Tag Archives: International Adoption

Five Reasons to Adopt From China


November is National Adoption Month! I thought I would kick off the celebration by giving some reasons why China’s adoption program might be a good fit for your family.

1. The process is streamlined and predictable. Unlike adopting from foster care, domestic infant adoption, or programs from some (but not all) other countries, the China program has a clearly defined set of steps. Most families will bring home a child 10-15 months after they begin the process. Many people switch to the China program after a failed attempt at adopting through another program, so the stability is appealing.

2. You have the ability to choose your child’s age, gender, and the special needs you are comfortable with. You will not be assigned a child, nor will you be penalized for declining a file which you do not feel is a good fit for your family.

3. China is generous in granting waivers for families or single women who do not meet the program requirements, particularly those regarding family income or parental health. Recently, they even approved a single man to adopt making this one of the few countries where it is possible for single men to adopt.

[Note: As of January 2017, China is no longer granting waivers. Most agencies expect this to be relaxed after a few months as has happened in the past, but no one can guarantee the future. If you do not currently qualify, speak to a reputable agency to find the current waiver status.]

4. Travel is a single two week trip, possibly longer if you are adopting two children, and only one parent is required to travel. Some countries require multiple trips or a lengthy stay in country to complete the adoption. While this gradual approach is undoubtably better for the child or children being adopted, the fact is that many families could not adopt if that were a requirement. China’s travel requirement is one which most families can meet.

5. China allows families to adopt two unrelated children at the same time. While I would urge families to carefully consider this option before deciding to do it, it is something which appeals to many families. [Note: As of June 30, 2017 this is no longer an option in the China program.]


If you are just beginning your adoption journey and found this post helpful, you might consider buying my book which has all of this information and more, including several chapters on travel.


Important Information for Adoptive Parents

This blog is read primarily by people who are adopting or have adopted relatively recently. Those of us who are adopting are benefiting from the Child Citizenship Act of 2000, which automatically grants citizenship to children adopted internationally by US citizens. Unfortunately, this was not retroactively effective leaving thousands of adoptees, who were adopted internationally during the previous decades, in a vulnerable position. Not all adoptive parents took the necessary steps to complete the citizenship process for their children.

The sad results of that inaction are that adult adoptees have been and are being deported if they commit even minor crimes. You can read a long list of adoptees deported as adults on the Pound Puppy Legacy website. While I’m sure everyone agrees that it would be better to never have committed crimes such as possession of marijuana or shoplifting, the punishment of being deported to a country where you have never lived and do not speak the language seems excessive. All adoptees whose parents failed to complete their citizenship paperwork are in a vulnerable position if they ever come to the attention of immigration officials. Deportation has increased over the past decadeThese adults are being punished for the negligence of their parents when they never had a choice in being adopted. 

screen-shot-2016-10-28-at-10-31-37-amHow does this effect you? As an adoptive parent, please support these adult adoptees who did not benefit from the Child Citizenship Act of 2000 as your children did. This past week, Adam Crapser, an adoptee who came to the US at age 3 from Korea, was denied a reprieve. He will be deported to Korea and separated from his wife and three children. Crapser, who was abused by his adoptive parents and ended up in state custody, seems to be the victim of a huge injustice. Was the state not partially responsible for securing his citizenship when he was removed from the custody of his adoptive parents? You can read what the New York Times refers to as a “bizarre deportation odyssey” here.

Please consider taking action by:

Finally, remember that this is why it is SO IMPORTANT for adoptive parents to stay on top of paperwork. It’s easy to delay once your child is home. I have seen countless adoptive parents say that they have not secured a US issued birth certificate for their child, lost their child’s adoption paperwork or Certificate of Citizenship. People lose these all the time when they move or in fires. Be aware that the cost of a replacement Certificate of Citizenship will soon be increasing from $600 to $1170! If you know you need a replacement and have been putting it off, submit the application now before the price increase goes into effect.

Adopting Out of Birth Order or Artificial Twinning

This is the 3rd in my series on special adoption situations. The first was on adopting two unrelated children at once and the second was for those considering adopting an older child.

