After School Programs
Many children receive most of their recreational experiences through these programs. Coaches can be wonderful mentors and for some families after school programs eliminate some daycare needs.

Audiologist
An audiologist provides intervention strategies and services for individuals with deafness or hearing impairments.

Classroom Teacher
Your child’s classroom teacher is the person who will spend the most time with your child and will know her best. A classroom teacher is a valuable resource for helping identify any educational, emotional or social issues the child may be having in school.

Early Intervention Services
Every state offers an early intervention program to help identify infants and toddlers (up to age three) who may have developmental delays or disabilities. An evaluation is completed to determine the child’s cognitive, physical/motor, speech, language, social, emotional and adaptive development. A physician or the local school district can direct families to those services.

Educational Advocate
An Educational Advisor or Advocate helps parents work with the child’s school. As an additional member of an Individual Education Plan (IEP) team, an Educational Advocate provides additional experience and expertise to get the best outcome for the child.

Occupational Therapist
An occupational therapist is a licensed health professional who provides strategies and services to assist individuals with motor or sensorimotor functions, including fine motor manipulation, self-help, adaptive work skills, and play or leisure skills.

Physical Therapist
A physical therapist is a licensed health professional who works with individuals with motor or sensorimotor functioning in such areas as mobility and positioning.

School Counselor
A school counselor may assist in the identification of a child’s needs and may help to determine appropriate responses.

School Nurse
A school nurse provides medical care during the school day, monitors allergic reactions and may administer medication needed during school hours.

School Psychologist
A school psychologist assists in the identification of a child’s behavioral, social, emotional, educational and vocational needs and helps to determine appropriate responses.

School Social Worker
A school social worker is trained to assess a child’s educational needs including social, emotional, behavioral and adaptive needs. She provides intervention services including individual, group, parent and family counseling and serves as liaison between home, school and community.

Special Education Instructional Specialist
The special education instructional specialist provides ongoing support to special and general education instructional personnel. The specialist helps to identify and plan for the least restrictive environment appropriate for the child.

Speech-Language Pathologist
A speech-language pathologist provides intervention strategies and services related to speech and language development as well as disorders of language, voice, articulation and fluency.

Transportation Specialist
A transportation specialist works with the school district to provide special transportation and equipment for students with disabilities.

Tutoring Services
Many children can benefit from short or long-term use of a tutor. Families receiving federal (and some state) subsidies should look to the schools for help rather than Children and Family Services.

Human Immunodeficiency virus (HIV) is a retrovirus that causes Acquired Immunodeficiency Syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections. HIV infection is a rare but growing problem among children adopted internationally. Eastern Europe, Central Asia and Africa are experiencing the fastest incidence of HIV growth.

In most cases, the HIV status of the birth mother is unavailable. Clinical signs of HIV infection may be similar to other conditions found in institutionalized children: failure to thrive, developmental delay, and recurring infections. Malnutrition may also increase the risk of opportunistic infections.

Most children are tested for HIV antibodies in the birth country, but the test results may be unreliable. If risk is indicated due to maternal HIV status or the presence of other sexually transmitted diseases, ask if the results can be obtained in their original form and retranslated by your own expert. Prospective adoptive parents may be able to request and pay for a second test at a Western-style lab – sometimes in the capital city of the child’s birth country. It is recommended that children be tested after arrival in the United States, and then again after six months.

If you are knowingly accepting a child with a high risk of HIV, take a careful look at possibly related health issues. Because medicines may not have been administered in a developing country, children are sometimes much sicker than those born with HIV in a developed nation. Line up HIV services, medical insurance coverage, and a knowledgeable network of support persons for yourself and your family prior to bringing your child home.

While there is no effective cure for HIV it can be controlled.

Tuberculosis (TB) is an infectious bacterial disease that commonly affects the lungs. It is one of the most deadly diseases in the world, and kills as many as 100,000 children each year. It is also a lifelong infection. It is found in most countries that place children for international adoption, and adopted children are 50 to 150 times more likely to have TB than the general U.S. population. However, that is not to say it is uncommon in the general US population.

TB is most prevalent where individuals are in close or frequent contact, like orphanages, and is easily spread by coughing, sneezing, spitting and speaking. Malnourished, immune-compromised, and very young children are all at higher risk of becoming infected.

Most of those infected (90%) have a latent form of the disease, never develop any symptoms, and cannot infect others. Children with an active form of the disease may also fail to exhibit symptoms.

Many countries immunize children against TB with a vaccine called BCG, administered to the upper arm. However, the vaccine does not protect against pulmonary (lung) tuberculosis, only complications affecting other organs. Therefore, it is vitally important that your child be tested for TB after you bring her home.

Risk Factors for TB

Risk of Infection:

• Born in country with high prevalence
• Poor access to health care
• Live or spend time in institution
• Close contact with persons with infectious TB

Risk of Developing Active Disease:

• Children under 4 years of age
• HIV infection
• Recent skin test conversion
• Concurrent medical conditions (including malnutrition)

A Mantoux skin test, also known as the PPD (purified protein derivative) is the standard method for diagnosing TB infection. A small amount of the TB germ is injected under the skin resulting in a swelling of the skin. The test is read 48-72 hours later and the size of the swelling is noted. A measurement of between 5-10 mm. should be followed by a chest x-ray if the child is HIV positive or immunosuppressed.

