Post-Adoption Guide

The Pre-Adoption Medical Check

A complete general physical examination gives your paediatrician a clear picture of your child's health at the time of adoption, and forms the baseline for everything that follows.

What the Examination Covers

• Nutrition assessment
• Hygiene
• Head-to-toe physical examination, including plotting of growth charts
• Screening for the presence or absence of congenital abnormalities
• Review of developmental milestones — attained or not yet attained

Hearing Screening

Two screening tests are commonly used to check a child's hearing:

• Automated Auditory Brainstem Response (AABR): Measures how the hearing nerve responds to sound, played through soft earphones into the baby's ears
• Otoacoustic Emissions (OAE): Measures sound waves produced within the inner ear

Understanding Your Child's Medical History

If medical documentation about the biological parents is available, it's worth focusing on:

Recommended Lab Tests After Adoption

Basic screening tests that should be done at the time of adoption:

• CBC and peripheral smear — to rule out anaemia
• Liver function test
• Renal function test
• Thyroid screening
• TORCH — infection screening for toxoplasmosis, rubella, CMV, herpes and others
• HBsAg for hepatitis B
• HIV — I & II
• Urine screening for inborn errors of metabolism

Additional tests, including those recommended in high-risk areas:

• ECG and ECHO — to rule out congenital heart defects
• USG abdomen — for congenital anomalies such as malrotations of the gut, malformed organs, or diaphragmatic hernias
• Chest X-ray
• HbS for sickle cell anaemia
• Hb electrophoresis for thalassemia
• Peripheral smear for malarial parasite

Serological tests such as HIV and hepatitis screening are especially important in a country like India, where the prevalence of these infections is high. Consider performing these at the time of adoption if documentation is unavailable.

Immunisation

Understanding your child's vaccination status — and how to fill any gaps — is one of the first practical steps after adoption.

You can check the number of vaccines your child should have received by their age against the National Immunisation Schedule published by the Indian Academy of Paediatrics.

Where to Get Your Child Immunised

Immunisation is available at any primary, secondary or tertiary health care centre. Most hospitals and nursing homes with a paediatric facility are equipped for vaccination under the National Immunisation Schedule. That said, it's always better to go to a known paediatrician who can assess your child and make sure the process — and future follow-ups — stay simple and consistent.

Developmental Milestones

Child development is the complete set of changes that carry a helpless newborn to a walking, talking child and, eventually, adult. In the usual sequence, this is a one-way process that unfolds largely on its own — provided the brain and body are supported, protected and given a good environment.

The challenge with adoption lies in providing that right support and environment, and then allowing the natural process to unfold. The intrauterine period and the earliest days after birth may not always have been ideal environments for adopted children — though, of course, the same can be true for biological children too. Fortunately, the brain has a remarkable ability to change, repair and rewire itself given enough time and space, at any point in life. This "neuroplasticity" is the key to developmental success, and harnessing it is something every parent — adoptive or otherwise — learns as they go along.

The good news: most of these delays can be rectified, even at later stages. The majority of adopted children catch up with their peers within months to years, and go on to reach the same developmental potential as any other child. What they need is opportunity and time — both of which lie in the hands of the parent. Development in an adopted child follows the same natural path as in biological children, just with a somewhat higher chance of initial delays that patience and support can close.

Milestones by Age — and the Red Flags to Watch For

Follow-Up Schedule After Adoption

• Social worker check-in once every 6 months, for 2 years
• Paediatrician review every 3–6 months
• Monthly progress notes maintained by adoptive parents

Nutrition

Gaps in developmental milestones and nutritional benchmarks are common among children through adoption. These gaps vary from child to child — often wider in older children and those with special needs — but in time, they can be bridged and deficiencies circumvented.

Much depends on what the birth mother experienced during the gestational period and after delivery, since many come from economically disadvantaged circumstances. Understanding the extent of these gaps — especially within the "golden 1,000 days" from conception until the child turns two — is important.

Micronutrient & Macronutrient Deficiencies

Children may have minor to major deficiencies. Micronutrient deficiency refers to a lack of vitamins and minerals such as calcium, folate, iron, iodine, zinc, vitamin A, vitamin B12 and vitamin D (leading to rickets). Macronutrient deficiency refers to a lack of carbohydrates, protein and fat — the nutrients needed in larger amounts for normal growth — and can cause stunting, wasting and other childhood health complications.

Fortunately, most of this is treatable and within your control — nutritional gaps in adopted children are among the easiest challenges to bridge.

