International Adoptions

General Information About International Adoptions

Citizens of the United States adopt approximately 15,000 infants and children from abroad each year. Infants and children from Asian nations (for example, China, Korea, India, Vietnam, Cambodia, and the Philippines), Central and South American countries (for example, Guatemala and Colombia), and eastern Europe (for example, Russia, Romania, and Ukraine) account for more than 90% of international infants and children adopted by U.S. citizens. To complete an international adoption and bring an infant or a child to the United States, a prospective parent or parents must fulfill the requirements set by the U.S. Immigration and Naturalization Service (INS), the foreign country in which the infant or child resides, and sometimes the state of residence of the adoptive parent or parents. The U.S. Immigration and Nationality Act (INA) is the U.S. immigration law regarding the issuance of visas to nationals of other countries, including infants or children adopted abroad or coming to the United States for adoption. Detailed information about the procedures and requirements for international adoptions is available on the U.S. Department of State (DoS) website at www.travel.state.gov/family/adoption/notices/notices_473.html. Additional information about international adoption is also available at the INS website at http://www.ins.usdoj.gov.

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The prospective adoptive parent or parents must comply with U.S. immigration procedures, initiated through the INS in the United States, to bring an adoptive child to the United States. Simply locating an infant or a child in a foreign country and going to the applicable U.S. embassy to obtain a visa for the infant or child will not meet these requirements. An infant or child cannot be brought to the United States without a visa, issuance of which is based on an INS-approved petition (Orphan Petition: form I-600 or I-600A). For more specific information about INS requirements, prospective adoptive parents should be advised to see U.S. Department of Justice INS brochure M-249Y, "The Immigration of Adopted and Prospective Adoptive Children." The INS also has a toll-free information number (1-800-755-0777) from which applicants may request copies of the brochure and obtain the telephone numbers of local INS offices throughout the United States. The INS suggests that, early in the preadoption process, the prospective adoptive parent or parents contact the INS office having jurisdiction over his, her, or their place of residence in the United States for information.

When the Orphan Petition has been approved, the adoptive parent or parents can apply for an immigrant visa (IR-3 for an infant or a child adopted abroad and IR-4 for an infant or a child adopted in the United States) at the appropriate U.S. consular office abroad. In addition to the approved I-600 or I-600A petition from the INS, the consular officer also requires specific documentation to conduct a visa interview and issue a visa. One of these requirements is the medical examination of the infant or child by a designated physician.

Overseas Medical Examination for International Adoptions

All immigrants (including infants and children adopted overseas by U.S. citizens) and refugees coming to the United States must have a medical examination overseas as part of the immigrant visa requirements. A panel physician must perform the examination. A panel physician is a physician who has been approved by the U.S. embassy or consulate to perform medical examinations for immigrant visas overseas in that country.

The medical examination focuses primarily on detecting certain serious contagious diseases that might be the basis for visa ineligibility; prospective adoptive parents should be advised not to rely on this medical examination to detect all possible disabilities and illnesses. If an infant or a child is found to have any of the illnesses or disabilities that might be the basis for visa ineligibility, the infant or child may still be issued a visa after the illness has been treated and is no longer contagious, or after a waiver of the visa eligibility has been approved by the INS. If the panel physician or the consular official notes that the infant or child has a serious disease or disability, the prospective parent or parents will be notified and asked if he or she or they wish to proceed with the infant or child's immigration.

The existing medical examination procedure consists of a brief physical examination and medical history. A chest radiograph examination for tuberculosis and blood tests for syphilis and human immunodeficiency virus (HIV) is required for immigrants 15 years of age or older. Applicants younger than 15 years of age are tested only if there is reason to suspect any of these diseases.

In 1996, a new subsection was added to the INA requiring for the first time that any person seeking an immigrant visa for permanent residency show proof of having received the recommended vaccines (as established by the Advisory Committee on Immunization Practices [ACIP] of the Centers for Disease Control and Prevention) before immigration. While this new subsection now applies to all immigrant infants and children entering the United States, international adoptees younger than 11 years of age have been exempted temporarily from the overseas immunization requirements. Adoptive parents are required to sign a waiver indicating their intention to comply with the immunization requirements within 30 days after the infant or child's arrival in the United States.

