Considering the Referral of a Child from Overseas

Considering the Referral of a Child from Overseas

Written by: Irene Jordan

Assessments and International Program Director



Receiving the referral of a child from overseas who is available for adoption can be incredibly exciting, but also very anxiety provoking. As prospective adoptive parents who have waited a long time for a child to join your family, it can be an intense experience to learn that there is a child who could potentially be your child. However there are many important considerations to be made in order to determine if you are able to meet the child’s needs and if this child will be a good fit in your family.


There are risks involved in adopting a child. You will need to carefully review the information that you have received about the child and evaluate the child’s needs. This careful review is needed in order to minimize the risk that you will adopt a child who has more extensive needs than you are prepared to handle. Even with a careful review, there is always a possibility that a child will have medical, developmental, learning or emotional issues that are not apparent at the time of referral.


You will be contacted by your placement agency social worker when there is a child available to be referred to you. The information available about the child can vary according to the country where the child resides.


·        The referral of a child from China generally includes medical reports, a developmental summary, a medical examination record, lab reports and photos of the child. There will be no information about the biological parents, as the children from China available for adoption have been abandoned by the birthparents due to Chinese regulations. The birth date of the child will have been determined based on the assessment of the child’s age at the time that he or she was found. The medical reports from China will include a set of measurements and developmental skills from a few months prior to the referral. If the child is a special needs child from China, there will be medical diagnoses and information about any surgeries that the child has undergone.

·        The referral of a child from Russia usually includes a basic medical report. In some regions one or more photos of the child are provided. There is usually very minimal information about the birthparents. It is helpful if the age of the birthmother is included in the information. Generally it is thought that a younger birthmother is less likely to have been drinking alcohol heavily during the pregnancy. The extent of the information available in advance of a first trip to see the child can vary greatly between regions. The medical report will sometimes include the birth date and birth measurements, recent measurements, blood test results, and basic developmental information. The medical reports from Russia often have neurological diagnoses, such as perinatal encephalopathy, that are not commonly used in this country. Some regions provide almost no information in advance of the first trip, while other regions provide fairly extensive information. In the regions that provide minimal information, the first trip is a very important opportunity to obtain additional information.

·        The referral of a child from Korea includes very detailed medical reports of the child, background information about the birthparents, and photos of the child in the foster home. The medical reports from Korea are thorough and similar to medical reports in this country. Lab test results are included.

·        The referral of a child from Ethiopia generally includes a description of the child, the child’s history, medical and developmental reports, and one or more photos of the child.


Consulting with a Doctor-

After reviewing this information with your social worker, you should decide if this is a child that you wish to consider.


It is very important to review the information with at least one international adoption physician who would be familiar with the medical terms from various foreign countries, and with the developmental delays to be expected depending on the length of time the child has been in an orphanage. These doctors are experienced with reviewing such information and with presenting their reviews to prospective adoptive parents. Your social worker will be able to assist you with locating an international adoption physician. 



There is a wealth of information available on-line, through books and through training programs. You should make use of this information so that you can be knowledgeable about the conditions and medical terminology included with the referral information.


Some of the important issues about the child being considered include:

·        Length of time in the orphanage: Children who have experienced orphanage care generally are physically smaller and developmentally delayed compared to a child who has been cared for in a family environment. Some research suggests that for every 3 months in an orphanage, the child’s growth is expected to be delayed by about 1 month. The length of time in an orphanage is also correlated with developmental delays.

·        Age of the child: Research shows that children who are over the age of 2 years at placement are at greater risk for developmental delays and attachment challenges. On the other hand, an older child may fit well into your family. Some children seem to be resilient and will respond to parents who provide structure and consistency. 