IMG_5573This post will focus on adopting out of birth order and artificial twinning. Disrupting birth order is when you adopt a child who will not join the family as your youngest. If you have a toddler and adopt a 5 year-old, you have disrupted birth order by displacing your oldest. If you have two children aged 6 and 2, and you adopt a 4 year-old, this would not disrupt any birth order because your oldest would remain the oldest and your youngest would remain the youngest. However, it would still be adopting OUT of birth order as the normal order of adding to the family would be to add a child younger than your youngest. In larger families, the birth order is somewhat fluid. Moving from #5 of 8 to #7 of 9 is not as big of a difference as when you are dealing with one or two children who already have an identity as the oldest or youngest in a family.

Artificial twinning is when you adopt a child under 9 months of age of a sibling. For a time they will be the same age and often will be placed in the same grade at school. Traditionally this is frowned upon by social workers because it disrupts the place of the child already in the family. Now he or she has a “twin” which was not there before. This can cause competition and conflict within the family as the two children struggle to determine who is “alpha” or who is oldest. A child adopted from institutional care would typically be more delayed and immature than a biological sibling of the same age. This might seem to make the artificial twinning a mute point at first, however as time goes on the adopted child might be resentful that they do not get the same privileges of the biological child of the same age such as a later bedtime or driver’s permit.

If you are considering adopting out of birth order or artificial twinning, be aware that this might not be allowed by either your placing agency or your homestudy agency. Generally, the older the agency the more likely they are to stick with what are called “best social work practices.”  These are things such as only adopting one unrelated child at a time, keeping birth order, avoiding “artificial twinning” (ending up with two children of the same age), etc. In most other countries these practices are not allowed but our American independent streak rebels at those sort of absolute guidelines. However, many agencies now are allowing these practices, at least in some situations.

Why any agencies not allow these things? Because agencies which have been around for decades have seen a lot of failed adoptions. I spoke with a representative of an agency often characterized as being “conservative” and “having a lot of rules.” I was told that their top priority was finding the right family for a child. They wanted to make sure that the adoption was successful and they didn’t want to risk the child’s placement by matching them with a family with the potential for disruption.  Please take the time to read my post on adoption disruption for a longer discussion on why you need to keep this possibility in mind as you decide whether or not these special adoption situations are right for your family. Although this article is about whether or not your family is cut out to adopt two at once, these same characteristics will be valuable for anyone considering adopting out of birth order or artificial twinning.

IMG_0584I see people asking about these three situations extremely often in online adoption related groups.  As I mentioned in my post on When You’re Asking the Internet About Adoption, please remember that these groups are full of people who are happy with their experience, and so you will most likely not hear from people who would tell you that they adopted and had a bad experience.  You can hear from many people who disrupted birth order in their family, adopted two unrelated children at the same time, or adopted an older child who was aging out and tell you how amazing it was for their family but that does not help you to know what YOUR families experience will be like.  You are a different family, adopting a different child or children.  That doesn’t mean I’m trying to talk you out of it, I’m trying to make sure that you’ve seriously considered all aspects of the situation.  Thinking about the hard aspects of adoption will only give you more tools to succeed.  Educated and informed families are the best families for children.  

Adopting out of birth order is probably the most common special adoption situation. With the average age of a child adopted from China being 3, there are many families with a toddler at home who do not want to wait for only for files of children who are very young. There are also plenty of families who consider children up to around age 5 with younger children at home. Best social work practice would say that you should adopt a child who is at least 9 months younger than your youngest child on the theory that this would be the closest naturally occurring spacing between siblings. Someone who adopted at the same time as I did spent several months convincing her agency that it would be acceptable for their family to adopt a child who was a mere 8.5 months younger than their youngest so some agencies hold very strictly to these guidelines.

If this is something you want to do, you will need to discuss it with your social worker and placing agency. Much of the success will be determined by the personalities of the children involved but unfortunately you won’t know your new child’s personality when you are making the decision. Here are some questions you should consider before pursuing this path of adoption:

  • Have we considered the personalities and birth order identities of the children already in our family? How will the children in our family likely feel about their new birth order place in the family?
  • What are our expectations for the child we want to add into the family? Have we considered the likely immaturity and behavioral problems of the new child?
  • Are we aware of the natural tendency to compare two children of the same age and how do we plan to deal with that?
  • Can we give a child adopted at an older age the time as “baby” that he or she needs, even if the child isn’t chronologically the youngest in our family?
  • Are we prepared for the baby of the family to imitate undesirable traits modeled by a recently adopted older sibling? Do we have a plan for meeting the needs of the youngest even as we are meeting the needs of the newly adopted child?