Additional information about the medical examination and the vaccination exemption for international adoptees who are 10 years of age or younger is available on the DoS website at http://www.travel.state.gov/adopt.html .

Recommendations for Follow-Up Medical Examination After Arrival

The varied geographic origins of internationally adopted infants and children, their unknown backgrounds before adoption (including parental history and living circumstances), and the inadequacy of health care in many developing countries make appropriate medical evaluation of international adoptees a complex and important task.

Usually, an internationally adopted infant or child should be examined within 2 weeks of his or her arrival in the United States. If the infant or child is suffering from an acute illness or has a chronic condition that needs immediate attention, he or she should be examined as soon as possible. Prospective parents might wish to meet with a physician before adoption to review medical records, if available, or to discuss common medical issues involving adopted infants and children. Parents who have not met with a physician before adopting should notify their chosen physician when the infant or child arrives so they can review basic medical issues.

All adopted infants and children should have a complete physical examination and medical history (for many internationally adopted infants and children, previous medical records and histories might be limited or unavailable), and should have age-appropriate screening tests, including evaluation for possible anemia, vision and hearing impairments, and assessment of growth and development. International adoptees frequently have additional medical needs. In studies of internationally adopted infants and children, infectious diseases are among the most common medical diagnoses and have been found in as many as 60% of infants and children, depending on their country of origin. Because many of these infections can be asymptomatic, the diagnosis must be made using screening tests in addition to medical histories and physical examinations. Some infectious diseases occur with sufficient frequency that all international adoptees should be examined for them; for other, less common infectious diseases, screening algorithms should be based on the prevalence of the specific diseases in the infant or child's country of origin or residence. Other important medical diagnoses include hearing loss and vision abnormalities, growth and developmental retardation, nutrition deficiencies, and congenital anomalies.

A good source of information and recommendations for the medical evaluation of adopted infants and children is the American Academy of Pediatrics (AAP), including the publication "2000 Red Book: Report of the Committee on Infectious Diseases, 25th edition," which has an excellent chapter on infectious disease screening recommendations for international adoptees ("The Medical Evaluation of Internationally Adopted Children for Infectious Diseases"). Another is the AAP policy statement, "Initial Medical Evaluation of an Adopted Child," published in "Pediatrics," Volume 88, Number 3, September 1991.

Internationally adopted infants and children frequently are not immunized or are underimmunized. These infants and children should receive necessary immunizations according to recommended schedules in the United States. Only written documentation should be accepted as evidence of prior immunization. In general, written records can be considered valid if the vaccines, dates of administration, number of doses, intervals between doses, and age of the patient at the time of immunization are comparable to the current U.S. schedule or World Health Organization recommendations. Although some vaccines with inadequate potency have been produced in other countries, most vaccines used worldwide are produced with adequate quality control standards and are reliable. However, immunization records for some internationally adopted infants and children, particularly those from orphanages, might not accurately reflect protection because of inaccurate or unreliable records, lack of vaccine potency, poor nutritional status, or other problems. Existing data are inconclusive as to the existence and extent of the problem among infants and children with recorded doses of vaccines administered abroad, and additional studies using standardized methodologies are planned or in progress. The ACIP is also currently formulating a statement on general recommendations on vaccination for internationally adopted infants and children that will be considered for approval in February 2001. Health care providers may follow one of several approaches if there is a question as to whether vaccines were administered to an international adoptee or were immunogenic. Repeating the vaccinations is an acceptable option. Doing so is generally safe and avoids the need to obtain and interpret serological tests. If there is a desire to avoid unnecessary injections, judicious use of serological testing can be helpful to the health care provider in determining which immunizations might be needed.

Credits: National Center for Infectious Diseases