I’ve read a lot about adoption in the internet and communicated much in forums. Stories are so different and no one is the same. However, there is one thing that puzzles me. Is this possible to adopt a healthy child? Or only children with illnesses and disabilities are available? I’m talking about international adoption. this was my dh’s and my decision. Currently, we regard India as a country to adopt from.
It depends what you mean by illnesses and disabilities.
In most foreign countries from which Americans adopt, children are not taken to a pediatrician every time they sneeze. And orphans often get less medical care than children in families. As a result, when you meet your child, referred as healthy overseas, he/she may have a barking cough, green slime coming from his/her nose, scabies tracks on his/her arms, head lice, pinkeye, worms, other intestinal parasites, or tons of ear wax. By adoption standards, children with these conditions are considered healthy, even though they may look awful when you first meet them. These are mostly conditions that spread easily in places where children live and play in close quarters, including American day care centers, if not treated promptly.
They can be treated easily, once home, with antibiotics, scabies cream, lice shampoo/nit combing, deworming medicine, treatments for Giardia and other parasites, etc., and there will generally be no long-term effects. As an example, my daughter from China came home with two ear infections, bronchitis, sinusitis, pinkeye, scabies, a branchial cleft cyst, and foul mushy orange stools suggestive of Giardia. Within a few weeks, all of these ailments were completely resolved, except for the foul stools, which eventually went away on their own, and the branchial cleft cyst, which healed on its own, without the need for surgery. I still believe that there were parasites, but possibly ones that were hard to detect and resistant to common anti-parasitic drugs. My daughter, 18 months old on homecoming, is 20 years old now, and totally healthy, just a little small, even for a Chinese person. She is highly intelligent (doing well at a great university), has held jobs, has a boyfriend, and is quite attractive -- in no respect different from any of her peers, except that she's Chinese and has a White single Mom.
Many of the children may also show signs of malnutrition. In some cases, it is because their orphanages didn't have enough food. In others, it is because intestinal parasites took away the children's appetite and robbed the child of nutrients, even if enough food was available. The children made available for adoption will not usually have such a degree of malnutrition that they will need hospitalization for slow refeeding, and will usually gain weight very quickly when they arrive home and have their minor bugs treated. Occasionally, as in my daughter's case, there may be some feeding issues that need to be addressed. As an example, a child who is fed nothing but formula and liquids with rice cereal after age one may be texture avoidant, and may need some work with a feeding specialist to learn to process solid food. Some children may also turn out to have food allergies or lactose intolerance. Again, these are not generally serious problems, and most children with malnutrition are referred as healthy.
Now, many countries do not have Western style medical care, even for their wealthiest citizens. Some problems that we might consider special needs are not identified, upon examination; as an example, some countries do not recognize the facial features of children with fetal alcohol spectrum disorders as indicative of a problem, as we do. And rushed doctors, doing physical exams so that children can be made available for adoption, may miss or misdiagnose even fairly obvious things. Children who spend time in a hospital -- for example, for pneumonia -- may get better diagnoses, but not always. And, alas, there are orphanages that purposely understate problems so that a child will get adopted, and those that overstate problems so their local governments will let them refer the child to an overseas family. As a result, even if you request a child who is healthy, you cannot be 100% sure that he/she will be -- but then again, even if you did everything right during a pregnancy, you could give birth to a child with physical, mental, or emotional challenges.
Many of the misdiagnoses, unintentional or intentional, can be picked up on a review of a child's referral documents. That is why agencies usually ask that families have their referrals reviewed by an adoption medicine specialist (the best option) or a local pediatrician with some adoption experience, before accepting them. It is better for a family to turn down a referral if the child appears highly likely to have a condition that the parents feel ill-equipped to handle, than to adopt the child and have the adoption fail. Unfortunately, there are times when a condition cannot be detected on a medical report, even if a video of the child is included.
