Screening protocols

beakersWe recommend a visit to the Adoption Medicine Clinic where our team, which includes pediatric and developmental specialists, will provide a comprehensive evaluation of your child. Our areas of expertise include interpretation of lab screens and assessment of immunization status based on the child's country of origin and medical history. By doing these labs in our clinic we can often avoid repeated needle sticks to draw the blood specimen for the tests.

New International Adoptee

  • Viral
    • Hepatitis A total Ig (with reflex testing for IgM if total Ig positive)
    • Hepatitis B (SAg, SAb, Core Ab)
    • Hepatitis C Ab
    • HIV 1 and 2 Ab
  • Bacterial
    • Syphilis screening (antitreponemal Ab, RPR or VDRL)
    • Tuberculin skin test (TST) if less than 2 years old
    • TST or QuantiFERON blood test if 2 years old or older
  • Parasitic
    • Stool examination for ova and parasites (x 3)
    • Giardia Stool antigen
  • Vaccine Preventable Infection Titers (if documentation of prior immunization)
    • Measles, Mumps, and Rubella Ab
    • Diphtheria and Tetanus Ab (can assume Pertussis immunity of DT both immune on testing)
    • Haemophilus influenza type b Ab
    • Varicella Ab
    • Alternative approach is revaccination according to current guidelines
  • General Health Screening
    • Complete blood count with differential, including a peripheral eosinophil count and red blood cell indices
    • Vitamin D total
    • Iron panel including C-reactive protein and ferritin
    • Thyroid stimulating hormone (TSH) and free thyroxin (free T4)
    • Lead
    • Haiti specific: G6PD, hemoglobin electrophoresis, malaria thick/thin smear if coming from a malaria-endemic area
    • Intellectual disability, syndromic features
      • Microarray
      • Fragile X testing- most females, especially with history of other family members with ID.  Males with ID +/or physical exam findings, FMRX testing is recommended
      • Consider MRI of the head
      • Consider referral to Neurology
      • Consider referral to Genetics
    • Abdominal pain: stool O and P, consider cleanout
    • Precocious Puberty: Bone age +/- High sensitivity Estradiol, LH (ICMA) and FSH, 17-OH Progesterone
    • Other consultants: 
      • Chronic snoring: consider trial of inhaled corticosteroid, ENT referral
      • Sleep:  behavioral modifications first, then consider Melatonin 0.1-0.5 mg qhs, consider clonidine. Consider sleep study for persistent poor sleep or severe issues
      • Pediatric GI:  severe, resistant constipation. Consider eosinophilic esophagitis if symptomatic
      • Pediatric psychology and pediatric neuropsychology
      • Pediatric psychiatry   
      • Pediatric Occupational therapy to assess for developmental milestones and sensory processing, make home and school recommendations

Note: Ig, immunoglobulin; IgM, immunoglobulin M, Ab, antibody; SAg, surface antigen, SAb, surface antibody; RPR, Rapid Plasma Reagin test.

Source: Adapted from Eckerle, J. K., Howard, C. R., & John, C. C. (2013). Infections in internationally adopted children. Pediatric Clinics60(2), 487-505.

Return International Adoptee

  • Viral
    • Hepatitis B (SAg, SAb) if not immune at initial visit
    • Hepatitis C Ab
    • HIV 1 and 2 Ab
  • Bacterial
    • Tuberculin skin test (TST) if less than 2 years old
    • TST or QuantiFERON blood test if 2 years old or older
  • Parasitic
    • Stool examination for ova and parasites (x 3) (if not already completed)
    • Giardia Stool antigen (if not already completed)
  • General Health Screening
    • Complete blood count with differential, including a peripheral eosinophil count and red blood cell indices
    • Vitamin D total
    • Iron panel including C-reactive protein and ferritin
    • Lead level if initial was elevated* (If elevated, MDH often gives recommendations on retesting timeframe)
  • Intellectual disability, syndromic features
    • Microarray
    • Fragile X testing- most females, especially with history of other family members with ID.  Males with ID +/or physical exam findings, FMRX testing is recommended
    • Consider MRI of the head
    • Consider referral to Neurology
    • Consider referral to Genetics
  • Abdominal pain: stool O and P, consider cleanout
  • Precocious Puberty: Bone age +/- High sensitivity Estradiol, LH (ICMA) and FSH, 17-OH Progesterone
  • Other consultants: 
    • Chronic snoring: consider trial of inhaled corticosteroid, ENT referral
    • Sleep: Behavioral modifications first, then consider Melatonin 0.1-0.5 mg qhs, consider clonidine. Consider sleep study for persistent poor sleep or severe issues
    • Pediatric GI:  severe, resistant constipation. Consider eosinophilic esophagitis if symptomatic
    • Pediatric psychology and pediatric neuropsychology
    • Pediatric psychiatry   
    • Pediatric Occupational therapy to assess for developmental milestones and sensory processing, make home and school recommendations

Note: Ig, immunoglobulin; IgM, immunoglobulin M, Ab, antibody; SAg, surface antigen, SAb, surface antibody; RPR, Rapid Plasma Reagin test.

