Recommended Screening Tests
and Evaluations for
child under adoption
Kopila- The Well Baby Clinic performs a variety of screening
tests for children being considered for international adoption.
These tests are essential for the health of adopted child and the
family as this provides adoptive parents with an unbiased assessment
of the child’s condition, so that a parent can make this crucial
decision in the most informed way.
This service consists
of two parts:
1. Medical evaluation
2. Neuropsychological screening (developmental screening)
1. Medical: the evaluation consists of a review of all available
medical records, physical examination, vision and hearing screening
(if age appropriate), laboratory tests and interpretation, and
anticipatory guidance about attachment and well child concerns,
especially those relevant to the post-institutionalized child.
There is consensus among adoption medicine specialists about the
screening tests that should be performed on every child adopted from
abroad initially. The list below is a more comprehensive list
recommended by most adoption medicine specialists and as per
guideline recommendations on Redbook of Pediatric Infections, a
publication of the American Academy of Pediatrics.
Children adopted from Nepal may have one or more of the illnesses
with absolutely no symptoms, namely no cough for TB, no diarrhea for
parasites, no jaundice for hepatitis B, and no growth failure for
These tests are done in state-of-art medical laboratories (in
Nepal and abroad) so that these tests need not be repeated when the
child arrives at the adopted home country.
It is suggested that families make an appointment with Kopila
Clinic as soon as you arrive in Nepal, before or after adoption
process begins. This will allow you to have your child examined for
any contagious illnesses, evaluated for any conditions that need
additional medical referrals (chronic problems), and allow to review
the child's immunization status.
Recommended blood, urine and screening tests
Your child should have several blood tests before or after
adoption process begins. If it is done before the process, you can
make informed decision on the adoption, and if done after, you will
be well prepared to deal with any underlying problems.
- A Hepatitis B profile is needed to
evaluate children for acute or chronic hepatitis B. This should
include the Hepatitis B surface antigen , Hepatitis B core
antibody and Hepatitis B surface antibody (HBsAg, anti-HBc or
HBcAb, and anti-HBs or HBsAb). These basic tests will show
if a child has hepatitis B, has been exposed or has had the
vaccine, or is a carrier of the disease. If any of the tests are
positive, the doctor may recommend further testing to delineate
the extent of the illness. It is necessary to do all of the
tests listed above (and not just the Hepatitis B surface antigen
commonly done by most doctors as a screen), as up to 60 percent
of children with Hepatitis B may be missed with only doing the
usual blood screen.
- Hepatitis C has also been seen in
some adoptees, and it is recommended that all international
adoptees be screened for the antibody to this virus.
- HIV testing by ELISA for HIV-1 and
HIV-2 is recommended for all children. This illness,
although not very common in Nepal unlike other Asian countries
like Cambodia and Thailand, is recommended for parental peace of
mind and for early identification of HIV.
- A stool examination for ova and
parasites, giardia and bacterial infections is recommended
for all adoptees from Nepal, not just (but especially) for those
with diarrhea. Children living in orphanages in Nepal are at a
higher risk, as are children who are significantly malnourished.
It is not necessary for children to have diarrhea for them to
have illnesses diagnosed by these tests.
- A complete blood count (including
Hemoglobin) to check for anemia, allergies, and/or infection is
- A blood test for VDRL (usually
syphilis) is recommended to evaluate the child for syphilis,
which could have been acquired from his/her birth mother. If
this test is positive, further blood tests are necessary. A
spinal tap to check for Neuro-syphilis which could cause
developmental problems may also be recommended..
A screen for hypothyroidism
(a TSH) is recommended now for all children adopted
internationally. Some babies are born with thyroid
problems not seen at once. Screening tests are available for
hypothyroidism (deficiency of the thyroid hormones), which is
extremely essential for the normal brain development of a baby.
Congenital hypothyroidism, a case of inadequate thyroid hormone
production in newborn infants, is the most common disorder
identified by routine screening.
This can occur because of an anatomic defect in the gland, an
inborn error of thyroid metabolism, or iodine deficiency.
