Nowadays adoption processes in some countries, such as Ethiopia, must always be carried out through an approved International Adoption Agency, and there is no possibility of adopting freely by a public protocol. A meeting of the Ministry of Health, Social Services and Equality Committee of Autonomous Community Child Services Directors, held on 16 October 2012, agreed, as a precautionary measure, not to accept new applications to adopt children from Ethiopia, a decision motivated by the large number of cases processed in that country, for fear of aggravating the lack of guarantees and legal uncertainty over the adoptions that are granted, although all those already submitted would continue to be processed normally. This has led to a significant slowing of the process of adopting children from these countries, and the legal procedures can take a long time. As a result of this situation, there has been an increase in Spain over the last 2 years in the number of international adoptions of children with some associated condition, “adoptions of children with special needs” or “green passage” adoption, as it is known in China. These children have physical or intellectual disabilities, a delay in growth or psychomotor development or a need for preferential medical or surgical treatment/followup.2 The legal procedures for adopting these children with associated conditions are quicker, as they are given priority because of the need for suitable early treatment.

Parents who undertake adoption via the special needs route often need advice from a paediatrician specialising in “preadoption consultations” who can carry out a careful assessment of the reports received in advance, with the particular characteristics of each country of origin, explain the severity of the associated illness to the family before they go and collect the child, and recommend how to act with the child when they receive him or her: hazards, precautions, special care, etc.3 It is also advisable, if the adoption is from a tropical country, for both the parents and the siblings, if they are going to travel, to attend an “international travel consultation” to bring their vaccination calendar up to date and receive advice and precise recommendations before the journey and/or a travel first-aid kit.

All children from international adoption, whether they have special needs or not, must be assessed upon arrival in Spain in multidisciplinary units with previous experience in the disease that they usually bring into the country, ideally in a specialised International Adoption Unit. The recommendation with these children is to compile a thorough and complete clinical history and perform an exhaustive physical examination and an analysis designed to screen for prevalent and/or serious bacterial infections such as tuberculosis and syphilis, viral infections such as hepatitis A, B and C and HIV, and parasitic infections such as malaria, intestinal helminthiasis, schistosomiasis and other parasitic diseases specific to the country in question.4,5 In these children it is advisable to carry out as complete an evaluation of immunisations as possible, reviewing the records supplied using internationally established criteria so as to match the original calendar to the one used in Spain, scheduling those vaccines that have not been administered and are available in Spain, such as the meningitis C and pneumococcal vaccines. It is also vital to screen for metabolopathies in those children for whom there was no opportunity to do so in the neonatal period in their countries of origin, as is now done in Spain with all newborns, at the same time as the analysis performed on arrival.

Of particular importance is the opportunity these specialised units provide to diagnose conditions that are common in such children, including malnutrition and/or severe anaemia, congenital infections, tuberculosis, chronic HBV hepatitis, etc., and other much more specific diseases that are endemic to particular tropical areas and much more difficult to diagnose, as they need a specialised laboratory, such as malaria, schistosomiasis and filiarisis in regions of Africa such as Ethiopia; strongyloidiasis, teniasis and toxicariasis in Asian countries and Chagas disease and dengue in parts of America and the Caribbean.

On arrival, children adopted from developing countries need an exhaustive assessment in multidisciplinary units with expertise in international adoption capable of diagnosing the general paediatric condition associated with special needs adoption but also, more importantly, performing an expert screening for specific tropical infectious disease. It is also advisable to rule out possible undetected metabolic conditions, provide appropriate protection with the vaccines available in Spain and finally refer the families, if necessary, to a paediatric specialist or Early Intervention Unit if the children show problems of development and adaptation.