Intercountry adoptive parent education

• Module 1 - Introduction
  • What is adoption?
  • Who is involved in the adoption process?
  • The adoption process
  • Adoption Services Queensland
  • Suggested reading
• Module 2 - The needs of overseas children requiring permanent adoptive placements in Queensland
  • Overseas country information
  • Are you suited to intercountry adoption?
  • Motivation to adopt
  • Issues and challenges faced by adoptive parents
  • Placement proposals
  • Building resilience with your adopted child
  • Suggested reading
• Module 3 - Child development
  • Understanding child development
  • Factors that impact on child development
  • A child's understanding of adoption
  • Suggested reading
• Module 4 - Attachment and bonding
  • Attachment theory
  • What is attachment and bonding?
  • Types of attachment
  • Attachment behaviour
  • Signs of healthy attachment and bonding
  • Attachment disorder
  • Impact of attachment on adoptive parenting
  • The arousal-relaxation cycle
  • Developing an attachment with your child
  • Suggested reading
• Module 5 - Separation, grief and loss
  • Definition of loss and grief
  • The impact of loss on adoptive parents
  • The impact of loss on adopted children
  • Effects and strategies for dealing with a child's loss
  • Understanding the impact of loss on an adopted child
  • The impact of loss on birth parents
  • The grief process
  • Suggested reading
• Module 6 - Identity and culture
  • Your feelings about ethnic background and culture
  • The impact of adoption on your family
  • Definition of ethnicity, culture and identity
  • Addressing cultural identity
  • The cultural heritage plan
  • Barriers to developing a child's cultural identity
  • A child's racial awareness
  • Stages of development of racial identity
  • Combating racism
  • Telling your child they are adopted
  • The adoptive family life cycle
  • Suggested reading
• Module 7 - Preparing for assessment
  • Departmental assessment considerations
  • Assessing a couple's suitability
  • Meeting the assessment criteria
  • The assessment process
  • Placement considerations
  • Assessors - their perspective
  • Establishing a family tree and Ecomap
  • Suggested reading
• Module 8 - Placement information
  • Medical assessment of children adopted from overseas
  • Lodging an application with the Department of Immigration and Citizenship
  • Migration Health Check
  • Naming your child
  • Travel arrangements
  • Arrival in Australia
  • Queensland Birth Certificate
  • Australian Citizenship
  • Adoptive parent support groups
  • Life Story Book
  • Suggested reading
• Module 9 - General reading
• Family profile
  • My family profile
• Printable version
• Contacts

Medical assessment of children adopted from overseas

This article was prepared by Dr Simon Latham, former visiting Medical Consultant for Adoption Services Queensland.

In Australia, we take for granted the very high health standards of our babies and children - the virtual absence of tuberculosis, AIDS and other life threatening diseases. We also have faith in the quality of our laboratory standards, which are excellent by world standards.

None of this can be taken for granted in less fortunate countries, where children will often die from these diseases. It is important that you should read this document carefully and then discuss with your doctor anything that is not clear to you.

All overseas infants and children who have been recommended for adoption and are awaiting placement with Australian parents are required to have a medical assessment by a doctor approved by the Australian Department of Immigration and Citizenship.

This is similar to the medical requirements of all immigrants to Australia and requires the following assessments:

• standard medical examination
• blood tests for hepatitis B (HBV)
• blood tests for AIDS and HIV
• examination for tuberculosis and a chest x-ray if indicated.

If tuberculosis is present, treatment will begin immediately. If the child tests positive for hepatitis B (HBV), the Australian Department of Immigration and Citizenship will require liver function tests before a decision is made to accept the child for entry into Australia.

Neither tuberculosis nor a positive test for hepatitis B are necessarily stumbling blocks for the child being accepted as an Australian citizen, but if they are present and a decision has been made by the immigration authorities to accept the child, the state medical authorities will need to advise the adoptive family and follow up with medical treatment.

Although adoptive agencies in foreign countries carry out the screening process with care, it is still possible that a child who has been accepted into Australia may carry a serious undetected disease such as AIDS or HIV, hepatitis B (HBV) or hepatitis C (HCV). The medical examination carried out in the adopted child's country may also fail to detect mental disorders. This is because the examination is a screening examination only and not a comprehensive medical examination.

