International Adoption

In the past 15 years, >260,000 children have come to the United States to join their families through international adoption. Families traveling to unite with their adopted child, siblings who wait at home for the child’s arrival, extended family members, and childcare providers are all at risk for acquiring infectious diseases secondary to travel or resulting from contact with the newly arrived child. International adoptees may be underimmunized and are at increased risk for infections such as measles, hepatitis A, and hepatitis B because of crowded living conditions, malnutrition, lack of clean water, lack of immunizations, and exposure to endemic diseases not commonly seen in the United States. Challenges in providing care to internationally adopted children include the absence of a complete medical history, lack of availability of a biological family history, questionable reliability of immunization records, variation in preadoption living standards, varying disease epidemiology in the countries of origin, the presence of previously unidentified medical problems, and the increased risk for developmental delays and psychological issues in these children.