Iodine deficiency disorders (IDD) affect an estimated 10 million
Nepalese nationwide, which is almost half of the entire
population and one of the highest in the world. Congenital
hypothyoidism retards growth and brain development. If it is
detected in time, a baby can be treated with oral doses of
thyroid hormone to permit normal development. It is difficult
to identify the babies with this problem by just looking at
them. But by doing a blood test on a few drops of blood, this
problem can be detected as early as first few days of life.
Most birth children born in the US or other developed
countries are screened for this disorder before discharge from
the hospital of birth.
- A PPD test should be placed on a
child's arm to screen him/her for tuberculosis. Many children
born in hospitals in Nepal receive a BCG vaccine shortly after
birth while some are also born at home, thus not getting
opportunity for BCG shots. This vaccine is supposed to protect
against tuberculosis, and the children may have some reaction to
the PPD after receiving this vaccine. However, it is still
strongly recommended that all international immigrants,
including children from Nepal be screened for exposure to
tuberculosis, regardless of whether they have received the
vaccine. This test can safely be done on children as young as
two months, as long as the BCG scar is not freshly healing. It
should be read (looked at to see if it is positive or negative)
in 48 to 72 hours by Kopila health care professional, not just a
parent. Because these children are children at high risk for
disseminated tuberculosis (spreading beyond the lungs,
potentially to the kidneys and brain), a positive result is one
where the injected area is raised above the skin 10 millimeters
or more. The interpretation of this test does not change even
if the child had the BCG vaccine.
- A urinalysis should be done on a urine
specimen to evaluate for any blood, protein or infection in a
child's urinary system that may need further evaluation.
Other recommended evaluations
- In addition to blood and urine testing, it
is strongly recommended that children have other medical screens
for problems for which he/she is at high risk. Some of these
problems may have no apparent symptoms at the time of his/her
adoption, but statistics show that these children are at
increased risk for concerns in these areas.
- A hearing screen is recommended for
all children adopted from Nepal. Early intervention with
children with hearing impairment is necessary to ensure proper
language development and hearing augmentation, so it is helpful
to have this screen done soon after you decide to adopt.
- Likewise, a vision screen and
evaluation by an ophthalmologist is recommended. Crossed eyes is
a common problem in institutionalized children. As children from
orphanage does not have birth history, it is not known if the
birth mother had any infections that could compromise the
child's vision long term. These infections could include
Toxoplasmosis (a parasite infection often passed through cat
feces) and Rubella (German measles). Similarly, a family history
of eye problems is not known, so the ophthalmologist should
screen for any hereditary eye problems.
2. Neuropsychological screening (developmental
screen is recommended to evaluate a child's developmental level
of a child. In some countries this information may also be useful in
helping a family to qualify for a special needs adoption subsidy.
This can be done by a pediatrician at Kopila through a test known as
the Denver Developmental Screening Test (DDST). The advantage of
having DDST done at Kopila rather than in home country is that this
developmental screening ideally should be done in the child’s
primary language and such opportunities are rare abroad.
Some children placed at orphanage will have received
immunizations prior to their adoption. Others may receive
immunizations at the time of their medical evaluation for adoption.
Generally, the timing falls into one of three categories:
Immunizations given to children while in orphanages should be
repeated. According to multiple adoption medicine specialists,
blood testing performed on children in similar institutional care
who had received immunization from government hospitals in Nepal
demonstrated that the children did not have full antibody protection
against the diseases for which they had been immunized, despite
records that reflected a full set of immunizations. There are strong
questions about the proper storage and administration of the
vaccines, as well as whether the records are even accurate
reflecting that the shots were even given. All live virus vaccines,
such as the MMR (Measles, Mumps, Rubella or German Measles) and
Chicken Pox vaccine should be repeated (once the HIV test is shown
to be negative). Blood testing should also include testing for the
Hepatitis B Antibody (as mentioned earlier), as this will show if a
child has antibody to Hepatitis B. Most of the vaccines used these
days have such low side effects that it is safe to repeat them, even
if a child actually received the vaccines at orphanage.