Resources on adopting out of birth order and artificial twinning:


If you are just beginning your adoption journey and found this post helpful, you might consider buying my book which has all of this information and more, including several chapters on travel.

Three Years Home


Labor Day weekend marked 3 years since Leo became part of our family. I don’t write as many personal posts on the blog now that it has transitioned from a travel blog for family and friends to a public blog for those considering adoption from China. However, I thought I would take the opportunity to reflect on what I have learned through this three years of adoptive parenting.

Yes, you can love the children you adopted as much as the children you gave birth to. More and more families are adopting after having biological children. A frequent concern is that it might feel different. People always laugh when I say this, but despite having 6 kids, I don’t actually like little kids that much. I’ve never wanted to be a kindergarten teacher, so you can understand how this was a big concern for me. While adoption might seem at first like babysitting the neighbor’s kid, I was surprised by how very quickly each of my sons felt right in my arms. I think the months of paperwork with seeing pictures and getting updates serves as the “paper pregnancy” preparing your heart. No it isn’t instant, but for most families their adopted children are simply their children, whether they also have biological children or not.

july4thSpecial Needs adoption does not require you to be a super parent. So many people are intimidated by the “special needs” label. We were already parenting children with special needs before we adopted–they needed glasses and braces. In the China program, you can choose which medical needs to accept and only receive referrals meeting that criteria. Sure, Leo’s weekly speech therapy, quarterly ENT nurse visit, bi-yearly ENT visit, and annual cleft clinic visit takes up a few more squares on the calendar, but not any more than squeezing in piano or baseball between the pediatrican-dentist-optometrist-orthodontist. August’s limb difference is going to require some intensive surgery this year, but after the initial correction his need will be less time intensive than Leo’s. Yes, these things take time and money, but you do it because it’s your child. We now know these waiting children aren’t “special needs kids.” They’re simply children whose biggest need is a family.

The other kids will be fine! Another common concern we had was how adopting IMG_2256might effect the children already in our family. Were we going to ruin their lives? However, from the very beginning our children embraced the idea of adopting a sibling. It opened their eyes to the fact that there were children who didn’t have a family. While we in no way approached adoption as a charity project, through our many conversations on the hows and whys they have become more interested in ways they could help children in need. Several of our children sponsor a child to help preserve a family, and two of our older children have written papers on adoption for school. I was so impressed by how understanding they were in the early days with grieving or tantrums because they understood what a huge scary change in was in the life of their brothers. Our children have become more caring and compassionate. Adoption changed the lives of all of our children for the better.

Don’t let fear hold you back. Many people consider adoption but few actually adopt. I don’t know what it is that makes some people take that step forward but I know exactly what it is that holds so many people back. Fear. It took us so long to decide to adopt, but before we had come home from China we knew we’d be going back. It changes you that quickly. Less than a year earlier, we had sincerely explained to our social worker that we would be adopting exactly oneimg_0823 child to complete our family. She was skeptical. As many have said before, adoption is hard to start but harder to stop. When you plan your biological family, you ask yourselves many of the same questions–does everyone have enough time and attention, can we afford another child, do we have another bed and seat in the van–but somehow there’s a greater urgency to the question when you’ve seen all those little faces. When you hold a child in your arms while the orphanage director says “This child needs a family.” After you’ve made that trip, it’s easier to understand why some families adopt over and over. (The children in this photo are home with families now. However, one of the little boys we met on this trip had a limb difference. Meeting him caused us to check the limb difference box during our second adoption, which led to August becoming part of our family.)