·        Medical diagnoses: The medical reports of children from Russia may include neurological diagnoses that sound worrisome, but that may not be as significant as some of the other information about the child. Waiting children from China with special needs have medical issues that prospective adoptive parents need to be ready to meet. There may be additional medical issues included in the information that are not identified as the child’s primary diagnosis. You should review your insurance coverage to be sure that you will be able to handle any surgeries and therapies needed for the child. You should also explore the availability of resources in your community to meet the child’s needs. Children adopted from overseas may need speech and language therapy, physical therapy, and other early intervention assistance.


·        Child’s early experiences: A child who has experienced neglect or multiple caregivers may be more likely to have attachment challenges, as the child has not learned to trust that adults will meet his or her needs. The child may need therapy or other services, in addition to a loving family.

·        Prenatal exposure to alcohol or other substances:  This issue is particularly important for children from Eastern European countries including Russia, Ukraine, Bulgaria, and Moldova where the use of alcohol is prevalent. The social use of alcohol in S. Korea is also increasing. A child who has been exposed to alcohol in utero is at risk for retardation, behavioral issues, learning disabilities and attention deficit disorder.  A physician with experience in fetal alcohol exposure can review the photos of the child to see if the child has the facial features of fetal alcohol spectrum disorder. These features include the lack of a philtrum (the indentation between the nose and the upper lip), a thin upper lip, and narrow eyes. The physician will also examine the birth measurements and growth of the child, with special attention to the head circumference. A small head circumference can indicate that the child’s brain is not increasing at the rate that it should. In addition, the physician will evaluate the child’s development to see if the child’s development is even more delayed than would be expected due to orphanage care.



Talking with Others-

You may find it helpful to talk with other adoptive families who may have first-hand experience with a child from a similar background. Often other adoptive families are able to understand the process that you are going through. 


You should think through the extent that you wish to talk with your friends and relatives when you are reviewing the referral information and making a decision. Some families find it helpful to talk to extended family members or close friends at this point in the process. They may be eager to share their news and to obtain support and guidance.


Other families find it works better to not share information about the child until they have made a decision. That way they can make a decision without being influenced by others who are not hearing directly from the international adoption physician. An additional consideration is that if the family does proceed with adopting the child, there may be background information about the child’s circumstances that you may prefer to keep private.


You should also carefully consider whether to share any information with children already in the family. Young children may not understand the process or the time frame.  On the other hand, sometimes families want to involve their older children throughout the process to include them and help prepare them for the change in the family.



Making the Decision –

Making a decision about a child who has been referred to you is a decision with lifelong implications.  If you are adopting as a part of a couple, it is important that both spouses be comfortable with the decision. Carefully consider the evaluation from the doctor’s review of the referral information. Think through whether you are prepared to meet the child’s needs and have access to the resources that the child will need. Remember that there are no guarantees about the child’s future health and development. Although through the review process you can lessen the risk of adopting a child who will have extensive needs, you cannot eliminate that risk.


If you are not comfortable proceeding with the referral, you should decline the referral. Some families experience guilt feelings when they decide not to proceed with a child, worrying that the child will remain in an orphanage. However, it would not be in the child’s best interest to be in your family if you are not prepared to meet the child’s needs.  Keep in mind that there are many children needing families. You should wait for the referral of a child that does feel like the right fit for your family. If you find that you decide against proceeding with several referrals, you may need to re-evaluate whether you are comfortable with international adoption.


On the other hand, after you have carefully considered the information about the child and the doctor’s evaluation, you may feel ready to “take a leap of faith” and proceed with adopting the child.  Arrangements will be made according to the country procedures for you to travel to see the child. In some countries, you will receive much more information about the child when you travel. Eastern European countries, including Russia, provide more medical and background information about the child when the family is there visiting. In addition, you will have an opportunity to observe and interact with the child. Families can then share this additional information with their international adoption physician prior to making a final commitment to proceed with adopting the child. 



­Meeting the Child  

When you meet the child, be prepared that it may not be “love at first sight”. The child may be frightened, as you are strangers. Often it takes time for the child to become comfortable. Attachment is a process that develops over time. Your family is just beginning.

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