Immunizations given at Kopila – The Well Baby Clinic are
proven to be more reliable, and do not need to be repeated. Vaccines
at Kopila comes directly from the International Manufacturers in
Lyon, France, Belgium and the United States, maintaining proper cold
chain and after it arrives at Kopila, utmost care is taken to insure
its shelf life as per the guideline recommended by CDC, USA. Again,
it is completely safe to repeat most vaccines, with no risk to a
Immunizations given to children at the time of the medical
evaluation for the visa are considered to be the safest and most
reliable of the vaccines. The record needs to be presented to Kopila
staffs so that s/he can then time the administration of future
vaccines using that information.
We strongly recommend that you include taking up
adoption package at Kopila in the adoption process because agencies
and facilitators are rarely qualified to assess a child’s health. If
a child is deemed to be healthy in the host country, an agency will
typically accept that assessment. Nevertheless, it is common to
identify health issues in the records of these children that should
be disclosed to parents. While many conscientious agencies
recommend or require comprehensive screening tests, others do
not recommend “looking for trouble” or performs tests merely to
The process: The medical records and growth data
review, physical examination, blood screening tests and
developmental tests are carried out by Dr. Anu Amatya at Kopila and
then these reports are scrutinized for evidence of conditions that
impact long-term health (such as evidence of microcephaly, or
prenatal infections, for example). Families will receive a written
report as well as consultation over the phone or in person. It is
understood that this is a time-sensitive process, so every effort is
made to complete the assessment within 7 days.
Background of Anu
Dr. Anu is a Consultant Pediatrician and
adoption medicine specialist at the Kopila – The Well Baby Clinic,
Pulchowk, Lalitpur, Nepal (00977-1-5542767). She is trained in the
USA and has more than 14 years of Pediatric experience in many
countries in Asia, Africa and North America including the United
States. She provides health evaluations for pre and post adoption.
Currently she sees about 200 patients per week which includes 8-10
international adoption per week.
Fees: Complete adoption
screening package including follow-up information and conference
with your pediatrician in your country –NPR 38,684.00 (equivalent to US$
563.00 @ 1 US$ = NPR. 70.00)
This adoption Package include following tests
which are in agreement with recommendations by the American Academy
of Pediatrics, Committee on Infectious Diseases as well as a
consensus of physicians in the US and other developed countries with
expertise in international adoption:
- Physical Examination
- DDST (Denver Development Screening Test),
a developmental exam essential for all international adoptees.
- Vision and Hearing Screening Test
- Comprehensive Blood Work
(To rule out Anemia, Recent infection
& Chronic infection)
Complete Blood count with differential and platelets
Renal Function Test
(To assess Kidney Function)
Liver Function Test-
(To Asses Liver Function)
Bilirubin (total, direct &
Gamma Glutamyl Transferase
Serum Total Proteins
Serum Albumin/Globulin ratio
HIV (I & II)- (ELISA Method)
Hepatitis B serology (C.L.I.A Method)
Hep B surface antigen (HBs-Ag)-E.L.I.S.A Method)
Anti Hep B core antigen-total (AHBc-T)
Anti Hep B surface antigen-total (AHBs-T)
Anti Hep B core antigen-IgM (AHBc-IgM)
Anti Hep C virus- Total (AHCV)-E.L.I.S.A Method)
TORCH Profile- (E.L.I.S.A. Method)
Toxoplasma Gondii (TOXO)-IgG
Toxoplasma Gondii (TOXO)-IgM
Herpes Simplex Virus (HSV)-IgG
Herpes Simplex Virus (HSV)-IgM
Thyroid Hormone Test (C.L.I.A. Method)
(To Asses Thyroid Function)
Free Tri-idothyronine (FT3)
Free Thyroxine (FT4)
Thyroid Stimulating Hormone
Serum Level for Lead, G6PD and PKU
(To assess Urine infection)
(To rule out Worms/Giardia)
Mantoux Test (to rule
Recommended Vaccine (not included in the package)