At this time, we feel our family is complete and have no plans to adopt again. (Famous last words, I know.) But I still remember how it felt to be trying to make the initial decision. How we went back and forth asking if we should or if we shouldn’t. We had so many fears. What I have learned from saying yes is that if you let fear make you say no, you’re saying no to letting your life change in a wonderful way. Saying no won’t prevent bad things from happening in your life. That happens to everyone. Saying yes WILL cause changes in your life. You’ll learn that you’re stronger than you think, what’s really important in life, and your family will be enriched beyond measure by the children that you didn’t know you had until you saw them in a photo.


Finding Your Agency

If you find this post helpful, you might want to read the expanded version in my book which includes even more information on this and all aspects of the China adoption process.


Now that you have an idea of what you are looking for in an agency, how do you go about finding an agency which matches that criteria? Rainbow Kids has 36 agencies listed with a China program, and there could be more who have not chosen to list themselves there. Trying to narrow down that many choices is daunting!

Get Recommendations

Most people will start by getting recommendations. If you know anyone in real life who has adopted from China, that is a good place to start. Where they happy with their agency? If so, what did they like about it? If you don’t know anyone, you can contact me at mineinchina@zoho.com or send me a private message via Facebook (I don’t accept most friend requests but do check my message requests daily) and I will be happy to recommend a couple of  good agencies.

If you have an agency in your town or general area, that is certainly an agency to consider. It’s convenient to be able to attend classes there or to drop off papers directly. However, it is not necessary for your placing agency to be in your area. Many people use placing agencies in a completely different part of the country where they live. Don’t feel an obligation to use an agency simply because they’re close.

Your next stop should be the Rate Your China Adoption Agency group on Facebook. You will get more feedback than you could ever want from parents who have used the agencies. No agency employees or volunteer advocates are allowed to join.

IMG_5308However, I do feel you need to keep some points in mind when soliciting opinions:

  • Ask specific questions. If your priority is matching time, post a question like “We are looking for a reputable agency with a shorter matching time for young girls with minor needs. Can people who have adopted recently give me your recommendations?”
  • Be aware of the timeline. As you might have noticed above, I strongly recommend being prepared to ask “When did you adopt with them?” a lot. Agencies and policies change frequently, sometimes for the better and sometimes for worse. You don’t want to miss out on a great agency because of outdated information.
  • Make sure you have the same priorities. Many people in the Rate Your Agency group will say you should NEVER use ______ agency because the agency uses a committee to decide a match if multiple families are interested in a child. If you don’t have a problem with committee decisions, or not being able to adopt two at once, or whatever issue, then you can freely disregard those negative reviews.
  • Go directly to the source. It’s always best to contact agencies directly with questions about their policies.
  • Be aware that there is no perfect agency. Every single agency that I can think of has made a mistake at one point or another. If my agency made a mistake that caused a mess in my adoption, I probably wouldn’t recommend them either. When you are listening to reviews, what you want to look for is persistent negative reviews. Don’t give too much weight to one person’s bad experience because, while regrettable, mistakes are going to happen.

Evaluating Contenders

When you have a shorter list of five or six potential agencies, go look at their websites. Is it IMG_5598clear and easy to read? Look over their information on program fees. Request the password for their waiting child photolisting to see what sort of files they have available and how they present the information. I have some potential red flags listed in this post.

Do a google search for the agency name along with the keyword “ethics” or “fraud.” Check the Council on Accreditation’s list of substantiated complaints.

Now it’s time to contact any agencies that you haven’t crossed off the list. I would suggest that you give them each a call. Ask a few questions and listen to the contact person chat about their program. How did you like the contact person? Many people will “click” with one agency more than others. Next, send a follow up email with an additional question or two. See how quickly you get a response. If an agency doesn’t make a potential client a priority then be skeptical that you will get any better service as a paying client. You can formulate your own questions based on your priorities, or if you need inspiration I have questions sprinkled throughout the blog series I linked to at the top of the post and a full list in the appendix of my book.

Finally, choose to go with the agency that is the best fit for the priorities you have, taking into consideration the feedback you have received and your personal experiences when you contacted agencies. Best wishes on your adoption journey!

Understanding China’s File Designations

If you find this post helpful, you might want to read the expanded version in my book which includes even more information on this and all aspects of the China adoption process.


This post was updated in April 2018 to reflect changes in the China program.

