American Journal of Law & Medicine

Adoption medicine and the internationally adopted child.

Throughout its history, this nation has opened its doors to people who, for more reasons than anyone can count, have needed new homes. It has taken us in, given us new lives. Adopted us. (1)



Dave and Susan brought five-year-old Liliana home from Romania in January. The couple was ecstatic about their new beautiful blonde-haired daughter. They had waited months for Liliana after beginning the international adoption process with a reputable agency based in the United States. Many aspects of the process--carrying large amounts of cash to Romania, bribing officials to release their new daughter from the orphanage and the total lack of information about Liliana's health or background--had disturbed them. (3) Dave and Susan were relieved when Liliana received a visa to travel to the United States because they thought. (4) that the physical examination for her visa had revealed nothing of import. Their concerns disappeared when they boarded the plane to head home to the United States. Liliana seemed healthy and happy, and she would adjust in no time.

In February, Susan and Dave knew that something was wrong. (5) Liliana was hoarding food (6) and she was emotionally detached from Susan. (7) She was also disturbingly affectionate with Dave. (8) Additionally, Liliana's blonde hair had darkened significantly and her fair skin was taking on an olive tone. (9) Alarmed, Dave and Susan took Liliana to a physician they found on the Internet. As a specialist in Adoption Medicine, the physician exclusively treated foreign-born adopted children like Liliana. The physician diagnosed Liliana with Reaction Attachment Disorder, (10) severe malnutrition and intestinal parasites. Unexpectedly, Liliana needed significant medical treatment and, potentially, years of emotional therapy. Dave and Susan were outraged that the agency, the orphanage and the Immigration and Naturalization Service (INS) physicians all missed or did not disclose Liliana's medical conditions. They were grateful to have access to an Adoption Medicine specialist rather than a general practitioner unfamiliar with the medical realities of a post-institutionalized Romanian child.


As more American couples face the challenges of infertility or choose to add another child to their household, adoption is becoming a solution that many investigate. (11) Although domestic adoption is an option for some couples, it can be an expensive, time-consuming and heart-breaking experience. (12) As birth rates decline and more unwed mothers choose to raise their children, fewer American infants are available for domestic adoption. (13) This, along with the fact that international adoption can be both quicker and cheaper than domestic adoption, (14) has lead to an annual increase in international adoption.

Recognizing this annual growth, the federal government has recently passed legislation addressing the needs of internationally adopted children, their adoptive parents and the public as a whole. (16) By making international adoption easier and safer, however, more foreign-born children will enter the United States with incomplete or nonexistent medical histories after receiving only cursory medical examinations. (17) Some adoptees have physical, emotional or mental challenges that are undetectable to adoptive parents, screening physicians and other U.S. physicians who are simply unfamiliar with common foreign diseases. (18) The rise of international adoption and the complexity of the medical issues have led to the creation of a new medical specialty, Adoption Medicine. The few Adoption Medicine specialists in the United States are experienced in recognizing and treating the medical needs of internationally adopted children. (19)

This Note addresses issues related to international adoption and the expanding specialty of Adoption Medicine. Part II discusses the international adoption process within the United States, and Part III focuses on the medical health of international adoptees, as well as the Adoption Medicine specialty. Part IV discusses adoption dissolution and wrongful adoption, and proposes that families should be required to consult an Adoption Medicine specialist before seeking dissolution or other remedies through wrongful adoption or abrogation. Finally, Part V outlines the new federal legislation addressing international adoption and discusses states' responsibilities toward international adoptees.



Harry Holt is the father of international adoption. (20) In 1955, he began facilitating the adoption of Korean War orphans. (21) South Korea remained the United States' primary source of international adoptees until the 1990s. (22) China then began allowing inter-country adoptions because their population-control policy resulted in an overflow of female children that were abandoned at orphanages. (23) With the fall of Communism, former-Soviet countries began participating in inter-country adoptions. (24) Romania was the first former-Communist country to allow such adoptions, and American couples were thrilled at the influx of Caucasian children. (25) More American couples began adopting Romanian orphans after the gruesome conditions of the orphanages were publicized in the early 1990s. (26)

Foreign orphanages are often in deplorable condition. (27) In 1996, for instance, Human Rights Watch, a human rights advocacy group, condemned China's orphanages because of a ninety-percent death rate. (28) Many orphaned children are malnourished, developmentally and physically stunted, and ill with indigenous infectious diseases. (29) Russian orphans, for example, are often diagnosed with rickets, and Central American orphans often have parasites. (30)

Fear of the unknown, however, has neither stopped nor stalled international adoption. International adoption in the United States has increased fifteen percent annually. (31) Last year Americans adopted approximately 16,000 foreign-born children. (32) Although domestic adoptions are still actively pursued, the number of desired available infants cannot meet the demand. (33) For every legally available Caucasian newborn, forty-five couples are waiting to adopt. (34) Rather than facing these odds, couples begin to look internationally. (35)


The international adoption process can be long and tedious. To adopt a Chinese orphan, for example, the U.S. and Chinese governments require fifty-nine forms to be completed and notarized. (36) Adoption officials scrutinize financial records and conduct home visits, and parents must determine if they are capable of caring for a special-needs or older child instead of a purportedly healthy infant. (37) Adoption, whether domestic or international, is also expensive. The estimated cost of international adoption in 1999 was between $12,000 and $25,000, not including medical expenses. (38)

Potential parents must first choose a country from which to adopt their new child. The top five home countries in 2000 for international adoptees were China, Russia, South Korea, Guatemala and Romania. (39) In 1999, eighty percent of international adoptees were from China or a former-Soviet country. (40) The numbers of adoptees arriving from Central American countries continue to increase as well. (41) Once the potential parents choose the desired country of origin, they can contact a foreign agency directly or get an American agency to handle the details. (42) The parents then receive an adoption referral, a description and picture of the child selected for them. The referral will usually include a medical history, however brief or inaccurate. (43) The parents can take this referral to a physician, preferably an Adoption Medicine specialist, who can perform a pre-adoption records examination. (44)

After all the paperwork is complete and the referral is accepted, at least one of the parents usually travels to the home country to pick up their new family member. (45) This is when the parent meets his or her new child for the first time, and it can be both a wonderful and terrible meeting. Institutionalized children often appear small for their age and have flu-like symptoms, skin rashes, shaved heads to combat lice and bald spots on their heads from lying flat for extended periods of time. (46) Regardless, for many parents, the meeting is wonderful because this is the child in the photo with which the parent has bonded. (47) The home country and the United States continue to work together to confirm that the child is available for adoption. (48) The parent must then complete additional paperwork and await additional confirmations before preparing the emigration papers. (49)

The next step in the adoption is the U.S. visa medical exam. Unfortunately, no international standards exist for the medical evaluation of adoptees. (50) The visa exam's two purposes are to protect the health of the American public and to exclude those who would become public charges. (51) Consequently, the exam does not find or test for many non-excludable conditions. (52) It does test for excludable conditions such as sexual diseases (e.g., syphilis), HIV and a "previous occurrence of one or more attacks of insanity." (53) If the child has no obvious abnormalities, however, tests for the listed infectious diseases may not even be performed. (54) Most parents never see the exam results, (55) and some conditions are noted on the report but never explained to the parents. (56) The visa examination "does not assure an adoptive parent that his child is physically, emotionally, or developmentally normal [but only that the child] has no infectious or contagious disease. …

Log in to your account to read this article – and millions more.