Building a Transition Diet

• Follow the institution or agency's diet and sleep schedule for the first couple of weeks to a month
• Gradually shift to the pattern best suited to your child as they settle into their new home
• Allow some "comfort food" from their familiar cuisine, introduced slowly alongside your chosen diet
• Stay aware that nutritional needs and deficiencies vary from child to child — depending on the mother's health during pregnancy as well as the care received at the institution
• Focus on well-balanced meals built around your child's likely deficiencies
• Be especially mindful with special needs children, who are at greater risk of malnutrition and poor growth

Common Nutritional Deficiencies

• Calcium deficiency
• Folate deficiency
• Iodine deficiency
• Iron deficiency anaemia
• Protein-energy malnutrition
• Vitamin A deficiency
• Vitamin B12 deficiency anaemia
• Vitamin D deficiency (rickets)
• Zinc deficiency

Early Signs of Nutritional Deficiency

• Depression and anxiety, or hyperactivity
• Delayed speech
• Dry skin and hair; light or brown-coloured hair
• Crowded, discoloured or late-erupting teeth, or cavities
• Low immunity to coughs and colds
• Cranky or sporadic emotions
• Poor cranial or flat head structure
• A tired, listless child

Recommended Lab Tests for Dietary Deficiencies

Simple Ways to Boost Nutrition

The best way to accelerate growth is by adding calories and protein to foods your child already wants to eat — every bite counts for slow or picky eaters.

• Add nuts, fig or date paste to oatmeal
• Purée legumes and add them to sauces and soups
• Add almond powder to porridge or oatmeal

Need guidance on your child's nutrition plan? Contact us at adoptpadme@gmail.com to speak with a specialist.

Children with Special Needs

Differently-abled children are generally not the first choice of prospective adoptive parents — yet they are often the ones most in need of a loving, supportive family to reach their full potential.

A child with special needs is one who can benefit most from the individualised care and resources that adoptive parents can provide, more than an institution ever could. From a parent's point of view, every child is a source of happiness, love, meaning and learning — children with special needs are no exception.

Common Disabilities

Follow-Up Schedule

• Identify and address acute and chronic medical problems, vision and hearing loss, and developmental delays — hearing screening in infants is especially important
• Evaluate behavioural and emotional concerns proactively, with appropriate therapy initiated early
• Maintain proper medical evaluation, therapy and follow-up from the point of diagnosis for the best long-term outcome

Building a Plan of Action

• Get educated about your child's condition. It can feel overwhelming at first, but learning more — especially about children with similar conditions who go on to lead fully functioning lives — builds the confidence to make good decisions
• Look beyond academics. Learning-related conditions can affect time management, organisation, focus, memory and reasoning, not just specific subjects
• Involve your child's care team. Reach out to therapists, paediatricians, school counsellors and teachers to learn more and ask questions directly
• Join a support group. Connecting with other parents raising children with similar needs offers insider knowledge, community and reassurance that you're not alone
• Set realistic, collaborative goals. Work with your child's treatment team to set short- and long-term goals, then revisit and adjust them regularly
• Stick to a routine. Predictable schedules help your child learn in a structured way and reduce confusion and overwhelm
• Avoid self-pity — practise empathy instead. Recognise small victories, lean on your strengths, and draw perspective and inspiration from others who've navigated similar journeys
• Stay involved at school. Be your child's advocate — work with the school system on objectives, Individualised Education Plans (IEPs), and share new, effective approaches as you learn them

Specific Learning Disabilities

Most academic learning takes place during school years, delivered by a teacher or facilitator. When a child shows large gaps in learning and understanding, it's worth examining where those gaps come from — and how to address them.

Specific Learning Disabilities (SLD) is an umbrella term describing several kinds of learning difficulties. SLD should not be confused with learning issues that stem from economic, cultural or social disadvantage, intellectual disability, delayed childhood milestones, emotional trauma or physical handicaps. Its underlying cause is neurologically-based processing difficulty in the brain, affecting basic academic skills like reading, spelling, math and writing. There is no single identifiable cause — most research points to a combination of genetics and environment. Importantly, children with SLD typically have average or above-average intelligence, but struggle to perform on tests and in the standard academic system.

Types of Specific Learning Disabilities

• Dyslexia: Difficulty with language processing, including reading and writing
• Dysgraphia: Difficulty with graphomotor or writing skills
• Dyscalculia: Difficulty with math and number-related processing
• Auditory processing disorder: Difficulty differentiating between sounds
• Language processing disorder: Difficulty associating words with meaning
• Visual motor/perceptual disorders
• Nonverbal learning deficit: Difficulty processing nonverbal cues
• Related conditions: ADHD, dyspraxia, memory-related deficits, and difficulties with planning and organisation

There is no "cure" for SLD, because it isn't a disease — but remedial education is essential. This means teaching in the style that works best for each child, helping close skill gaps, and building strategies for independent functioning, all with the goal of minimising the effect on the child's social, emotional and intellectual life, now and as an adult.

SLD affects children across every background — economically privileged or disadvantaged, urban or rural, biological or adopted — and is now believed to be equally common in boys and girls. In children through adoption, some pre-adoptive history of stress, genetics or trauma may be unknown, which can make differential diagnosis more complex. That said, a child benefiting from the supportive home environment that adoptive parents typically provide is often well positioned to receive and respond well to remediation.

Strategy for Dealing with SLD

• Early identification of the condition
• Acceptance of the situation by parents, adoptive or biological
• Ensuring adequate remedial education
• Working with the child's strengths and building their confidence
• Engaging with the child in a supportive way — at home and through an inclusive school
• Encouraging the child's interests — many children with SLD show real talent in music, art, sport or the performing arts

Frequently Asked Questions