If the measurement is 10 mm or more, it is an indication of positive exposure to tuberculosis. The child should have a chest x-ray to rule out pulmonary tuberculosis. If the x-ray shows no evidence of active disease, the doctor should prescribe a daily dose of Isoniazid, to be taken for the next 9 months.

It is recommended that the Mantoux test be repeated for all children 3-6 months after arrival.

Note that a TB test is an element of the visa physical. Occasionally, a child tests positive who was previously undiagnosed. This will likely delay entry into the US for several months until she receives sufficient treatment not to be contagious. If you are adopting from a country with a high TB risk, check with your consulting physician and consider your options should you face this unexpected challenge.

TIP: ALL children adopted internationally MUST have a PPD test even if they had a BCG vaccine.

Hepatitis is an inflammation of the liver, usually caused by a virus but may be caused by alcohol, toxic chemicals or drugs. There are several different types of hepatitis, the most common being Hepatitis A, and B.

Hepatitis A (HAV) is frequently found in developing countries and is usually acquired through contact with contaminated food or water. HAV infection may have no symptoms, lasts only a few months, and causes no long-term damage. Those who have had the disease have lifelong immunity, but there is also a vaccine.

Hepatitis B (HBV) can be transmitted through sexual or blood contact as well as through saliva, such as through a bite. See photo at right. Infants may be infected by their birth mothers and be born with HBV.

Infants and children often exhibit no symptoms of the disease, but may remain infected for years and can pass the disease to others. Carriers of HBV may develop liver problems later in life.

TIP: Families traveling abroad should get vaccinated for Hepatitis A and B before they travel.

All children adopted internationally should be tested for hepatitis B when they arrive. Although not currently recommended by CDC or AAP, repeat screening again six months after arrival may be considered for all children who initially test negative for hepatitis surface antibody. The tests will determine if the child was ever infected and if it is still present. The results of the testing will indicate whether the child requires vaccination or treatment.

Interpretation of test results can be difficult so your doctor may want to consult with an infectious disease specialist or a pediatric liver specialist.

Because hepatitis B (HBV) is not uncommon in international adoption, older family members and anyone who will be in close contact with the child should get immunized. HBV is highly transmissible within the household. All members of households adopting children with chronic HBV infection should receive additional tests for HBV e antigen, HBV e antibody, hepatitis D virus antibody, viral load, and liver function. They should be vaccinated for hepatitis A if they are not immune. They should also have a consultation with a pediatric gastroenterologist.

Syphilis is a sexually transmitted disease that is readily passed from an infected mother to her unborn child. Syphilis is seen frequently in China and the former Soviet Union. Many countries fail to screen birth mothers or newborns for syphilis, or provide adequate records of treatment for the disease.

Only about one-third to one-half of infants display symptoms of the disease at birth and many go undiagnosed for months or years. Left untreated syphilis can cause failure to thrive, persistent fevers and rashes in infancy. In older children the disease may cause tooth abnormalities, bone changes, neurological problems, blindness or deafness. Congenital syphilis can be completely cured if detected and treated early.

If a child’s medical records indicate exposure to syphilis, parents should try and determine if the mother was treated and if the child was treated at birth. If this is unknown, the child may still be at risk. Medical records which indicate many penicillin shots may indicate that the child was treated for syphilis.

Because congenital syphilis can be difficult to diagnose, tests for syphilis (RPR and FTA-ABS) should be part of the post-adoption examination for all adopted children. If either test is positive, a pediatric infectious disease expert should be consulted to determine if the child has the infection or was exposed to the antibodies in the womb. Hearing and vision should also be screened, to determine if these were affected by the infections.

Severe acute respiratory syndrome (SARS) is a viral respiratory disease. An outbreak of SARS in southern China between November 2002 and July 2003, caused over 8,000 cases, and almost 800 deaths worldwide.

Anxiety and fear slowed or halted some adoptions from China at this time.

It is important to note that no cases of SARS have been reported worldwide since 2004.

Influenza (Flu) is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent flu is by getting a flu vaccine each year.

Influenza is highly contagious. It is most often spread by droplets when people cough, sneeze or talk. The virus can also live on surfaces for a time. People are contagious even before they themselves show symptoms.

Children are more likely to contract flu than older adults. They may be particularly susceptible to flu outbreaks in orphanages or while traveling home. Practice good hygiene and proper hand washing while overseas and traveling to help prevent this disease.

Measles was all but eradicated from the United States in 2000. Periodic outbreaks since then were traced to unvaccinated people traveling to the United States or, more recently, to the rising number of US citizens choosing to not vaccinate their children. This is due to debunked reports that linked the vaccine to harm in children.

Children adopted internationally may or may not have been vaccinated but it is important to follow up with your physician after arriving home.

Meningitis is a rare infection that affects the membranes covering the brain and spinal cord. There are several types of this disease, including bacterial, viral, and fungal.

Bacterial meningitis can be life-threatening and spreads between people in close contact with each other.

Viral meningitis tends to be less severe, and most people recover completely without treatment.

Fungal meningitis is rare and usually affects people who have a weakened immune system.