File Designations

When you choose to adopt from China, you can either choose an agency to match you with a child or you can choose a waiting child and sign with the agency who has their file. There are pros and cons to either of these matching methods. Let’s begin by discussing the different types of files.

Shared List – The shared list is a listing of files available to any agency. For many countries outside of the US, it is the only source of files. The shared list can only be viewed by agency personnel and is composed of both LID and Special Focus files. At any given time, the shared list is about 75% boys and 25% girls. There are usually very few LID files on the shared list because they get locked almost instantly by agencies. With the partnership program ending, China will be moving to an all shared list system for file distribution.

LID Files – Your LID is the Log In Date for your dossier. LID files are reserved for families who already have a dossier logged into China’s system. LID files tend to be younger children with minor needs. Because adoptive parents overwhelmingly prefer to adopt girls, girls will often be designated LID to an older age or with more moderate needs. Fewer boys are labeled LID, and boys are more likely to be designated as special focus even if they are young and with minor needs. LID files are designated to an agency for only 3 weeks, and they may be switched to Special Focus if they remain unmatched after about 3 months. It is unlikely that LID files will continue to be designated to agencies once all partnership files have been completed.

Special Focus Files – Special Focus files are files which China feels will need a little more help to place. For that reason, they may be matched to a family who does not yet have a dossier in China. Special Focus files are often for children who are a little older, or have moderate or greater special needs. However, as LID files can be changed to Special Focus simply for not being matched quickly, it is very possible to find young children with minor needs who are designated Special Focus, particularly boys. If you fall for a child who is labeled Special Focus, don’t worry that you are missing something. The only thing you are missing is a wonderful opportunity to add a child to your family!

This post has some examples to give you an idea of Special Focus versus LID files.

Designated Files – Designated files are any files not on the shared list, but designated to a particular agency. Previously, this could be through a partnership, a program such as Journey of Hope, hosting program, or simply because the agency requested the file be designated to them. Moving forward, designated files are likely to be those which have not been matched after a period of time on the shared list. Designating files to a specific agency for advocacy makes it more likely for the child to find a family.

Partnership Files – Previously, agencies would partner with specific orphanages. In exchange for providing aid to the orphanages, any files prepared from that orphanage would be designated to the partner agency first for a period of time. The partnership program was ended in 2017.

Finding Your Child First

IMG_0086Many people prefer to find their child first and use the agency which has the file. Because of new regulations from the US Department of State you will need to have a completed home study before you can be matched with a child. Finding your child first will involve adopting a child designated Special Focus, so you will need to be open to at least a moderate amount of needs. Flexibility in gender and age is also helpful. People who prefer to find their child first often like the idea of adopting a waiting child or like to have more control over the matching process. If you find your child first, you will have a longer wait from the time you identify a child until you travel, so consider how you would feel about that when deciding if finding your child first is best for your family.

Besides agency photolistings, here are some ways to view waiting children, most agency designated:

While some people are fine with using any agency which has their child’s file, others prefer to rule out a few agencies that they absolutely would not use. It can be useful to ask a few questions to make sure you are comfortable with an agency before viewing their files.There are three different methods that agencies use to decide which set of potential parents will end up with a child on a photolisting. I know this information makes the post a little long, but it is important to ask the agency how they will match photolisting files with families, because you might not be the only one who is interested in the child.

The most common is First Come, First Served. The first person to ask for the file gets to review it, and other people who want to review the file are added to a list. The first couple has a certain amount of time to review the file and decide–maybe a few days, maybe a week or two. (While files which are pulled from the shared list are only locked for 72 hours, agencies have a greater latitude in their designated files.) If they decline the file then it is passed to the next family on the list, and so on until someone is ready to submit a Letter of Intent (LOI).

Pros: Only one family views a file at a time, which does not put pressure on the family to rush into a decision. First come, first served is a principle which seems fair to Americans (further on into the process you will realize this is not an Asian view), so it is not as disappointing to not get matched with a child you love. You know it’s not personal, you just weren’t first in line.

Cons: This can really drag out the process for the other families and the child involved. If there is a child who is seriously cute but with a serious medical condition, the file could be viewed numerous times before someone is ready to write a LOI. One parent told me their child’s file was turned down 50 times before they accepted it! For children with time sensitive medical needs or who are close to aging out, this method can waste valuable time.

