Neurodevelopmen

t Rotation:
Adoption

RICARDO VEGA, PL2

Pediatrician role for
adoption:
∙ Counseling prospective parents pre-adoptively

∙ Evaluate Children after adoption

∙ Provide ongoing care to the child (adoptee)

∙ Serve as an advocate
Terminology:

∙ Birth or biological parent: avoid “real” or “natural”

parents
∙ Adoption constellation: birth parents, adoptive
parents, adoptee, siblings, extended family and
adoption professionals
∙ Adoption plan: arrangement done by birth parents to
to relinquish parental rights. Avoid the term: “giving
up” the child
∙ Kinship adoption: adoption by a biological relative
 Confidentiality:
∙ To balance privacy and anonymity of biologic parents with the “right to know” of the
adopted child.
∙ Types:
• Confidential records: original birth certificate and adoption records are kept by the
court and inspected only with court approval
• Open records: adopted adults are given access to adoption records or original birth
certificate
• Search and consent: intermediary investigates the location of one party at the request
of another
• Mutual consent: information is in a central file where adopted adults, biologic parents
and some times adoptive parents register their names and consent to release
information
What does the AAP
recommed?

∙ Provision of both the original and

amended birth certificate to the
adoptive family at the time of adoption
(unless specifically denied by the birth
parents) and of granting the adopted
person access to the original birth
certificate at age 18 years
Types of adoption:
∙ Agency adoption

∙ Independent adoption

∙ Subsidized adoption

∙ Open adoption

∙ Legal risk placement

 Medical Evaluation:
Pre-adoption
∙ Pre visit information gathering:
• Review the prospective adoptive child's health information.
• Prospective adoptive families generally seek information
about potential long-term care needs, prognosis for
specific medical problems, and availability of community
resources.
• PCP vs Adoption Medical Specialist
• Thorough FH
• Social history of birth parents
• Circumstances of adoption
• BH, PMH, child's behavioral and mental history
• Strengths, special interests, abilities
 ∙ Initial medical evaluation of an adopted child
must be comprehensive:
• Assess medical, developmental and
psychosocial

• Timing of first visit is determined by the

age of the child and circumstances related
to adoption:
• New born or child from foster care:
ASAP
Medical Evaluation: • International child: within 2 weeks of
Post-adoption: arrival to the USA
 First Visit should
include:
∙ Assessment of growth
∙ Assessment of development
∙ Physical exam:
• General appearance
• Eye examination: strabismus, fundoscopy
• Skin: infectious disease (impetigo, scabies, lice),
congenital (birth marks), trauma, scars, signs of
sexual abuse
• Neurological exam
∙ Age-appropriate screening tests
∙ Assessment of immunization status
Early Adjustment Issues:

∙ After placement, newly adopted children

undergo an adjustment period:
• They must feel safe in the new
environment
• Need time to create a bond and trust
new caregiver
• Period of ”cocooning” is
recommended: staying at home to
create a bond
 Other mental health issues:
∙ Adopted children have a higher risk: socioemotional problems, ADHD, ASD
∙ Early placement can mitigate risk  risk associated to institutionalization
• Risk factors: prenatal exposure, previous abuse/neglect, multiple
placement

• Screening for mental health disorders is recommended with every visit

• Validated screening tests:
• PSC: Pediatric symptom checklist
• Brief Infant-Toddler Social Emotional Assessment
• ASQ: Social-emotional
Developmental stages
of Adoption:
∙ Adoption is a lifelong process: questions, concerns,
emotional issues  for parents and children.
∙ Adoptive parents may experience a mixture of
emotions, grief and loss related to fertility issues or
the loss of a child, happiness, and anxiety regarding
their ability to care for the adopted child. They also
must decide how to integrate the child into their
existing family structure and prepare answers to the
questions that the child or other family members will
ask about the adoption:
Preschool children:

∙ Begin to ask questions about their histories.

∙ Begin to have magical thoughts about their
past: people and places
∙ May notice ethnic differences
School-age children (6-
12):
∙ Changes in cognitive and socioemotional
development  implications for their
understanding of and adjustment to adoption:
• Recognition of the loss of the biologic
family
• Feeling responsible for their biologic
parents making an adoption plan
 Adolescents:
∙ Issues of identity
∙ Idealize the birth family and begin to express a need to search for
birth relatives.
• This search for biologic identity is not a rejection of the
adoptive family
• Normal developmental stage.
• Addressing the child's wishes may improve the child's sense
of identity, long-term adjustment, and relationship with the
adoptive parents
 Communicating
about adoption:
∙ Encourage open discussion about adoption with appropriate
adoption language:
• Beginning from the time of adoption
• Use the words "adoption" and "adopted" in a warm
and positive manner
• Developmentally appropriate information should be
provided to the child with love and respect

• Be prepared to answer questions:

• Truthfully and expanding their explanations if the

child indicates that they want to hear more
• Be alert for opportunities for open discussion about
the child's birth, birth parents, and adoption
 Long term
Developmental and
Behavioral Outcomes:

∙ There are no long-term, prospective studies looking at developmental

and behavioral outcomes of adopted children as a group

∙ Most individuals with a history of adoption in infancy are well-

adjusted and psychologically healthy in childhood, adolescence, and
adulthood.

∙ Children are at greater risk for a range of developmental and

behavioral problems when they have multiple adverse risk factors.
 Indications for referral:

Referral to a mental health provider with expertise in adoption include:

Mood disorders (anxiety, depression, etc)
Attachment concerns
Trauma/grief

Potential indications for referral to an Adoption Medical Specialist include:

Postadoption screening, for example:
The provider is not comfortable or familiar with postadoption
screening
The provider has questions about screening labs or catch-up
immunization
Concerns about struggles with feeding, sleeping, timing of school
placement, age-approximation, developmental delay, learning, attention
or behavior
 Resources for families:

∙ American Academy of Pediatrics (AAP), Council on Foster Care, Adoptio

n, & Kinship Care
∙ AAP Mental Health Toolkit (
Addressing Mental Health Concerns in Primary Care: A Clinician's Toolki
t
; some materials are available to the public; others require purchase or
subscription)
∙ AAP policy statement on health care issues for children and adolescents in
foster care and kinship care
∙ AAP policy statement on promoting the well-being of children whose pare
nts are gay or lesbian
∙ Child Welfare Information Gateway
References:
∙ Elaine E. Schulte, MD. MPH. (03/2021). Adoption. UpToDate.com. Available on:
https://www.uptodate.com/contents/adoption?search=adoption&source=search_resu
lt&selectedTitle=1~150&usage_type=default&display_rank=1

∙ Child Welfare Information Gateway Glossary.

https://www.childwelfare.gov/glossary/glossarya/
∙ Jones VF, Schulte EE, Waite D, COUNCIL ON FOSTER CARE, ADOPTION, AN
D KINSHIP CARE. Pediatrician Guidance in Supporting Families of Children Who
Are Adopted, Fostered, or in Kinship Care. Pediatrics 2020; 146.
∙ Jones VF, Schulte EE, COUNCIL ON FOSTER CARE, ADOPTION, AND KINSH
IP CARE. Comprehensive Health Evaluation of the Newly Adopted Child. Pediatric
s 2019; 143.