International Adoption: A Review And Update

1. Judith Kim Eckerle, MD*,†\n2. Megan Marie Bresnahan, OTR/L†\n3. Maria Kroupina, PhD, LP*,†\n4. Dana Ernest Johnson, MD, PhD*,†\n5. Cynthia Ruth Howard, MD, MPHTM*,†\n\n\n \n\n1. *Department of Pediatrics, University of Minnesota, Minneapolis, MN\n\n2. †MHealth Fairview University of Minnesota Masonic Children’s Hospital, Minneapolis, MN\n\n* Abbreviations:\n Ab : : antibody\n ACE : : adverse childhood experience\n CDC : : Centers for Disease Control and Prevention\n CXR : : chest radiography\n IA : : international adoptee\n TB : : tuberculosis\n\n1. Key information for accurate assessment of the preadoption referral.\n\n2. Determining immunization status and planning catch-up strategy.\n\n3. Updated screening protocol for and treatment of latent tuberculosis infection.\n\n4. Evaluation of developmental delays in the context of international adoption.\n\n5. Screening for risk factors indicating the need for referral to child mental health and developmental specialists.\n\nAfter completing this article, readers should be able to:\n\n1. Review the basic components of an adoption referral file and know when to consult an international adoption medicine expert.\n\n2. Perform the initial medical assessment of a newly arrived international adoptee, including evaluation of the efficacy of previous immunizations and planning of catch-up immunization based on new recommendations.\n\n3. Screen for tuberculosis and treat latent tuberculosis infection based on recent Centers for Disease Control and Prevention (CDC) guidelines.\n\n4. Understand the multiple areas of a developmental baseline of adopted children and assess for catch-up needs.\n\n5. Identify the child with multiple risk factors and/or parental or family stressors who needs a referral to an adoption-competent mental health specialist.\n\nAlthough interest in intercountry adoption continues to be high, the numbers of international adoptions have changed dramatically since the peak in 2004 when 45,483 international adoptees (IAs) were placed in families worldwide. By 2017, the number dropped 79% to 9,387. In the United …