Let’s call the second method of matching Race To The Finish! Agencies who use this methodOLYMPUS DIGITAL CAMERA will allow all interested families to view the file at the same time. The first family who is ready to write a LOI gets the child.

Pros: This more efficient methods cuts down on the wasted time of First Come, First Served.

Cons: This method can really pressure families to make a decision before they’re ready. Maybe they’re still waiting to hear back from a doctor who reviewed the file but they don’t want to chance losing the child. Unethical agencies can pressure families to act quickly by saying they think another family is really interested when really, they just want to close to deal and get you to sign.

The third method is Committee Decides. Multiple families are allowed to view a file at the same time and if multiple families are ready to move forward then an agency committee chooses from among the potential families.

Pros: Committee Decides is the least popular method and it is easy to find people who are angry about it online. From my perspective, I’m not sure how “I saw her first!” is any more fair? Committee Decides is a child-centered method to find the best family for a child. While most of the young children with minor needs would thrive in any loving family, there are often instances where some families would be a better fit than others. If a child has a time-sensitive special need such as Thalassemia, isn’t better that they be matched with a family who is already DTC so that they can come home six months sooner than if the family who saw the child first was only starting on their home study? Wouldn’t a better family for a child who is deaf be a family who is already fluent in sign language and a part of the deaf community? How about older children? Wouldn’t the best family for an older child be a family who is experienced with the challenges of older child adoption and who has parented past the age of the child rather than a family with only younger children and just beginning their first adoption? So I will take the unpopular stance and say that I think this method is better for the children who are being placed.

Cons: I will also acknowledge the serious flip side to this method, which is that it is harder on the potential families. It is very common for people to feel emotionally connected to a child from the first moment they see the picture. I can understand how devastating it must be to feel deep in your heart that this is your child, and now a committee is telling you that there is another family better for the child than yours. Not only is it a loss, but it comes as a veiled insult. If you feel you can’t handle the heartbreak of a committee deciding that you aren’t the best family for a child then it is important to know which agencies use this method and avoid their photolistings.

Next week we will look at more general agency considerations for those families which prefer to choose an agency first.

More considerations when choosing special needs


Categorizing the special needs

This post is a continuation of my post Which Special Needs? which discussed choosing which  special needs are a good fit for your family.  Now that you’ve taken some time to consider what resources you have in your area, what sort of time commitment you have, and other practical factors let’s look at some other considerations.  

For the majority of people, the question might be “What are the easiest needs?”  However, other people might want to adopt a child who is considered difficult to place so they might be asking “Which are the needs which few people are willing to accept?”  Here are a few different ways of categorizing the special needs which are found in files:

What are the most common needs people are open to when they are looking for a child with minor needs?

  • Minor and correctable heart conditions
  • Cleft lip and cleft palate
  • Club feet
  • Birthmarks
  • Treated congenital syphilis
  • Missing or extra digits

These represent special needs which are correctable, do not affect intellect or mobility, and are generally less visible once corrected.

What are the most common special needs in the files made available for adoption?

  • Cerebral palsy
  • Heart conditions
  • Down syndrome
  • Hydrocephalus
  • Cleft lip/cleft palate
  • Limb differences
  • Spina bifida
  • Anal atresia

This list is pretty much a list of the most common birth defects in any human population with the exception of anal atresia which has a higher incidence in China than in the US.

What special needs do the children have who are most difficult to place?

  • Being a boy
  • Any intellectual/cognitive delay
  • Urinary or bowel incontinence
  • Uses a wheelchair
  • An identified syndrome
  • Visual impairment
  • Disordered Sexual Development (genital malformation or intersex disorder)
  • HIV+
  • Cancer, or a history of cancer, such as retinoblastoma

Other than being a boy, these are all things that cause people to go “I just couldn’t handle that!”  We will discuss some of these needs later on because often they are not so scary if you have a better understanding of what is involved in the need.

Which special needs are matched fairly quickly for girls but cause boys to wait for families?

