What are some of the health concerns and social issues associated with international adoption from China?

China is the number one country that places children for international adoption in the U.S.

Virtually all children adopted from China are girls. The reasons for this discrepancy are the government’s one-child policy and the cultural preference for male-born children. These selective properties have caused abandonment, infanticide, and failure to register countless numbers of female infants yearly. Most of these infants come from rural villages. The decision to abandon a child is determined by the family composition of siblings. Usually, the second or third female is abandoned. The health of these infants is usually very good. Boys are rarely abandoned, but when it does occur, they may be handicapped, ill, or born to unwed mothers.

When a child is abandoned in China, the event generally takes place a great distance from the family’s home. The reason for abandoning children far away from their home is because the incentive by the authorities for investigation is lessened if the child was removed from the local jurisdiction. Children are often left in a crowded market or transportation station. Leaving the child in a crowded facility makes the probability of finding the infant better, and this lessens the possibility for the child to suffer from health issues.

In China, abandonment or endangering the welfare of a minor is not considered a criminal offense as in the U.S. Fines and penalties for the abandonment of an infant are similar to those imposed for an “over-quota” child. The lack of criminal prosecution and additional fines make the abandonment of an infant a tolerable risk.

While the overall general health of Chinese adoptees is very good, many of the same medical problems exist as in other countries, with some country-specific issues. While not a major epidemic in China, the illicit use of drugs and alcohol has been expanding. Infectious diseases found in China include Dengue fever, plague, Japanese encephalitis, and malaria. The more recently publicized epidemic of SARS brought a temporary halt to adoptions from China to reduce international transmission of the disease.

Some children who are slated for adoption are placed in a foster care environment. Other children are placed in a modified institutional care setting in which, during the day, the child spends time in a group setting and later returns to the foster family at night. While there is no perfect replacement for a loving parent, these minimal interventions can help to enhance child development. Chinese adoptees tend to be healthier medically and have better developmental milestones. The risk for Fetal Alcohol Syndrome and Effects is considerably lower in Chinese children when compared to Eastern European children, but the risk is always there.

Other problems found in Chinese children have a similar prevalence to other countries. These problems are as follows:

  1. Growth and developmental delays.
  2. Intestinal parasites such as Giardia
  3. Latent tuberculosis (+PPD)
  4. Lead intoxication
  5. Hepatitis B surface antigen-positive

These conditions are not country-specific; they occur in environments where children live in overcrowded and poor hygienic living conditions.

China has become a desirable country for international adoption for a variety of reasons.

  1. Availability of infant children
  2. Possibility of adopting a child with better health conditions.
  3. Placement in a foster care environment as opposed to institutional care living

Even though Chinese children have a better medical outcome when compared to other countries, this does not preclude families from having a pre-adoption medical consultation performed. Health records, pictures, and, if available, video recording should always be evaluated by an adoption medical records specialist.

These consultations can enlighten families about unsuspected medical concerns that are not easily recognizable by their agencies. I have heard many parents and adoption agencies make the following statement: “There are no medical problems in children adopted internationally from China, therefore we do not need to consult with a physician.” While I do agree that I have seen fewer issues with children adopted from China, they are still at risk for being neglected and malnourished, and having untreated medical conditions. All of these similar issues can be found in all internationally adopted children, regardless of their country of origin. Parents need to educate themselves by consulting with a professional, and not just follow the statements found on the Internet, given by agencies and/or other parents.

International adoption is a leap of faith, but with proper education and knowledge obtained with the help of your adoption consultant, it can become a calculated leap of faith.

by George Rogu, M.D.



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