Nowadays, many of the countries that once had lots of fairly healthy children to adopt no longer do. Part of the reason is that the countries have become more prosperous and Westernized. People in those countries are increasingly willing and able to adopt those healthy children, both because they have the means to support them, and because traditional prejudices against raising a child who is "not of one's blood" (not biologically related) are disappearing. That is actually a good thing, as children should be raised in their birth countries, if possible. China offers a particularly good example. The number of healthy Chinese infants has decreased so much that most American agencies have suspended their traditional programs, and are accepting applications only for children with special needs. Families in China still don't adopt children with special needs all that often, in part because the country lacks the resources to treat certain problems and in part because of traditional beliefs that such children are "unlucky" or "cursed". Still, fairly healthy children are available in some countries.
You also need to consider what "special needs" involve. In some countries, at least in the past, children with something as minor as a prominent birthmark, an undescended testicle, or an extra toe or finger (not part of a syndrome) were referred through the special needs program. Nowadays, however, people are recognizing that these problems are truly minor and correctable, and won't affect a child's ability to get an education, hold a job, marry and have children, etc. China is now referring many of these children to prospective parents requesting a healthy infant, for example.
Special needs can also involve children who are medically healthy, but of school age or in sibling groups of three or more. Many families will not adopt older children, especially boys, so these children languish in care for a long time. Many agencies will offer discounted fees for families who are willing to adopt these children. The only thing to watch out for is that the longer a child remains in care, and especially if he/she has had multiple placements or has experienced some form of abuse, there is a possibility that he/she will have some emotional issues that require treatment
There are some physical and intellectual special needs that are not correctable and that will require special services during a child's lifetime. As an example, there are available children who are blind, or who have Down's syndrome. It takes a special family to decide to adopt one of these children, who will need special schooling and other resources. In many cases, the families who adopt them have had experience with a bio child or a relative's child with the same need, or have worked with children in schools for people with disabilities. But most children with special needs do not have such issues, and you can choose the types of need that you feel you can handle.
On the other hand, there are some physical special needs that are fairly easy to deal with. Children with a missing hand or arm can often lead full and productive lives -- going to college, getting good jobs, finding a marriage partner, and so on. Most don't require a lot of medical care. Some children don't even want a prosthesis, as they learn to compensate for their missing limbs in other ways. I know an adult male who was born with one arm absent below the elbow; he drives a car with a stick shift, golfs, builds things in a workshop, and runs health care institutions; he does not use a prosthesis. And I have seen kids with limb differences playing ball and so on.
And some physical special needs are correctable, though parents will need good insurance that will cover a child's care. As an example, children with cleft palates often need several surgeries and a good bit of dental work. Children with heart defects may need only one surgery, but it is likely to be a complex one, with a long recuperation period. Families should recognize that such children may do best receiving treatment at a children's hospital, and that they may have to travel and stay close to that hospital during a child's hospitalization.
As far as emotional special needs, some children are diagnosed with autism and other conditions overseas. Unfortunately, here is where more of the unknowns happen. Children in orphanages rarely get to see psychiatrists and psychologists. An orphanage may describe a child as naughty, when in fact, he/she has an attachment disorder or depression. Milder forms of autism, such as Asperger's, may be missed altogether, and a child's behavior may be diagnosed as stubbornness, a preference for playing alone, and so on. If a child has difficulty with quantitative reasoning, he/she may be diagnosed with low intelligence, rather that prenatal exposure to alcohol; he/she may be labeled as naughty, if he/she is highly impulsive, another possible effect of having a birthmother who drank during pregnancy.
Children who are chronic carriers of Hepatitis B are often available in certain countries, particularly in Asia. In the past, Hep. B chronic carrier status was considered a special need. Today, however, it is less of an issue. Most of the adoptable children don't have liver involvement and can have totally normal childhoods While contact with blood and bodily fluids can spread the disease, most American kids are immunized against Hep. B and won't be harmed, and most workers in hospitals and day care centers are required to be immunized. Parents can teach their children about "universal precautions" and choose whom they tell about a child's condition. Visits to a specialist can identify any liver involvement and prescribe drugs to minimize damage. And research leading to a true cure is well underway; already, many of the children seroconvert (turn negative). China has begun to refer some Hep. B positive children as healthy, and there are many parents open to the condition, once they learn about it. A pregnant person with chronic Hep. B status can notify her obstetrician, who can then prescribe medications to prevent the transmission of the disease to her children during the birth process.