  • Albinism
  • Giant congenital nevus
  • Dwarfism
  • Ichthyosis
  • Microtia
  • Deafness
  • Age*

Girls with these needs are so easily matched that their files are often labeled LID only if they are young.  What is interesting about this collection of needs is that with the exception of deafness they are all visible needs.  In some ways you might expect this to have a greater impact on girls than boys.  Perhaps similar to the impulse people feel to adopt “unwanted” girls as a way to show that they have value, people also decide to adopt a girl with a visible special need because they want to teach her that she is beautiful in her own way as a reaction against a society which prizes beauty in girls.  

*Older girls are not matched quickly in the way that young girls with the medical needs listed are.  However, it is substantially more difficult to find a family for an older boy than an older girl. There are twice as many boys as there are girls over age 10 on the shared list.

Which special needs will lead to a shortened life expectancy due to the limitations of health care available in an orphanage if the child is not adopted?

  • Cancer
  • HIV+
  • Thalassemia
  • Congenital heart conditions
  • Hemophilia
  • Spina bifida

These conditions really have nothing in common.  Children sometimes receive heart surgery or chemotherapy in China, but the quality of medical care is usually much better in the US.  However, congenital heart conditions and cancer are still potentially lethal for the children even if they are adopted and receive the best treatment available.  

Chronic blood shortages mean that children with Thalassemia are not infused as often as needed causing their life expectancy to be only age 10 in China, while they are expected to live normal lives in the US.  The clotting factor given to people with hemophilia in the US is not available in China, so the life expectancy of a hemophiliac there is only to age 24.  

Children with spina bifida or other diagnoses which can cause incontinence who are in orphanage care in China are often left in diapers rather than using a catheterization routine.  This can lead to routine bladder infections and over time cause the kidneys to stop functioning.

China has a strong stigma against HIV+ individuals.  Medication may not be as readily available and HIV+ individuals, even children, are often turned out of hospitals when they are ill because of their status.   While the long term life expectancy of children living in the US who are HIV+ is uncertain due to how recent the medical advances have been, those whose viral load remains at the “undetectable” level is currently assumed to be the same as the general population.


What parents want you to know

This final section should not be considered medical advice.  Rather, I’m going to pass along some information shared by parents of children who have some of those “I could never do that” special needs.  These are the needs that I often hear people saying “I never considered this need but there is a child I am drawn to who has it.  Can you tell me what daily life looks like?” If this information helps you to think a need might be a possibility for you, I would encourage you to do more research.

Blindness/Vision Impairment– More people are open to albinism as a special need than to other vision impairments, which is a confusing phenomenon when you consider that most people with albinism are legally blind.  So many parents find any special need associated with vision to be very scary because they can’t imagine what their own life would be like without sight.  What parents who have adopted visually impaired children want you to know is that they find it so easy, they feel it really shouldn’t be a special need at all!  These kids compensate in so many other ways for their loss of vision.  Most attend public schools and will grow up to marry and lead productive lives.  I had a friend in high school who was blind.  He taught me to play chess, was the marching band drum major, walked across four lanes of traffic every day to take calculus at the university near our high school, and is now a professor of music.  However, children with VI who are adopted from China will need time and therapy to overcome the delays they experience due to caregivers who don’t understand how to give them the non-visual stimulation they need to grow and develop.

Deafness– Surprisingly, what I heard from parents who have adopted children with this special need was kind of the opposite than that of blindness.  Parents want you to know that the communication is a greater challenge than they expected, but it is worth the effort.  It is vital that you have access to resources to learn ASL, something you should begin doing before you even meet your child, because they will soon surpass you.  Ideally, your entire family would sign all the time, even conversations which don’t include your deaf child. Being unable to take part in routine conversation, even indirectly, will over time cause your child to feel excluded.  While hearing aids and cochlear implants are helping children to hear, they sometimes fail so having the ability to sign will insure that he or she always has a way to communicate.  Finally, be aware that there is a deaf subculture and topics such as whether or not to implant children, or send them to a school for the deaf versus mainstream education are all very loaded topics.  As with any special need, it will be up to you to educate yourself and be your child’s advocate.