It is also not always possible to diagnose some disorders until the child is older. Errors can occur in laboratory testing as the tests may be incorrectly carried out - there may be a laboratory error, or there may be a clerical error in recording the result. It is also possible that the test is carried out before the child has contracted the disease.

It is therefore very important that any child who is adopted from overseas should have a full examination carried out by a paediatrician in Australia, and laboratory tests should be repeated in Australia where there are strict quality control standards.

Countries such as Korea, Fiji, Taiwan and the Philippines have a comparatively low rate of AIDS or HIV, their testing is of a good standard and the rate of 'false negative' results are relatively low. In comparison, India and Ethiopia have high rates of AIDS or HIV, the accuracy of testing has been subject to strong criticism at times and 'false negative' results are a possibility.

The Australian Department of Immigration and Citizenship has attempted to correct this problem in Ethiopia. However, reservations over the handling of samples in Ethiopia still exist. Colombia and Thailand have high rates of HIV infection and the accuracy of testing is unlikely to be as good as in Korea, Fiji, Taiwan and the Philippines. In all of these countries, hepatitis B (HBV) is relatively common amongst the general population. Hepatitis C (HCV) is not normally tested.

Another problem occurs in testing for AIDS or HIV and hepatitis B (HBV) when a child has been recently infected with either of these viruses. It takes up to three months after infection for HIV and HBV to show up in a blood test. Therefore, even if a test is properly conducted, it may be too early to detect HIV or HBV.

If there is a concern, the child should be retested in their country of origin three months later. It is now standard procedure in Ethiopia for children awaiting placement to be tested twice for HIV, twelve weeks apart.

Prospective adoptive parents need to be aware that while a medical assessment is carried out, a satisfactory result cannot be considered as a guarantee that the child is free of illness or infectious disease. For this reason, Adoption Services Queensland advises all couples to fully consider the risks at the time of placement.

It is also recommended that parents take their adopted child for a paediatric assessment following their return to Australia. In accordance with the Intercountry Adoption Clinic protocol carried out at the Melbourne Royal Children's Hospital, Adoption Services Queensland recommends that all overseas adopted children should have the following screening tests done:

• HIV I and II antibodies
• Hepatitis V surface antigen
• Hepatitis C antibodies
• Syphillis serology
• Full blood examination and differential
• Liver function tests
• Faeces micro and cultures, faeces parasitology, urine micro and culture
• Mantoux test and Guthrie card screening for children under 2 months.

The Melbourne Royal Children's Hospital has carried out a follow up assessment of 100 consecutive children adopted from overseas countries - mostly from Korea, India, Philippines, Fiji, Sri Lanka and Thailand.

There were a number of common findings on examination:

• 31 children were markedly underweight
• 7 children had scabies
• 6 children had severe dental cavities
• 4 children had head lice
• 4 children had evidence of chronic middle ear infection.

Other conditions detected included heart failure, foetal alcohol syndrome, hearing loss and diminished visual acuity.

Laboratory tests revealed intestinal parasites in 23 children, active tuberculosis in 3 children, 12 children were anaemic, 9 had signs of liver inflammation, 2 tested positive for HBV and 1 had acquired syphilis. HIV screening was negative in all cases. This study was carried out between March 1988 and October 1999. Recent communication with the researchers at the Melbourne Royal Children's Hospital suggests that these findings apply to children currently being adopted from overseas.

Prospective adoptive parents must realise that an adopted child from overseas may carry an undetected medical condition, a disability or an infection. In spite of the care and goodwill of overseas adoptive agencies, the efforts of the Australian Department of Immigration and Citizenship and Adoption Services Queensland, it is not possible to guarantee the accuracy of the medical information supplied by the country of origin.

It is essential that couples thinking about adopting a child from overseas consider and accept these risks before proceeding with an adoption. Every adopted child from overseas should be taken for a specialist paediatric assessment as soon as they arrive in Australia.

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Last updated

19 October 2007