Medical problems of foreign-born adopted children

Over 8000 foreign-born children, almost all from third-world countries, are adopted by citizens of the United States each year. Most primary care practitioners do not have enough experience to evaluate and manage their problems efficiently. We reviewed the medical care of the foreign-born adoptees followed up in a single pediatric group practice. The 128 children arrived from one of eight countries in Asia or Latin America at ages ranging from 1 month to 10 years; 57% were female. The median duration of follow-up was 20 months. The most common problems identified included deficient immunizations (37%), intestinal parasites (29%), emotional or behavioral problems (22%), skin diseases (16%), estimated age (12%), scabies and/or lice (10%), and congenital anomales (10%). Twenty-one other classes of problems were identified, including developmental delay, lactose intolerance, vision and hearing deficits, and chronic hepatitis B carrier status. At arrival or within one month, 49% of the children had acute infectious diseases, including upper respiratory tract infection, otitis media, rubeola, varicella, and mumps. Nineteen percent of the children underwent surgical procedures ranging from circumcision to cleft lip-palate repair; 46% of these children were never screened for hepatitis B. Fourteen percent were hospitalized at least once, 5% within the first month after arrival. We developed a simple protocol to screen foreign-born adopted children, allowing rapid identification of treatable problems at the least cost and inconvenience to the family. Thirty-six percent of the families made at least one preadoption visit, permitting an explanation of the protocol and potential problems before the child's arrival.