Post-Adoption Support

A complete head-to-toe examination, along with screening tests for hearing. Two common hearing screens are used:

• Automated Auditory Brainstem Response (AABR): measures how the hearing nerve responds to sound played through soft earphones
• Otoacoustic Emissions (OAE): measures sound waves produced in the inner ear

A blanket immunisation schedule given when vaccination records are unavailable or the child starts getting immunised late.

At any primary, secondary, or tertiary health care centre — most hospitals and nursing homes with a paediatric facility offer vaccinations under the National Immunisation Schedule. It's best to go to a known paediatrician who can assess your child and simplify future follow-ups.

If documentation is available, look for:

Birth history: full-term status, mode of delivery, indication for C-section, post-delivery complications

Obstetric history of the mother: previous births, congenital anomalies, abortions

Medical history of the parents:

• Mother's medical status (anaemia, thyroid disorder, psychological disorder)
• Known medication intake, especially teratogenic medicines; HbsAg and HIV status
• Family history of sickle cell anaemia, haemophilia, thalassemia, etc.
• Blood groups
• History of tuberculosis, asthma, diabetes, hypertension, seizure disorder
• Breastfeeding history and duration

A complete head-to-toe examination and full set of blood investigations should be done. For immunisation, follow the catch-up schedule based on the child's age, then continue with the usual guidelines.

Basic screening tests:

• CBC, 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 for high-risk areas:

• ECG and ECHO — to rule out congenital heart defects
• USG abdomen — for congenital abdominal anomalies
• Chest X-ray
• HbS for sickle cell anaemia; Hb electrophoresis for thalassemia; peripheral smear for malarial parasite

• Proper review of physical, motor, verbal, and mental examination of the child
• Initiating immunisation and follow-up
• Helping break social barriers by counselling parents and following up on the child
• Staying informed about adoption procedures and sharing this knowledge with adoptive families

• Social worker follow-up: once every 6 months for 2 years
• Paediatrician follow-up: every 3–6 months, with monthly reports from adoptive parents

Serological tests such as HIV/Hepatitis screening are especially important in India, given high prevalence, and should be considered at the time of adoption if documentation is unavailable.

A growth chart is used by paediatricians to track a child's height, weight, and head circumference over time, comparing them with expected parameters for children of the same age and sex. If a child's weight is at the 50th percentile, it means 50 out of 100 children their age are bigger and 50 are smaller. In India, the normal range spans the 3rd to 97th percentile, with the 50th percentile considered average.

Doctors pay closer attention when a measurement stays below the 10th or above the 90th percentile, when head growth is too slow or fast, or when a child's measurement shifts significantly between visits. This is a signal to investigate further, not necessarily a medical problem on its own.

Differently-abled children are often the ones most in need of a supportive, loving family and can benefit greatly from the individualised care adoptive parents provide. 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.

• Adoption is generally easier and faster
• More children in this category are available for adoption
• Special medical care, extra attention, and awareness about the condition are needed
• A child can be adopted 15 days after being declared legally free for adoption
• CARA's decision on the category is final

• Acute and chronic medical problems, vision and hearing loss, and developmental delays should be identified and addressed early — hearing screening in infants is especially important
• Behavioural and emotional concerns should be evaluated proactively with appropriate therapy
• Medical evaluation, therapy, and follow-up should begin as soon as the disability is identified, for the best long-term outcome

• Get educated about your child's disability — understanding it builds the confidence to make smart decisions
• Recognise that learning disabilities can affect more than academics — also time management, organisation, focus, and memory
• Reach out to your child's therapist, paediatrician, school counsellor, and teachers to learn more
• Join parent support groups — local, online, or through Parent to Parent programmes — to connect with others on a similar journey
• Set realistic short- and long-term goals with your child's treatment team
• Stick to a consistent routine to reduce confusion and build security
• Practise empathy and self-compassion rather than self-pity
• Stay involved at school and advocate for your child's Individualized Education Plan (IEP)

Catch-up growth is a faster-than-normal rate of weight and length gain that occurs when a child receives more calories and protein upon arriving home. It's seen among most adoptees, and is critical among children who are severely malnourished.

Refeeding syndrome involves fluid and electrolyte disturbances that occur when children are given too many nutrients too quickly. To avoid it in severely malnourished children, consult a paediatrician or dietician before increasing intake.

Common deficiencies: calcium, folate, iodine, iron (anaemia), protein-energy malnutrition, vitamin A, vitamin B12, vitamin D (rickets), and zinc.

First signs to watch for:

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

Baby formula is the next best substitute for breast milk. When choosing a formula, check its form, protein and carbohydrate type, and other ingredients — it should dissolve easily in boiled water without lumps. Always check for milk allergies with your paediatrician first, and use an iron-fortified, cow's-milk-based formula for the first 9–12 months. Follow the packaging instructions precisely, as too much or too little formula powder can make an infant ill.

Commonly available options in India include Similac Advance, Lactogen, Enfamil A+, Farex Stage 1, and Nutricia Dexolac.

Signs of a food allergy:

• Itchy mouth and throat when eating certain foods
• Hives (raised, itchy red bumps)
• Stomach trouble — diarrhoea, cramps, nausea, vomiting
• Swelling of the face or tongue; trouble breathing

Lactose intolerance occurs when the body doesn't produce enough lactase to break down lactose. It's rare before age 3 but can persist for some children. Calcium can still be provided through lactose-free milk, fortified soy milk, yogurt, orange juice, broccoli, almonds, and ragi — along with a vitamin D supplement in consultation with your physician.

PICA is the persistent eating of non-nutritious substances (sand, ice, paint flakes, glue, chalk, and in more dangerous cases glass, stones, or metal objects). It's often a sign of nutritional deficiency, particularly iron, calcium, or zinc, and may also relate to worm infestation, developmental disorders, or psychosocial concerns.

For some children, PICA resolves with a fairly simple approach; more severe cases need a professional, structured plan. If symptoms persist beyond a month, report to your paediatrician. Helpful steps for parents include:

• Increasing communication with your child
• Creating a "PICA box" of edible items your child can choose from instead of their go-to substance
• Using positive reinforcement when your child avoids PICA behaviours