All in all, there are many adopted children who are no more likely to have physical, mental, or emotional conditions than those who remain with their bio parents. But anyone adopting should be aware that children with undiagnosed or undisclosed special needs sometimes are referred as healthy, and that some children with known special needs have almost no requirement for special services. And some parents choose to adopt children with special needs, if they have the resources to provide care that is required, and rejoice in the amount of progress that their children make, once home.
Sharon, please forgive me for the delay in response. My dh and I went on unplanned journey to Kiev, Ukraine and it was a real adventure. We were invited on a wedding of our close friends. Even though the flight was long and tiring, it was worth trying. My friend Tania is Ukrainian but we got acquitted here in Kansas. Her wedding was very comfy within family and friends circle. We also spend three days travelling all over Ukraine. I should tell that I fell in love with this country and people. My dh and I initially wanted to adopt from India but after this trip it seems that we will most obviously adopt from Ukraine. There are so many orphans and abandoned children there in children homes. They live in extremely poor conditions and don’t get proper care. In any case, this idea came to my mind already when we got back home.
Your comment is just gorgeous and really informative. It explained much to me. Yes, I understand that children from care are not always properly cared and don’t get necessary medical treatment. Correctable conditions are ok for us. I meant severe diagnosis that can’t be corrected or treated. I’ve communicated a bit with adoptive families and they all say that there are much more special needs children available for adoption than healthy (more or less). But you are right: even if you carry your own child, you never know if he or she will be born healthy or not.
A lot depends on your definition of healthy.
In many foreign countries, the most common reason for placing a child for adoption is poverty -- poverty on a level that you can't imagine unless you have traveled there, poverty unlike anything you have seen in the U.S. Women start having babies young and may have eight children or more before their bodies stop working, because contraception isn't available or culturally acceptable. Without free public education, many people grow up illiterate and unskilled, and can get only very low paying, physically hard jobs, if any, so providing adequate care for a child may not be possible. Many of the countries do not have the resources to offer a social safety net, like Medicaid, WIC, and so on. Prenatal care may not be available or affordable, and the nutritional status of the pregnant women may be poor. Babies aren't always born in hospitals, because there may not be a hospital in rural areas, and families couldn't pay for care in any case. The babies often have no medical care, even when they are born early or very small or both, due to the age and health of the mother. Families sometimes place babies for adoption because it's the only way the other members of the family will have a marginally adequate diet.
Other reasons for placing a child include single status. It is still very shameful for a woman to become pregnant outside marriage, in many countries. And in many countries, sex education for girls is culturally prohibited, so young women often get pregnant without fully understanding how it happened, or how it could have been prevented. They may not get medical care until late in pregnancy, if at all. In some countries, since women may not be allowed to own property, a single woman can't start a business to earn income that would help her raise a child, whether she gave birth outside marriage, or was widowed or divorced when her child was young. Or she may be shunned by her parents, friends, and neighbors, and forced to live on the streets or get into the sex trade.
Still others may include government regulations, like China's recently lifted one-child policy, which was often enforced by corrupt officials who levied indecently large fines that often went into their own pockets, or forced late term abortion or sterilization after birth. And superstition also plays a role. In many villages around the world, a child born with a visible birthmark may be thought "cursed" as a result of his/her mother's sins. A boy born with an undescended testicle may be considered likely to be infertile and unmanly, even though the testicle may descend later or via a minor surgical procedure and won't affect his ability to function as a male. With no health insurance and a culture that stigmatizes certain conditions and fails to provide barrier free environments and protections against discrimination in workplaces for people with any sort of challenge, families often feel that they do not want to raise a child with even a minor issue like an extra finger or an easily corrected "lazy eye". In China and India, the only two countries in the world which traditionally have had more girls than boys available for adoption, a cultural preference for sons has led to the placement or abandonment of many girl babies. The cultural preference does not reflect negative attitudes about females, necessarily; in China, at least, it comes from the tradition that boys must support and care for their parents when they get old and sick; girls go to help their inlaws, with their husbands. With no health insurance, having sons in some parts of China is like having Medicare and Medicaid in the U.S.
