The Referral You've Been Waiting For

formerly, Planning for the Health Needs of Your Institutionalized Child
By Dana E. Johnson, M.D., Ph.D., and Margaret K. Hostetter, M.D.

The mountain of paperwork, hours of meetings, stressful interviews and empty checking account fade from view as you tear open the envelope containing information on your assigned child. Onto the table spill pictures, perhaps a video and a written description of your child that most likely contains some medical information. How do you evaluate the health status of a child from afar, particularly if they have spent their formative years in an institutional care setting?

Before you start dealing with specific details in the referral documents, consider the following:

You are entitled to information on the health of any child you are considering adopting. 

Your agency has an obligation to provide medical information about a child they are placing with you. Frequently available are: family medical history; circumstances surrounding pregnancy, labor and delivery; weight, length and head circumference at birth and at the time of referral; developmental milestones attained; immunization status; and health history since birth. Any information that is available should be provided to you in English. However, information may not be available in some situations; e.g., an abandoned child, an uncooperative orphanage director, an orphanage located in a very remote location, etc. Talk to your agency about what information is likely to be provided and if additional information can be obtained if necessary.

Just because information is available doesn’t mean it’s correct. 

Medical information may be confusing, obscure or frankly bogus. In some countries, specific diagnoses may be applied to children simply to make them available for international adoption or to garner more support for the orphanage where they are housed. On the other hand, diagnoses made in the country of origin should never be discounted or ignored. Consult your agency or a medical professional familiar with current trends in international adoption for help interpreting these records.

You are entitled to a reasonable amount of time to evaluate information on a specific child. 

Adequate time for consideration is one of the cornerstones of good decision making. The decision you are about to make will affect you for the rest of your life. Gather as much information as you can from adoption and medical professionals, and from friends and family. Then put the cute pictures away (or don’t look at them at all) and, as dispassionately as possible, consider all the issues involved in accepting the referral. The world, however, is not a perfect place and there may be situations where a rapid decision is necessary; for example, when a country is about to suspend international placements. If this is a possibility, your agency should alert you in advance to the medical issues which you are likely to face. If a rapid decision is necessary, you would then have had time to inform yourself about the health problems that are common in your child’s country of origin.

You are entitled to knowledgeable, unbiased medical advice. 

Your agency should have a list of community and national resources that can assist you in evaluating the medical status of your child. A list of physicians and clinics can be found at the end of this document.

You know more than you think you do.

You know a lot about the country from which you are adopting. There is a direct relationship between a nation’s economic status and its health care delivery system. Therefore, children from a country where economic standards are high will receive good health care, immunizations will be up to date, medical information will be accurate, and the possibility of getting follow-up information will be quite good. The opposite is true in destitute countries—children are at increased risk for a variety of infectious diseases, immunizations will be incomplete or non-existent and information may be inaccurate, with little likelihood that additional information will follow.

Even if you have never had a child, you know that their job is to grow and develop. If a child is not growing and/or developing in a normal fashion, there may be a problem. The two major exceptions to this general rule—premature infants and children who grow up in orphanages or hospitals—are discussed in Understanding the Medical Information in Your Referral Packet.

Finally, It’s okay to say no.

With a biologic child you have the opportunity to make choices. You influence your child's genetic makeup through your selection of the other parent, you have the opportunity to optimize medical and personal care during the pregnancy, and you control your child’s environment during the formative years of life. You don’t have those options with an adopted child, but there are other choices you can and should make. You are searching for a child that you are capable of parenting. Your family’s size, job commitments, income, insurance coverage and general health are all issues that must be considered carefully when adopting a child who may have special needs. Remember, your whole family as well as your adopted child participate in the benefits and burdens of any adoption decision.