Cleveland_Clinic_Host: Elaine Schulte, MD is a board-certified pediatrician who has been in practice for over 20 years. She serves on the Executive Committee of the Section on Adoption and Foster Care for the American Academy of Pediatrics and is also a member of the Joint Council on International Children’s Services.

As a pediatrician with expertise and a special interest in international adoption, Dr. Schulte has cared for hundreds of children from China, Russia, Ukraine, Kazakhstan, Korea, Guatemala, Ethiopia, Cambodia, Vietnam, Romania, Bolivia, Columbia and India.

The goal of the International Adoption Program (IAP) of the Cleveland Clinic Children’s Hospital is to provide comprehensive care to internationally adopted children. Based in the Department of General Pediatrics, the IAP offers a wide range of specialized services, including:

  • Pre- and post-adoption evaluations
  • Ongoing primary care
  • Multidisciplinary team evaluations of physical, developmental, behavioral and educational needs
  • Referrals to medical subspecialists, as needed

The overwhelming majority of internationally adopted children make the transition from orphanage or foster care to home life without difficulty when parents are well-prepared. Dr. Schulte has been fortunate to witness the unimaginable joy that these children bring to their adoptive families and she welcomes the opportunity to help you and your family.

Whether you live within or outside Northeast Ohio, our team of specialists is available for evaluation and consultation.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Elaine Schulte. We are thrilled to have Dr. Schulte here today for this chat. She is the Chair of the Department of General Pediatrics, and Medical Director for the International Adoption Program. Let’s begin with some questions.

What is an Adoption Medical Specialist?

toot_toot: What is an adoption medical specialist?

Speaker_-_Dr__Elaine_Schulte: An adoption medical specialist is a physician who is experienced caring for adopted children and their families. The physician may have expertise in caring for domestically adopted children, internationally adopted children, or both. Some adoption doctors assist families prior to the adoption, by reviewing medical records (preadoption consultation). Others support families when they travel abroad and provide medical care (post-adoption screening) for the newly adopted child.

Here at the International Adoption Program (IAP) at Cleveland Clinic Children’s Hospital, I provide preadoption consultation, post-adoption screening, and ongoing primary care.

BettyLou: Can our adoption agency or private attorney guarantee the health of the child? Do we need to consult with a doctor?

Speaker_-_Dr__Elaine_Schulte: No one can give you any guarantees about the health of any child - whether it's a birth child or an adopted child.

It's a good idea to consult with an adoption medical specialist who has experience reviewing records and examining children who have been internationally adopted.

Daisey99: How much information will I have about the child's health before I adopt? Where can I get good medical advice about an international adoption?

Speaker_-_Dr__Elaine_Schulte: The amount and quality of the information you will receive will vary, depending on the age of the child, and the country where he or she is residing.

An adoption medical specialist can provide good medical advice about a prospective adoptee.

Larry1: My wife and I are considering adopting a child from Russia who has known medical issues. What can we do during the process and right after adoption to help take care of these issues as soon as possible?

Speaker_-_Dr__Elaine_Schulte: I would strongly encourage you to work with an adoption medical specialist. You should be as fully informed as possible, before you adopt a child with special health care needs.

If we know about problems in advance, we can plan for appropriate care prior to your arrival home.

Preadoption Consultation

Ellie_D1: What is a preadoption consultation?

Speaker_-_Dr__Elaine_Schulte: A preadoption consultation is a service provided by myself and others like me, adoption medical specialists. The consultation service is accessed through eClevelandClinic.

We provide complete medical record review, photo/videotape review, and phone consultation for questions about prospective adopted children, domestic or international. We will review medical information and developmental, behavioral and transitional issues that parents should be familiar with prior to adoption.

Howdie: When should a consultation be requested?

Speaker_-_Dr__Elaine_Schulte: A preadoption consultation can be requested at any time. It is best to register for this service at least one month before the adoption, but can be requested at any time.

tandy: When you adopt internationally, are you given any information about the birth mother/family?

Speaker_-_Dr__Elaine_Schulte: Typically, families are given some information about the birth mother, though the information may be very limited. Family history is often not available, but may be, depending on the country.

MN_1999: What would be the advantages to taking my child to an international adoption service, such as yours, versus just going to a pediatrician?

Speaker_-_Dr__Elaine_Schulte: As an adoptive medical specialist, I have reviewed hundreds of medical records, and cared for hundreds of internationally adopted children over the last 17 years. I have followed many of these children for most of their life times. I understand the unique medical and developmental needs that many of these children have. I also work with many national organizations that are focused on internationally adopted children.

Kron_23: Can I have a consultation overseas?

Speaker_-_Dr__Elaine_Schulte: Yes. I am available via e-mail, or phone, 24/7 for families wishing to contact me while traveling abroad.