As a result, most of the children who find their way into foreign orphanages may not be the "Gerber babies" you see in American hospital nurseries. In India, particularly, many of the children who are placed in orphanages were born early and low birthweight, in part due to poor parental nutrition and lack of medical care, but also due to having very young mothers or mothers who have already given birth to many children. Most of the children will turn out just fine, but there are risks that they could have chronic respiratory, neurological, cardiovascular, or gastrointestinal issues. Some children born premature and low birthweight will have learning issues. Some of these issues will be identified before the child is adopted, and the child will be placed only with families open to them. However, some of the issues won't show up until much later.
Many children in foreign orphanages, just like children in the U.S. foster care system, were removed from parental homes for reasons such as abuse or neglect. Abuse and neglect can cause physical and emotion problems, some easily handled, and some long lasting, And, unfortunately, some orphanages don't hire and supervise workers well, and abuse of children by caregivers or other children occurs -- and is not reported to the adoption authorities. Also, many of the children in orphanages came there because of parental alcohol or drug abuse. Fetal alcohol spectrum disorders can occur in the children of women who drank while pregnant; they are basically a form of brain damage, which can be mild or severe. In some cases, usually severe ones, a newborn with FASD will have facial features that are highly suggestive of the disorder, but many cases of FASD are not identified until a child is of school age, when cognitive deficiencies, impulse control problems, and so on are more noticeable. Drugs can cause similar brain damage, although there are so many illegal and legal drugs being abused, often in combination, that assessing the impact on a child's brain may be more difficult. Do not believe anyone who tells you that women in a certain country do not drink alcohol or use drugs; even in countries where the prevailing religion, such as Islam, forbids the use of such substances, women with tough lives DO drink or use drugs, and children are affected prenatally. Many of the women drink or use drugs in secret, and do not disclose their consumption to doctors and when making an adoption plan. And in many countries, which do not have a Western style medical system, FASD and similar problems are not in the diagnostic categories learned by doctors in training, so they do not show up in adoption records.
Orphanages, being congregate living situations, are subject to all of the health problems found in American day care centers, college dorms, and military barracks. If one child gets sick, it is likely that most of the other children will catch whatever he/she has. When you go to meet your child, even if he/she has no special needs, in the strictest sense, at all, he/she is likely to have a lot of minor "bugs". Respiratory problems, such as sinus infections and bronchitis, are extremely common, and children who catch them rarely see doctors. Skin parasites, especially scabies and lice, may be prevalent, and the worst part of these is that the very things new parents do to promote bonding, such as holding a baby against their bare skin, or cuddling with them on a bed, or wrapping them in their own bath towel, can pass the critters to the parents! Luckily, scabies and lice are very treatable, but the whole household could be itching for a while.
In many of the countries where Americans adopt, intestinal parasites are common, spread in contaminated water and food. You may find that your child doesn't grow well, doesn't eat well, has stomachaches, vomits often, has messy poop, and so on. When you get home, you will collect stool samples for your doctor -- and the occasional roundworm that emerges into your baby's diaper -- for parasite testing. The good news is that worms are very treatable. Other parasites may be harder to diagnose and treat; Giardia lamblia is one of the most common and most elusive. It WILL go away, with treatment, but if you don't use scrupulous hygiene when changing diapers or disinfecting surfaces like bathroom sinks, your whole family can pick up the nasty microscopic critters before your child is fully cured. So observe CDC recommendations for safe eating and drinking when you travel to adopt -- and use good hygiene when dealing with your child's bodily fluids. Remember that, in most countries, children aren't immunized against common food- and water-borne diseases, like Hepatitis A, as they are in the U.S. And even if their records show immunizations, those from some countries tend to be suspect because outdated vaccines may be used and immunization schedules can be falsified; your child may need to have a full series of shots when he/she gets home. At present, I think that South Korea is the only country whose shot records American adoption medical professionals consider totally reliable, as the country has a Western style medical system and a strong emphasis on childhood immunizations.
