If infertility is a problem for you, another option may be adoption. Adopting a baby or child can be one of the most rewarding experiences of your life. So many babies, children, and adolescents in the United States and around the world need a family. Some of these are healthy infants, and many are children with special needs, including physical, emotional, or mental disabilities. If you do adopt a child with special needs, there are both federal and state sources of financial assistance available to help you afford the child's care.

There are two types of adoptions:

• Open adoption – The birth mother, and possibly the birth father, know something about the adoptive parents. They might even meet and exchange names or addresses.
• Closed adoption – The birth mother and adoptive parents do not meet each other or know each others' names.

The laws of each state differ on whether, after a period of time, the files of a closed adoption can be opened later to reveal this information. State laws also differ on whether adoptions can be handled by an adoption agency or independently (such as through a doctor, lawyer, counselor or independent organization). Most adoption agencies carefully screen and study the adoptive parents.

CDC recommends that you try to collect health information about your child who has been adopted before you travel to bring him or her home. Any available medical and vaccination records should be shared and discussed with your medical provider here in the United States so that they can be better prepared once your child arrives.

Many vaccine-preventable diseases are more common in the countries of origin of children who have been adopted from other countries. Therefore, family members traveling to pick up the child, as well as close contacts of the child in the United States (e.g., other family members, babysitters) should make sure they are fully vaccinated according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). CDC’s Travelers’ Health homepage has more information on vaccines you may need and other healthy travel tips.

The medical examination process for your child who has been adopted begins overseas with a visit to a panel physician. A panel physician is a Department of State-designated medical doctor who performs medical exams overseas for immigrants (including children who have been adopted from other countries), refugees, and migrants coming into the United States. Panel physicians, who are located in many countries in the world, must refer to CDC guidelines (technical instructions) on medical exams. Panel physicians are trained in the technical instructions that CDC provides.

The purpose of the overseas medical exam is to identify applicants, including children who have been adopted, with Class A conditions. Children with these conditions must be treated or get a waiver before they can get a visa to come to the United States.

The visa medical exam differs from a normal physical that you may be used to. The visa medical exam includes:

• a physical exam
• a series of vaccines
• a screening for tuberculosis/TB (skin test/chest x-ray examination)
• a blood test for syphilis (not routinely done for children under 15 unless there is reason to suspect infection)

Once the medical exam is completed, the panel physician will give you a sealed packet containing the medical exam forms. When you arrive in the United States, give the sealed packet to the Customs and Border Protection (CBP) officer. The CBP officer is an immigration official who will process your paperwork when you first enter the United States. During the medical exam, you should ask for an extra copy of the medical exam forms and give them to your child’s medical provider in the United States. Children should also receive a medical exam once they enter the United States.

Vaccinations

Vaccinations are an important part of the overseas medical examination. The Immigration and Nationality Act requires that all immigrant visa applicants, including children who have been adopted, show proof of having received certain vaccinations named in the law, as well as others recommended by the Advisory Committee on Immunization Practices, before they may be granted an immigrant visa. Vaccination requirements depend on the age of your child. The age-appropriate vaccinations your child may require can be found in the vaccination schedules for children. Some children who have been adopted can receive an affidavit to have their vaccinations delayed until after they arrive in the United States. Children who receive an affidavit must receive the required vaccines once they arrive in the United States.

Once you have brought your child into the United States, you need to find a medical provider with whom you feel comfortable taking your child for medical care. CDC encourages parents to schedule their child’s medical visit within a few weeks of arrival. Your child’s first medical visit in the United States will be more detailed than his or her visa medical exam. Since the visa medical exam only screens for certain diseases, it may not give you a complete picture of your child’s health. The first U.S. medical exam will help you find out about any other health issues your child may have and allow for timely treatment, if needed.

During your child’s first medical visit in the U.S., the doctor may:

• Check growth and development
• Test hearing and vision
• Screen for these diseases, if needed:
  • HIV/AIDS
  • Syphilis
  • Hepatitis B
  • Illnesses caused by parasites
  • Tuberculosis

Your child must also get vaccines if he or she did not receive them overseas. Parents are required to get their children vaccinated within 30 days of arrival.

Your child’s medical provider may also want to learn about your child’s medical history. If you have any forms or papers with details about your child’s medical background, bring them to the first visit.

If you are looking for a medical provider, you may want to consider pediatricians who focus on treating children who have been adopted from other countries. They tend to have more experience with medical conditions seen in children adopted overseas.

Class A conditions are illnesses of public health importance that prohibit a person from entering the United States. Many children who have been adopted come from countries where Class A conditions are more common than in the United States.