Health Concerns & Adoption

Tall_777: If we decide to adopt internationally, what are some of the things that we should consider before making a final decision? Are there more health concerns?

Speaker_-_Dr__Elaine_Schulte: Any adult wishing to create a family - either by birth or through adoption, needs to be prepared for the unexpected.

Many internationally adopted children have no health issues, while others have some medical problems which can be treated quite easily. Others have more complicated, long term health problems.

silver: Is there a way to have a child medically evaluated prior to the adoption?

Speaker_-_Dr__Elaine_Schulte: This is a very common question, with a complicated answer. Children living in orphanages are cared for by physicians who work there. They may not, necessarily, be Western-trained, board certified pediatricians. There are instances where parents may be able to find physicians living in the country, who are willing to examine children living in orphanages. Sometimes, orphanage and country rules will prohibit this type of visit.

playing_around: What medical issues do adopted children have?

Speaker_-_Dr__Elaine_Schulte: Depending on the type of adoption (domestic or international), medical issues can vary from the short term risks of malnutrition – like anemia and parasites, to longer term consequences, like developmental delay and reactive attachment disorder. Some adopted children have many medical problems, while others will have virtually no medical issues. It is impossible to predict which problems, if any, adopted children will have.

smbaker79: Hello, my name is Sarah. My husband and I have been trying to conceive for almost 2 years. I am 30 years old. I have an 8 year old son from a previous marriage. We would like to consider adoption and it is not necessary for the child to be of the same race/nationality as us... but we are unsure exactly of the time frame we could expect for local vs. international adoption as well as the requirements by the countries, genetic or other health factors from international adoption as well as cost differences. Any advice you could give would be appreciated.

Speaker_-_Dr__Elaine_Schulte: Sarah thanks for your question. As you may be able to understand, this is a very complicated question, and one that would be difficult to answer during a webchat. Do you have any specific questions?

smbaker79: I think my main question would be the health risks of adopting internationally. What types of problems are you more prone to having when adopting out of the country verses in?

Speaker_-_Dr__Elaine_Schulte: This is a very difficult and complicated question to answer. There are unique medical risks for domestically adopted children versus internationally adopted children.

I can better answer these types of questions through our eClevelandClinic consultation service. If you'd like further information, go to

Best of luck with your decision.

blank_321: My husband and I have been considering going through with an international adoption. Depending on the country we choose to adopt a child from, what are the concerns for us, as the new parents, in terms or health issues? Do we need to be vaccinated before we go to that country to pick up the child? How about in relationship to the child and any diseases he/she may be carrying?

Speaker_-_Dr__Elaine_Schulte: There are health concerns for parents as well! You can use a travel clinic, or consult with an adoption medical specialist to learn about appropriate immunizations and medicines that you may need to take along. An adoption medical specialist can also advise you about taking appropriate precautions against certain infectious diseases your child may have.

There is a type of adoption called a "blind" referral, where parents travel to a country and select a child living in an orphanage. Medical information can be sent for review, and parents can take live videotape, and send for review as well. This process works extremely easily, and almost "real time" through eClevelandClinic.

WellsFargo2: How much does it cost?

Speaker_-_Dr__Elaine_Schulte: There are a variety of preadoption services through eClevelandClinic. Full descriptions of the services, and a fee schedules are available at

Multicultural Families

BethAnn: My husband and I adopted a baby girl from China. What are the issues with raising multi-cultural children that I need to be concerned with?

Speaker_-_Dr__Elaine_Schulte: As our society becomes more global, it has become much more common to see families of mixed race and ethnicities.

Adopted children typically adjust very well to their families. They will discover many families like their own, as they go to school and venture out into the world.

Children will follow their parents lead. If parents are comfortable with their own transracial family, their children will be comfortable as well.

Post Adoption Services

Not_now: When should I have my adopted child screened?

Speaker_-_Dr__Elaine_Schulte: Ideally, a post-adoption screening visit should occur 7-10 days after arrival into the child’s new home. However, for acute medical problems, we are available here to see your child sooner, if needed.

Post-adoption screening includes a complete history review, a developmental screen, a physical examination, immunizations (as needed) and screening blood work and stool collection.

Please: When you say that your service will provide medical care for my adopted child through their upbringing, what does this include? Is it just standard medical care, as would be given any child who goes to their pediatrician regularly, or is there some type of specialized care? How about psychiatric services, to help my child adjust to their new environment and way of life?

Speaker_-_Dr__Elaine_Schulte: This is an excellent question, and one that is often not thought of. An adoption medical specialist is attuned to the unique medical and developmental needs of adoptive children, and provides more than "standard" pediatric care.

Developmental, behavioral, and transitional support for the child, as well as emotional support for the newly adoptive parent is also provided. These special needs are often overlooked.