Disordered Sexual Development– This is a very large category of special needs which means that there is an abnormality in the systems which affect a child’s sexual development.  Some of these children have hormonal abnormalities such as with Congenital Adrenal Hyperplasia (CAH) while others might have physically ambiguous genitalia, often labeled by the antiquated term “hermaphrodite” in Chinese files.  These files will often be listed as “sensitive special need” on advocacy photolistings.  Parents who have adopted children with these special needs want you to know that these kids are healthy and normal!  Their greatest need is for a loving family who will support them as they develop a sexual identity as male or female, protect their privacy, and help them to navigate peer and romantic relationships as they grow.  Being within travel distance of a specialized DSD clinic is important to make sure your child is getting the most modern treatment options.  Be aware that surgery to assign a gender to a child at a young age is not medically necessary.  The current recommendation is to wait on surgery until the child is old enough to want it, and many adults with DSD have chosen not to have surgery at all because they are happy with their bodies intact.

HIV+– Parents want you to know that dealing with people’s ignorance is the greatest challenge about adopting a child who is HIV+.  Thanks to new medications, the virus can reach levels so low that they are “undetectable” in a blood test.  This means that as long as they are taking their medication twice a day (sometimes dropping to once a day after age 12) they can expect to have a normal life expectancy.  Many HIV positive adults are married and have biological children with an HIV negative spouse.  Insurance companies will pay for the medication and there are many programs available which will even cover the cost of the copayment.  Most families pay only $30-$60 per month for their medication.  China currently considers HIV+ children to be unadoptable so few files are made available.  This will change if more families request HIV+ children, so let your agency know if you are open to this need.  Be aware that most of the  HIV+ kids available for adoption are usually older and have come into care after the death of their parents.  These files will often be listed as “sensitive special need” on advocacy photolistings.

Hydrocephalus– This diagnosis literally means “water on the brain” and it is a condition in which there is excessive fluid in the brain.  It is sometimes the result of brain damage or occurs in conjunction with spina bifida.  Hydrocephalus is most commonly treated by a surgical procedure to shunt the excess fluid away from the brain.  Hydrocephalus can cause brain damage if left untreated but it is typically not a condition which affects intelligence.  Parents of children with hydrocephalus find this condition to be very manageable.

Incontinence– Parents want you to know that yes, you will deal with pee and poop.  However, this doesn’t mean your child will be attending prom in diapers!  There are many modern medical advances which make it possible for people with incontinence to achieve “social continence” which means that they wear normal underwear.  Urinary incontinence is usually managed through a catheterization routine.  Children are able to self-cath by age 8 and sometimes younger with girls usually becoming independent before boys.  Bowel management can mean routine enemas or surgical methods which ease the process.  Social continence isn’t achieved instantly, so you should have a flexible attitude and a good sense of humor as you work with your child’s doctor to find the management system which works best with your child. 

Spina bifida– This is a very common birth defect with a wide variation.  The most common associated conditions would be reduced mobility, incontinence, and hydrocephalus. Please refer to the entries related to those conditions. Club feet is another associated condition, so if you are open to club feet as a need you might want to research spina bifida as well because you could learn once your child is home that they actually have a mild form of spina bifida.   Children with spina bifida are intelligent and grow up to live independent and productive lives.

Wheelchairs– Parents want you to know that children are not “limited” by a wheelchair.  It gives the child mobility that they are lacking!  If you are adopting a younger child then you probably do not need a special house or van, although many parents find these helpful once the child is too heavy to lift.  Depending on their special need, your child can probably get him or herself up and down stairs, into a vehicle, in and out of their wheelchair, and live a fully independent life as an adult.  Most parents say the most difficult aspect is visiting private homes which do not have a wheelchair ramp to enter, but portable ramps can be purchased to take along when you visit friends and relatives.

Many parents begin their journey into the world of special need adoption tentatively, and asking “what are the easiest needs?”  However, my hope is that this post will cause you to consider the many children who are waiting because of their particular special need.  You might be scared about a need being too difficult for you, but also consider how much more difficult life will be for that child without what they need most–a loving and supportive family.  For more information on these or any special needs, please join the Special Needs Resources group on Facebook.



If you are just beginning your adoption journey and found this post helpful, you might consider buying my book which has all of this information and more, including several chapters on travel.