Class A conditions include:

• Tuberculosis
• Syphilis
• Gonorrhea
• Hansen’s Disease (Leprosy)
• Mental Disorders (with Associated Harmful Behavior)
• Substance Abuse

The diseases in the following two categories are also Class A conditions:

• Quarantinable diseases designated by any Presidential Executive Order: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and novel influenza (e.g., pandemic flu).
• Events that are reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005: polio, smallpox, SARS, novel/pandemic influenza (flu), and other public health emergencies of international concern.

The Class A condition that is most relevant for children who have been adopted from other countries is tuberculosis (TB). In 2007 CDC updated the TB technical instructions for panel physicians to improve TB screening. TB is a disease that is caused by bacteria which are spread from person to person through the air. Tuberculosis is considered infectious (active) when the TB bacteria overcome the defenses of the body and begin to multiply. People with active TB can spread TB bacteria to others. Most TB can be treated with antibiotics.

In certain instances, waivers can be granted so that a child with a Class A condition can enter the United States. A waiver request may also be filed on religious or moral grounds (for vaccinations only). CDC’s role in the waiver process is only to review and provide an opinion. The final decision to approve or deny a waiver is made by U.S. Citizenship and Immigration Services (USCIS) in the Department of Homeland Security (DHS).

Here is the process to apply for a waiver:

• If a child is found to have a Class A condition, parents should talk to the panel physician and the U.S. Consulate to find out if it is possible to get a waiver.

You cannot apply for a waiver before the child is found to have an inadmissible condition. Thus, all tests must be completed and read by the panel physician before a class can be assigned.

• Parents will have to complete a waiver request form (Form I-601) with USCIS.

* Finding a U.S. doctor or health-care provider is a vital step in the waiver process. You must list the doctor who will treat your child in the United States on the I-601 Form, and the I-601 Form must be completed and signed by the doctor. For children with TB, you must contact your state or local health department; the health department must complete the I-601 waiver. They can tell you if they will be able to treat the child. They may not agree to treat your child until they get all the medical forms about his or her case.

• The panel physician will send the child’s medical forms to the U.S. Consulate (American Embassy).
• The I-601 will be sent to USCIS, and then USCIS will send the I-601 to CDC for review.
• CDC will check the I-601 and medical forms to make sure they are correct and complete.
• CDC will then provide an opinion to USCIS about the case.
• USCIS will make the final decision to approve or deny the waiver. This decision will be reported to the U.S. Consulate and CDC.
• USCIS will tell the parents whether the waiver was granted. If the waiver is granted, the child will receive a visa.

CDC's Intercountry (International) Adoption Goals

• To ensure that children receive proper medical screening overseas, so they can receive timely treatment and care
• To provide information to parents so they can understand their children’s health conditions
• To communicate with adoption organizations and physicians treating children
• To encourage safe and healthy travel for parents going overseas to adopt children
• To respond to disease outbreaks in children who have been adopted
• To work with countries and partners to streamline the visa medical examination process while maintaining the quality of medical exams

If you’re adopting a child, ask for vaccination records so that you can confirm which vaccines the child has already received.

International adoption

Vaccinate according to the U.S. schedule

All international adoptees should receive vaccines according to the United States Childhood Immunization Schedule.

Vaccines your adopted child may need

Ask your adoption coordinator for your child’s vaccination records. The child’s birth country may have vaccines or a vaccination schedule that is different from the recommended immunization schedule in the United States.

An internationally adopted child should be considered susceptible to disease and be vaccinated (or revaccinated) against vaccine-preventable diseases if vaccination records:

• cannot be located,
• are incomplete,
• cannot be understood, or
• if you or your child’s doctor thinks they are inaccurate.

If you are unsure whether or not your child was vaccinated, your child’s doctor can have their blood tested for antibodies to determine your child’s immunity to certain diseases. However, these tests may not be accurate. Doctors may prefer to revaccinate for best protection. Talk to your child’s doctor to determine what vaccines are needed to protect against diseases.

Protecting the entire family

You should be up to date on your vaccinations especially specific travel vaccinations before traveling to your child’s country of origin. See detailed information on healthy travel for international adoptions.

It is also very important that any other children or caregivers in your home are up to date on their vaccines.

Domestic adoption

When you adopt a child who was born in the U.S., ask your adoption coordinator for your child’s official vaccination records. If the records are not available, you may have to search for the records. For tips on locating your child’s vaccination record, see Finding and Updating Vaccine Records.

If you are unable to locate your child’s vaccination records, doctors recommend vaccinating according to the recommended immunization schedule. Your child may be vulnerable to vaccine-preventable diseases if you are not certain about the vaccines that your child has received. It is safe for your child to be revaccinated.

Work with your child’s doctor to catch up on any vaccines your child needs.

Foster children

Each state’s child welfare agency has different policies about vaccinating foster children. Talk to your child’s caseworker or placement agency about getting consent for routine medical care for your foster child. Once you have permission, ask for any available medical records. A healthcare provider can use these records to determine if your foster child is behind on any vaccines. You should keep records of all vaccines your foster child receives.