International Adoption

Each year more than 100,000 children are adopted in the United States. Almost 22,000 of these children a re from overseas. This number has been consistently increasing. The most common countries from which children are adopted are China, Russia, South Korea, Guatemala, and Romania. In many of these countries the documented risk for lead exposure is much higher than in the United States.

How are exposure sources different in other countries than in the United States?

Children’s exposure to sources of lead, outside of the United States, varies by country. Even within countries, lead exposure may also vary by ethnic group or income level. Lead-based paint and lead contaminated dust and soil remain the primary source of lead exposure for children in the United States. However, in other countries, important sources of lead exposure include:

Leaded gasoline exhaust;

Industrial emissions;

Cottage industries (e.g., battery breaking and recycling plants);

Traditional medicines;

Cosmetics;

Food;

Ceramic ware; and

Drinking water.

Parents or perspective parent of adopted children

Why should I be concerned?

Some adopted children may have been exposed to lead. Research has shown that foreign-born adopted children tend to have higher lead levels in their blood than children born in the United States (1, 2). An elevated level of lead in a child’s blood can cause learning, attention, behavioral, and developmental problems.

Will I know if my child has been exposed to lead because of their country of origin?

Research has shown that a number of children have elevated blood lead levels depending on the country of origin (1, 2). Specifically, those children emigrating from Asia, Eastern Europe, and Central and South America tend to be more at risk for lead exposure because of the varied number of exposure sources within these countries (2). Lead exposure may also vary by ethnic group or income level within countries.

What should I do if I believe my child may have been exposed to lead?

See your health care provider. He or she can perform a blood test to see whether your child may have been exposed to lead and if exposed, your health care provider can recommend treatment options. Most children with elevated blood lead levels do not have any symptoms. As blood lead levels increase, so does lead’s effects on health.

Who can I contact for blood lead testing or further information?

You can contact either your health care provider or local health department. There are currently 25 international adoption medical clinics in the United States and Canada that specialize in the health care needs of internationally adopted children. For further information, you may want to contact your state or local Childhood Lead Poisoning Prevention Program.

⁽¹⁾ Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics 2001;108:158-162.

⁽²⁾ CDC. Elevated blood lead levels among internationally adopted children – United States, 1998. MMWR 2000;49(5):97-100.

Health Care Providers

Why should I test an internationally adopted child for lead exposure?

Recent studies have found that a significant proportion of immigrant and adopted children have elevated blood lead levels. Risk varies by country of origin (1, 2). According to one study, 40% of children from Cuba and Haiti, 37% from Asia, 27% from Vietnam and Africa, and 25% from the Near East had elevated blood lead levels. Overall, approximately 11.3% of adopted foreign-born children have elevated blood lead levels (1).

The American Academy of Pediatrics recommends that children who have been adopted or have emigrated from countries where lead poisoning is prevalent be screened for elevated blood lead levels (3). Early identification of elevated blood lead levels can benefit a child’s health by triggering appropriate medical management and other follow-up care.

Aren’t children tested for lead exposure before they enter the country?

No, blood lead testing is not required. Prior to arrival in the United States, all immigrants are required to have a medical examination overseas by a physician approved by the U.S. embassy or consulate. This medical examination focuses primarily on detecting serious disabilities and contagious diseases.

Where can I receive more information about blood lead testing children?

You can receive more information about blood lead testing and medical management recommendations from this site. You can also contact the Childhood Lead Poisoning Prevention Program in your state.

⁽¹⁾ Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics 2001;108:158-62.

⁽²⁾ CDC. Elevated blood lead levels among internationally adopted children – United States, 1998. MMWR 2000;49(5):97-100.

⁽³⁾ Committee on Environmental Health. Screening for elevated blood lead levels. Pediatrics 1998;101:1072-78.

Adoption Agencies

What should we be doing to increase awareness of lead exposure among internationally adopted children and of the importance of blood lead testing?

As prospective parents experience the joy of adopting a child and anticipate providing the child with a promising future, they need relevant information to safeguard the health of their prospective child. Under current regulations and routine practice, foreign-born children may not have their elevated blood lead levels identified. As a result, their parents lack information that could help them maximally improve their children’s growth, development, and prospect for the future.

Include lead-exposure information in health fact sheets provided to prospective parents. Encourage parents and health care providers to test foreign-born children for lead exposure upon arrival into the United States.

Additional Resources

Child Welfare Information Gateway: Intercountry Adoption
Information on the adoption of children who are citizens of one country by parents who are citizens of a different country. The Child Welfare Information Gateway is a service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.

U.S. Department of State
This site provides information and guidance to U.S. citizens seeking information about international adoptions.

U.S. Citizenship and Immigration Services
This site provides information on intercountry adoptions and the immigration process.

Joint Council on International Children’s Services (JCICS)
JCICS is a nonprofit international adoption organization that works to promote ethical practices in intercountry adoption. This site provides information relevant to international adoption agencies, community based-organizations, parent support groups, and medical clinics.

• Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.