Also remember that orphanages and foster homes are no substitutes for a permanent loving family. Even the very best of them cannot provide the emotional security that a child needs -- and, unfortunately, most are not the very best. In poor countries, orphanages are often understaffed, staffed by minimally trained people, limited in available foods, lacking in weather-appropriate clothing, lacking in toys, lacking in programs supporting stimulation and developmental progress, and so on. When you meet your child, he/she may be terrified of you or emotionally shut down from shock and grief. For most of the children, the love and structure of a permanent home will be enough to help them function normally. However, you do have to recognize that some children may need professional help for attachment disorders. Attachment disorders often occur in children who lose their birthparents, then lose one or more orphanage caregivers or foster parents. They come to feel that adults cannot be trusted to stay around and meet their needs, and a few fail to develop a conscience. It is worthwhile to do some reading about attachment disorders in adoption, as well as other psychological problems that may be caused by the conditions that lead to a child's availability for adoption. Parenting an adopted child, and certainly an internationally adopted child, presents challenges that parenting a homegrown child rarely does.
All in all, there are many levels of health and illness in adoption. What you're not generally going to find is a child who was born to two happily married people with the financial and other resources to support a family. You are going to meet a child whose needs could not be addressed by his/her biological parents, and who never really found a good substitute for a caring family. You are going to meet a child who may have known food insecurity, whose parents may have been homeless, who may have been abused or neglected, who may have untreated minor bugs, who may have had minimal preventive medical care, who may have been left in a crib for hours and hours so that he/she doesn't know how to do things a homegrown child does at his/her age, who may have been born with correctable medical conditions that would be a no-brainer to fix in the U.S. but that were deemed terrible in the foreign country.
Do a lot of research about the health of orphans overseas, and especially in India. Join adoption support groups and meet families who have adopted there. Talk to American adoption medicine specialists. I think you will find that you will find a lot of very happy adoptive families. Some will have encountered very few problems that a homegrown child would not have had. Others, however, will say that they faced some significant challenges, but that it was worth it to be able to parent their child. I think they will all tell you that there are many unknowns in adoption, and that adoption requires a major leap of faith. But if you think of adoption in terms of your ability to meet the needs of a child, not in terms of your ability to have a child that meets your needs, you'll be on track to have a wonderful parenting experience.
I adopted a daughter from China when I was almost 51 and single, and she was 18 months old. Talk about a big leap of faith -- especially given that I got minimal information on her: the wrong picture, incorrect height and weight statistics, a medical report where everything was simply listed as normal, and the only accurate quantitative information was that she had ten teeth. And when I met her, she was totally shut down -- no crying, no smiling, little curiosity, no speaking or even understanding Mandarin or the local dialect. On that basis, I adopted her and made her my daughter.
We had our challenges, to be sure. She had feeding and growth issues for over a year after adoption, along with messy orange poop that suggested Giardia but never tested positive for it. The doctor thought she'd have learning issues because of her small head circumference and other statistics -- but she quickly proved him wrong on that score. She had mononucleosis in elementary school, a branchial cleft cyst that resolved on its own, depression in high school. And so on. Still, we had an amazingly wonderful time, and I was one happy Mom. She was amazingly like me in some ways, and amazingly different from me in others.
Today, Becca is 21. She is about to graduate from a top-notch college, where she has been on the Dean's list consistently. She is majoring in economics. She already has a high-paying job with a prestigious consulting firm lined up for next year. She has received almost a free ride from the school, and is self-supporting for her non-school time. She lives independently and doesn't ask me for money. She has had a nice boyfriend for the past three years; he is from India. She has great social skills and chooses friends wisely. She does not use drugs. She occasionally has a glass of wine with dinner, but hates the bar scene and drunken behavior. She is a safe driver. She does her own taxes very well, can read a lease knowledgeably, and knows how to choose a good health insurance plan.
Yes, she is tiny, even for a Chinese person, at 5 feet tall and 100 lb. My guess is that her birthparents were small. But she's physically fit -- runs and uses a fitness center -- and rarely ill. And she loves fashion, so she is often seen in four inch heels and stylish business clothing, found in discount stores. And there's no lack of brain cells; in elementary and middle schools, she tested four years above grade level, and her academic achievements since then have been remarkable. She is a competent horseback rider and a total animal lover. She puts a lot of pressure on herself at times, but has, on her own, talked to a therapist when her stress level got too high.
What more can I want? She is one wonderful young woman, and I can't believe that I ever thought that maybe I shouldn't adopt.
Sharon, I just want to say that your thorough, thoughtful, and articulate responses to questions in this community are amazing. Thank you so much for taking time to share your wisdom with everyone here.