Skip to Main ContentSkip to Footer

International adoption services for providers


The Division of General Pediatrics at Children's Hospital looks forward to collaborating with you to care for your patients who are adopted internationally.

We recommend a first medical exam two weeks after the adoptive family returns to the United States. It should include:

Growth and nutritional issues

  • Measure length, height, weight (unclothed), and head circumference (for ALL children). Use standard CDC or WHO growth charts to determine growth percentiles.
  • Growth should be monitored with further work-up done if there is not catch-up growth by 6 months after arrival in the home. 
  • CBC to evaluate for anemia, blood disorders. Hemoglobin electrophoresis should be done for children at risk for hemoglobinopathies. 
  • Lead level for environmental risks.
  • TSH (in some countries the soil is deficient of iodine). 
  • Newborn metabolic screen up to 2 years. 

Infectious diseases

  • PPD or currently recommended testing for tuberculosis exposure. This should be done even if the child was immunized with the BCG vaccine. 
  • Hepatitis B virus serologic testing: Hepatitis B surface antigen (HBsAg).
  • Hepatitis C virus serologic testing  
  • HIV serologic testing. 
  • Testing for tuberculosis, Hepatitis B, Hepatitis C, and HIV should be repeated after the child has been home 6 months. Some children may not respond initially if the incubation period is inadequate or if they are malnourished.
  • Syphilis serologic testing: RPR or VDRL, and FTA-ABS or TPPA
  • Stool examination for ova and parasites (3 recommended, best collected 48 hours apart) with specific request for Giardia and Cryptosporidium testing. 
  • Stool bacterial culture (if diarrhea present). 
  • Serologic testing for other parasites such as Trypanosoma cruzi, lymphatic filariasis, Strongyloides, Schistosoma species may be indicated for certain children.
  • Evaluate immunization status by checking antibody titers for vaccines previously given (e.g., diphtheria, tetanus, polio neutralizing titers) or repeat immunizations. Exceptions may include children from foster homes in Korea.

Other recommended screenings

  • Screen of development and behavior, mental health needs, trauma history. 
  • Assessment of vision and hearing. 
  • Oral health assessment, with referral to a dentist. 
  • Referrals for Speech/OT/PT and early intervention.

Child Psychology referrals

Many of your families may ask about, or may benefit from, seeing our Developmental Psychologist, Linda Ashford, Ph.D. Dr. Ashford has worked in this field for 16 years and specializes in helping families with the transition of adoption. She can also assist families with more specific needs, which might include behavioral issues, developmental delays and school challenges. Contact Dr. Ashford’s services through our Center for Child Development.

Occupational, Physical and Speech Therapy referral

We anticipate that most children will have some delays upon adoption, and so we recommend referral to Children’s Hospital's Rehabilitative Therapy services. Developmental delays may include difficulties with sensory processing, feeding, motor coordination and speech. If your patient demonstrates good gains in skills, interest in learning and no difficulty with trying new things, they would likely most benefit from a positive home environment where the family is able to provide and encourage opportunities for learning. However, if your patient struggles to engage and play, has motor or sensory difficulties with activities or does not seem to be picking up on communication, a referral to therapy may be appropriate. Other factors to consider are the child's age and readiness to attend school. Language skills for school are very different than social and preschool skills, so earlier intervention may be warranted.

For questions about our therapy services, call Jennifer Pearson, MS/OTR-L at (615) 322-4090. 


A child's catch-up immunization schedule will be based on the child's lab results. This chart is a helpful resource.

Physician-to-physician consultations

Dr. Rebecca Swan is available from 8 a.m. to 4 p.m. Monday through Friday to answer provider questions. Call (615) 936-6800. Our call center team will page Dr. Swan, who will respond by the end of the business day.