The publicity about crack babies and babies infected with HIV has made
potential adoptive parents very concerned with the health of the baby in
question. Less well publicized is the high level of tuberculosis in adoptive
children from Third World countries. Physicians examining babies for adoption
are subject to malpractice lawsuits if they fail to diagnose conditions, within
the standard of care for pediatrics, that would be grounds for not adopting the
baby. In some states, physicians may be sued for fraud if they withhold
information about the baby that would influence the adoption decision. Since
such information may involve the mother’s behavior, the physician must have a
written authorization from the mother or a court order before transmitting such
information to the adoption agency or prospective parents. There may be a
conflict with the physician–patient relationship for family practitioners and
others who are treating both the mother and the baby. Evaluating the infant
for adoption may put the physician in conflict with the mother if the physician’s
determination is at odds with the mother’s wishes.
In addressing the specific problem of HIV testing for children to be placed in
foster care or adoptive homes, the American Academy of Pediatrics’ Task Force
on Pediatric AIDS [American Academy of Pediatrics Task Force on Pediatric
AIDS. Perinatal human immunodeficiency virus (HIV) testing.
1992;89:791–794] found the following:
In response to the legitimate need for preplacement HIV testing of the
infant or child in areas of high prevalence of HIV infection in childbearing
women, procedures should be established by foster care and adoption
agencies in collaboration with medical care facilities, to accomplish the
1. Develop the expertise to provide prospective foster care or adoptive
families with comprehensive and up-to-date information regarding all
aspects of pediatric HIV infection.
2. Establish a process that would accomplish, with the appropriate
consent of the infant’s legal guardian, the preplacement HIV testing of
infants or children, initiated either (a) at the request of the prospective
adopting or foster care parents through the physician who is responsible
for that child’s care, or (b) through the request of the infant’s physician
in response to his or her judgment that the mother is at high risk for
HIV infection and that the infant’s health supervision and/or placement
may be affected by knowing the infant’s antibody status.
3. Provide comprehensive and up-to-date interpretation of the meaning
of test results, taking into account the age and health status of the child
and the reliability of the test.
4. Establish a record-keeping system to contain information regarding
the child’s test results with access to such information strictly limited to
those who need to know, but specifically including the informed
adoptive or foster care family and the physician responsible for the
infant’s medical care.
5. Establish a procedure whereby all infants who have positive results on
HIV antibody tests are retested on a regular basis to distinguish
between passively transmitted antibody and true HIV infection in the