Complex Kids Need Specialized Care

Children who Join Families through Adoption Have Specific Medical Requirements

By Dionne Joseph

Eyal Dagan and Chris Poore’s children are thriving. Seven-year-old Sam just competed in his second golf tournament, while his 6-year-old sister Bella is busy exploring her passions of fashion, art and dance.

Both children were adopted by the couple and as with any family, they’ve had their ups and downs — including medical challenges with Bella, who was born six and a half weeks early. That’s when Dagan and Poore discovered adoption medicine.

The New York-based couple had been matched with Bella’s mother in a pre-adoptive arrangement, who lived in Florida. When health issues caused Bella’s mother to deliver prematurely, the couple was put in touch with Dr. Melissa Goldstein, a physician at New York City’s Carnegie Hill Pediatrics who specializes in interpreting birth records. This connection was vital, they said.

Newborn Bella required an extended stay in the Neonatal Intensive Care Unit. It was a stressful time for the family, and they relied on support from Dr. Goldstein. “She would call into the hospital every morning after rounds and call us every night to explain,” Dagan said, explaining that since the baby was born in Florida, Goldstein consulted from afar. “So basically, she was like an off-site NICU doctor.”

When the family returned to New York about a month after Bella was born and her adoption finalized, they were so impressed with her care, they chose to keep Dr. Goldstein as their pediatrician despite a significant distance they travel to see her.

The parents appreciate Dr. Goldstein’s knowledge, accessibility and her familiarity with the complexities of adoption.

“She understands so much more. She’s attuned to missing information,” Dagan said, referring to gaps in the health history of Bella’s birth parents.
Like Bella, children who join families through adoption may have special health, behavioral and developmental needs, according to the National Council for Adoption (NCFA).

Adoption medicine refers to healthcare professionals who are committed to understanding these kids’ health needs within the complex context of adoption.

This unique field of medicine includes general practitioners and pediatricians who are familiar with interpreting medical records, are concerned with pre- and postnatal care, are typically trauma-informed, and can assess and support the medical, behavioral and developmental needs of adoptees or children experiencing foster care.
Adoption medicine was developed in the 1980s when international adoptions were more common.

Though these adoptions are much less common today, adoption medicine doctors still often consult with these families. They may offer support regarding certain countries’ laws and regulations and health issues specific to that region.

For example, the NCFA recommends that internationally adopted children be evaluated for undiagnosed health problems, especially infectious diseases and micronutrient deficiencies based on the child’s birth country.

An estimated 60% of children being adopted from another country have a serious medical condition, according to the International Adoption Clinic at the University of California-San Francisco’s Benioff Children’s Hospital.

“One person who should be involved in the adoption process is a medical doctor,” said Goldstein, who worked as a pediatrician in Russia where she performed pre-adoption evaluations for international couples who wanted to adopt children from Russian orphanages.

Part of her job is helping families navigate domestic and international adoptions while providing pre-adoption medical counseling.

She helps interpret medical records so that families understand the risks associated with a prospective birth mom’s health history. “I dissect medical records and talk about what it means,” Goldstein said. “I have a checklist I go through with people before they get matched (with a prospective birth mom).”
A sound interpretation of available and ongoing data is crucial since medical records may be incomplete, or a prospective birth mom may miss prenatal appointments. Goldstein said most parents she works with who are considering adoption have accepted the likelihood of prenatal drug or alcohol exposure.

Early in the process, adoption medicine doctors provide an “evaluation of information” that gives peace of mind to adoptive parents. “It helps to have someone to bounce things off of,” Goldstein said.

“It is the best hand-holding and comforting available in an otherwise difficult and stressful journey,” Dagan said.

While international adoption has dwindled, there is a growing demand for adoption medicine professionals to assist families adopting children who have been exposed to drugs or alcohol during pregnancy, particularly amid the national spike in opioid use disorders.

Neonatal Abstinence Syndrome (NAS) is an umbrella term for the cluster of symptoms a baby who is prenatally exposed to substances, particularly opioids, displays after birth.

According to the Center for Disease Control the number of babies born with NAS increased 82% nationally from 2010 to 2017. Increases were seen for nearly all states and demographics.

These numbers don’t include other classes of substances or alcohol, which is by far the most damaging to a developing fetus, according to experts. An article from the National Institutes of Health states, “prenatal alcohol exposure may have a broader range of effects — and more permanent effects — than prenatal exposure to other drugs.”

This is partly due to the accessibility of alcohol and the quantity a mother can consume while pregnant.

Symptoms of fetal alcohol spectrum disorder are wide-ranging, and can occur at any point in a child’s life.
Data suggests that children who are adopted or in foster care are significantly more likely to struggle with these illnesses. For many years, doctors did not well understand these conditions.

An adoption medicine doctor is able to put this information in context and provide trauma-informed care to the kids and families.

Dr. Todd Ochs, a Chicago-based pediatrician who has been practicing adoption medicine since 1997, said that assessing children’s experiences prenatally and postnatally, and what environment they were in prior to adoption, is critical to holistically understanding their health and needs. “When kids come into care, they may have inherited psychiatric diagnoses,” said Ochs, who has served more than 1,000 internationally adopted children and runs a sleepaway camp for children with FASD. “They may have endured prenatal substance exposure, prenatal malnutrition, postnatal malnutrition, and certainly postnatal trauma.”

The importance of healthcare that takes all of these factors into account cannot be overstated, Ochs said: “Their futures depend on it.”

As the father of five daughters, one biological and four internationally adopted with special needs, he knows hope and love are essential but not exclusive. “Love is important, but it doesn’t fix everything,” he said.

The information that he shares with patients is often hard to hear, and Ochs admits his recommendations only go so far.

But while this specialized medical care can be a game-changer for families, it is not always easy to access. As many foster, adoptive and kinship families can attest, receiving adequate treatment for children can be arduous.

The emotional toll on a family and the financial cost can dampen the joy that parenting is supposed to bring. The isolation of living with a child with complex needs, coupled with poor healthcare, is exhausting.
With these limitations in mind, Ochs has some wisdom for those considering international or domestic adoption. “Learn as much as you can about the child before, so you can provide what they need. Set-up ahead of time allows the luxury of exploring a relationship with the child.”

While this is ideal, he cautions that parents “will never have the full story” of their child.

Second, he encourages parents to ensure they have access to resources. Think about the proximity to hospitals and providers and the availability of psychiatric resources.

Finally, he encourages parents to determine if they can handle a child with potential special needs emotionally and financially.
Doctors who practice adoption medicine are there to guide families through a complex web of developing bodies, family histories, international borders and systems like foster care.

They work as interpreters, advisers, encouragers, and probably shoulders to cry on when the information they share is overwhelming.

Like all providers, they bring training and expertise to the table. They are great consultants, but ultimately, the choice to adopt a child with unique needs is personal. Foster, adoptive and kinship parents move toward the mystery of parenting, hoping for the best. Adoption medicine doctors do, too. “I’m in pediatrics because children are resilient human beings,” Ochs said.

If you have a child with Fetal Alcohol Spectrum Disorders between the ages of 9-18 who may benefit from camp, learn more about Camp-A FASD Community at


Given the name, “Auntie Mom” by her first foster daughter, Dionne Joseph has been fostering since 2016. She is an adult transracial adoptee who has also had the privilege of adopting. Joseph serves on Washington’s Parent Advisory Group and is an advocate for children and families. A writer and runner from the Pacific Northwest, Joseph and her husband have five children, Goldendoodles and cats.