help adoptive parents obtain and evaluate medical information, consider the unique medical needs of the adopted child, and provide a source of advice and counseling from the preadoption period through the issues that may arise when the child is an adolescent. A preadoption visit may allow discussion of medical information that the prospective parents have received about the child and identify important missing information such as the medical history of the biologic family and the educational and social history of the biologic parents. The preadoption period is the time that families are most likely to be able to obtain this information. Depending on the preadoption history, there may be risks of infections, in utero substance exposure, poor nutrition, or inadequate infant care that should be discussed with adoptive parents.
When the adopted child is first seen, screening for medical disorders beyond the typical age-appropriate screeningtests should be considered. If the child has not had the standard newborn screening tests, the pediatrician may need toobtain these tests. Documented immunizations should be reviewed and, if needed, a plan developed to complete theneeded immunizations (see Chapter 94). Children may be athigh risk for infection based on the biologic mother’s socialhistory or the country from which the child was adopted, including infection with human immunodeficiency virus, hepatitis B, cytomegalovirus, tuberculosis, syphilis, and parasites. A complete blood count may be needed to screen foriron deficiency.
A knowledgeable pediatrician also can be a valuable sourceof support and advice about psychosocial issues. The pediatrician should help the adoptive parents think about how theywill raise the child while helping the child to understand thefact that he or she is adopted. Neither denial of nor intense focus on the adoption is healthy. Parents should use the term adoption around their children during the toddler years andexplain the simplest facts first. Children’s questions shouldbe answered honestly. Parents should expect the same orsimilar questions repeatedly, and that during the preschoolperiod the child’s cognitive limitations make it likely thechild will not fully understand the meaning of adoption. Aschildren get older, they may have fantasies of being reunitedwith their biologic parents, and there may be new challenges as the child begins to interact more with individuals outsideof the family. Families may want advice about difficulties created by school assignments such as creating a genealogicchart or teasing by peers. During the teenage years, the childmay have questions about his or her identity and a desire tofind his or her biologic parents. Adoptive parents may needreassurance that these desires do not represent rejectionof the adoptive family but the child’s desire to understandmore about his or her life. In general adopted adolescentsshould be supported in efforts to learn about their past, butmost experts recommend encouraging children to wait untillate adolescence before deciding to search actively for thebiologic parents.
Although adopted children have a higher rate of school, learning, and behavioral problems, much of this increase is likely to be related to biologic and social influences before the adoption. The pediatrician can play an important role in helping families distinguish developmental and behavioral variations from problems that may require recommendations for early intervention, counseling, or other services.
Foster care is a means of providing protection for children who require out-of-home placement, most commonly because of homelessness, parental inability to care for the child, parental substance abuse, or child neglect or abuse. From the late 1990s through 2005, over half a million children were in foster care, but between 2005 and 2010, the number of children living in foster care decreased by about 20%. These decreases were associated with changes in federal and state policies that have emphasized shortened stays in foster care, promoted more rapid adoptions, and expanded efforts to support troubled families.