General Questions about Adoption

broken_3: How can you find out what countries are allowing international adoptions? My husband is from Jamaica and would be interested in possibly adopting a child from his homeland. Do specific countries have international adoption programs or do countries do adoptions on an individual basis?

Speaker_-_Dr__Elaine_Schulte: I would refer you to the US State Department website:

SMITH_K: Are there requirements that a couple or individual has to meet to become adoptive parents? How do we know if we qualify to adopt?

Speaker_-_Dr__Elaine_Schulte: Each country has it's own set of requirements. A good place to start is the US State Department website:

2009_PF: My husband and I have been talking about an international adoption. Are there risks involved in this process?

Speaker_-_Dr__Elaine_Schulte: There are always risks for any adults planning to create a family - whether it's through birth or adoption. Internationally adopted children come with limited family medical histories, birth histories, and pre-adoptive histories. Many internationally adopted children have lived in orphanages, and may be malnourished and neglected.

D_Brown: Is there any possibility in obtaining financial assistance for the adoption process?

Speaker_-_Dr__Elaine_Schulte: The US government offers a $10,000 tax credit for those families who have adopted. Additionally, many employers offer a cash benefit as well as paid time away from work.

TULIPZ: How much does an international adoption cost? Is that more or less than a domestic adoption? When are the fees due?

Speaker_-_Dr__Elaine_Schulte: Adoption fees vary by agency and country. Domestic adoption can be quite expensive, depending on how long the process takes. Each agency has its own fee schedule.

M-N-M216: Is a Home Study needed in all international adoptions like it is in domestic cases?

Speaker_-_Dr__Elaine_Schulte: Yes. A home study is required.

Parent247: Where do I go to find a reputable adoption agency to help us? Can I work with an agency that is located elsewhere?

Speaker_-_Dr__Elaine_Schulte: The internet is a good place to start. You'll want to work with an agency that is very experienced and is Hague accredited.

You should also talk to families and friends who've adopted and learn about their process and the agencies they've worked with.

You may be able to work with an agency in another state.

SuperMOM: I know of couples who had done or are considering international adoption. Why choose international adoption versus domestic adoption?

Speaker_-_Dr__Elaine_Schulte: This is a very common question, and the decision is usually personal. Many people choose international adoption because there is a definite "beginning" and "end" to the process. Domestic adoptions can take months or sometimes years to complete.

Some folks are concerned about the potential for an "open" adoption with the domestic process, meaning that the birth mother, or birth parents, may want ongoing contact with the adoptive family. Some adoptive families are very interested in maintaining contact with the birth family, while others are not interested in having this type of relationship.

Medical risks are present with both types of adoption. Just like children who grow up in birth families, adopted children may have unknown medical or developmental issues.

JerryZee: Why do so many people adopt from other countries? What are the most popular countries to adopt from?

Speaker_-_Dr__Elaine_Schulte: International adoption has become very popular over the last 15 years. Many parents feel an ethical obligation to help children who live in less-developed countries.

Today, China, Guatemala, Ethiopia, Russia, and Korea are some of the most popular countries.

asknow: What about getting medical insurance? What is the usual process for getting insurance for my adopted child, so that when I do get them, I have them evaluated and treated (if necessary) immediately?

Speaker_-_Dr__Elaine_Schulte: Adoption is a qualifying change of life event for employers who provide medical insurance, meaning you should have no problem adding your newly adopted child to your health plan.

I recommend that you contact your insurance carrier prior to adoption, and give them the approximate date the adoption will take place overseas.

Frank_Carr: Is it hard to adopt a child from another country? Can single people adopt?

Speaker_-_Dr__Elaine_Schulte: There is a fair amount of paperwork involved in adopting a child, whether it be a domestic or international process. Waiting for the adoption to actually take place is probably the hardest burden for parents.

Single people can adopt. Agencies and countries have varying rules, which change from time to time.

668790: Do all adoptions from the same country take the same amount of time?

Speaker_-_Dr__Elaine_Schulte: No. The process varies by agency and country.

Sue_Tanner: Can we request to adopt a child of a particular sex or age? Can more than one child be adopted at the same time?

Speaker_-_Dr__Elaine_Schulte: Rules about requesting gender or age will vary by agency and country. Also, some countries will have more children of a certain gender (i.e. There are more girls available for adoption in China) available.

Some countries allow more than one child to be adopted at the same time, though this is less common than it used to be.


Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Elaine Schulte is now over. Thank you again Dr. Schulte for taking the time to answer our questions about adoption and health concerns.

Speaker_-_Dr__Elaine_Schulte: Thanks - this has been great.

More Information

  • To make an appointment with Dr. Elaine Schulte, or any of the other specialists in the Pediatric Institute and Children’s Hospital at Cleveland Clinic, please call please call 216.444.KIDS (5437) or call toll-free at 800.553.5056. You can also visit us online at
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This health chat occurred on November 9, 2009.

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