Source: Adapted from Eckerle, J. K., Howard, C. R., & John, C. C. (2013). Infections in internationally adopted children. Pediatric Clinics60(2), 487-505.

Domestic Adoption

  • Viral
    • Hepatitis B (SAg, Sab ) *
    • Hepatitis C Ab *
    • HIV 1 and 2 Ab *
  • Bacterial
    • Syphilis screening (antitreponemal Ab, RPR or VDRL) *
    • Tuberculin skin test (TST) if less than 2 years old *
    • QuantiFERON blood test if 2 years old or older *
    • Urine GC/Chlamydia if hx of sexual abuse*
  • General Health Screening
    • Complete blood count with differential
    • Vitamin D total
    • Iron panel including C-reactive protein and ferritin
    • Thyroid stimulating hormone (TSH) and free thyroxin (free T4)
    • Lead * 
  • * Testing not needed if pt born in US hospital, has documented prior testing after being placed in stable environment

  •  Intellectual disability, syndromic features
    • Microarray
    • Fragile X testing- most females, especially with history of other family members with ID.  Males with ID +/or physical exam findings, FMRX testing is recommended
    • Consider MRI of the head
    • Consider referral to Neurology
    • Consider referral to Genetics
  • Abdominal pain: consider bowel cleanout
  • Short stature: Igf/BP3, celiac screening
  • Precocious Puberty: Bone age +/- High sensitivity Estradiol, LH (ICMA) and FSH, 17-OH Progesterone
  • Other consultants:
    • Chronic snoring: consider trial of inhaled corticosteroid, ENT referral
    • Sleep:  behavioral modifications first, then consider Melatonin 0.1-0.5 mg qhs, consider clonidine. Consider sleep study for persistent poor sleep or severe issues
    • Pediatric GI:  severe, resistant constipation. Consider eosinophilic esophagitis if symptomatic
    • Pediatric psychology and pediatric neuropsychology
    • Pediatric psychiatry
    • Pediatric Occupational therapy to assess for developmental milestones and sensory processing, make home and school recommendations

Note: Ig, immunoglobulin; IgM, immunoglobulin M, Ab, antibody; SAg, surface antigen, SAb, surface antibody; RPR, Rapid Plasma Reagin test.

Source: Adapted from Eckerle, J. K., Howard, C. R., & John, C. C. (2013). Infections in internationally adopted children. Pediatric Clinics60(2), 487-505.

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/

Foster Care

  • Viral
    • Hepatitis B (SAg, Sab )
    • Hepatitis C Ab
    • HIV 1 and 2 Ab
  • Bacterial
    • Syphilis screening (antitreponemal Ab, RPR or VDRL)
    • Tuberculin skin test (TST) if less than 2 years old
    • QuantiFERON blood test if 2 years old or older
    • Urine GC/Chlamydia (if concern for sexual abuse)
  • General Health Screening
    • Complete blood count with differential
    • Vitamin D total
    • Iron panel including C-reactive protein and ferritin
    • Thyroid stimulating hormone (TSH) and free thyroxin (free T4)
    • Lead
  • Intellectual disability, syndromic features
    • Microarray
    • Fragile X testing- most females, especially with history of other family members with ID.  Males with ID +/or physical exam findings, FMRX testing is recommended
    • Consider MRI of the head
    • Consider referral to Neurology
    • Consider referral to Genetics
  • Abdominal pain: consider bowel cleanout
  • Short stature: Igf/BP3, celiac screening
  • Precocious Puberty: Bone age +/- High sensitivity Estradiol, LH (ICMA) and FSH, 17-OH Progesterone
  • Other consultants: 
    • Chronic snoring: consider trial of inhaled corticosteroid, ENT referral
    • Sleep:  behavioral modifications first, then consider Melatonin 0.1-0.5 mg qhs, consider clonidine. Consider sleep study for persistent poor sleep or severe issues
    • Pediatric GI:  severe, resistant constipation. Consider eosinophilic esophagitis if symptomatic
    • Pediatric psychology and pediatric neuropsychology
    • Pediatric psychiatry   
    • Pediatric Occupational therapy to assess for developmental milestones and sensory processing, make home and school recommendations

Note: Ig, immunoglobulin; IgM, immunoglobulin M, Ab, antibody; SAg, surface antigen, SAb, surface antibody; RPR, Rapid Plasma Reagin test.

Source: Adapted from Eckerle, J. K., Howard, C. R., & John, C. C. (2013). Infections in internationally adopted children. Pediatric Clinics60(2), 487-505.

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/