adoptions

For parents interested in adopting, Dr. Vayman specializes in the care and assessment of both domestic and internationally adopted children.

We provide comprehensive care to internationally adopted children from the time the parent receives the referral to the time the child arrives and beyond.

Dr. Vayman has not only been practicing pediatrics for 19 years, but she is, also, a Fellow of the Adoption and Foster Care Section of the American Academy of Pediatrics. Dr. Vayman provides adoption services for children from all countries. However Dr. Vayman has a unique knowledge of children from Russia and other former CIS states, such as Kazakhstan, Ukraine, Latvia, Belarus, Georgia, etc. Since she is originally from Latvia, Dr. Vayman speaks and reads Russian fluently, so there will be no need to translate documents that are written in Russian.

Adoptions Overview

We are happy to provide adoption consultations to anyone who wishes to come meet with us. It is important to note that we are not an adoption agency and that we do not place children, therefore we are able to provide unbiased medical evaluations. Services include pre-adoptive consultation and review of referral information and videos, as well as, comprehensive new-arrival medical and developmental assessments. Post-adoption ongoing primary pediatric medical care services are, also, available to families.

The adoption of a child from a foreign country is accompanied by special challenges. Appropriate preparation, as well as, ongoing care, and guidance after the child's arrival help parents meet the physical, emotional, and developmental needs of their new child. We offer the same services for domestic adoptions, although the pre-evaluation of information is a little different. We usually have a great deal more information to review and the information usually, but not always, is of a higher quality. We can do an analysis of prenatal records when pertinent, review of medical/social history of birth family, and consultations with an obstetrician and pediatrician as it applies.

The adoption process can be complex for both domestic and internationally adopted children, but in the end it can be very rewarding with thorough preparation. Our goal is to educate adoptive parents using the limited medical information available about their child. It is this knowledge that empowers adoptive parents to make an educated decision, and not just take a leap of faith. We never tell families which child to adopt and we do not pick out children. For more information, or to schedule a consultation, call (770) 442-5437, Monday-Friday from 9:00 a.m. to 5:00 p.m.

Services

Services include:

  • Pre-adoption consultation
  • International Pre-adoption medical review of referral information and videos. To observe any physical or developmental disabilities, a thorough review of the child's medical history and health information is performed, including examination of videotapes and photos received from the adoption agency and/or orphanage.
  • Domestic Pre-adoption Evaluation - Analysis of prenatal records, review of medical/social history of birth family, and consultations with obstetrician and pediatrician.
  • A list of what additional information would be desirable or essential in order for you to make an informed decision.
  • Letters in regards to medical care and notary services as needed for each country.
  • Travel preparation information for you and your child.
  • Ongoing review of additional information about the child as it becomes available.
  • Availability for consultation by email or telephone while abroad.
  • Comprehensive new-arrival medical and developmental assessments.
  • Ongoing primary pediatric care for those children that live near us or Coordination of care in collaboration with the primary care physician to provide expertise in problems unique to this population of children.

For those early in the process of deciding to adopt:

  • We are happy to talk with you about the general medical, developmental, and psychological needs of adopted children, as well as about specific concerns of children in institutional care or in specific countries or regions of the world.
  • We do not endorse specific agencies.
  • Please feel free to contact us with any questions you might have about adoption (international and domestic), the health needs of internationally adopted children, or the services we provide. One of our staff members will be happy to get back to you as quickly as possible.

For those that have already adopted:

  • If you have non-urgent questions about a child who is already home with you, please call us at 770-442-5437.
  • If your child is ill and possibly in need of medical care, call your child's primary care physician (call our office if we are your child's PCP).
Statement of Non-Discrimination

The World of Pediatrics does not discriminate based on race, religion, gender, disability, or sexual orientation.

We believe that children can and do thrive with families of all descriptions, and are happy to work with singles and couples from all walks of life.

statement of non discrimination for world of pediatrics adoptions
Blind Travel Adoptions

Blind travel is the process of traveling to adopt without any information on a particular child. We recommend the conventional referral process rather than blind travel. However, if you choose to travel blind, we'd be happy to work with you and consult once you're in country.

"Blind" Adoption is extremely difficult due to the potential for surprises and the inherent pressure to make a quick decision, typically before you come home. Many times the emotional and intellectual agony of meeting a child (or children), participating in one or several medical consults, and making a decision within hours of first seeing any information, is just too stressful. Also, this process is truly unfortunate for the children involved, especially older ones that have some idea of what is going on.

Your agency may not agree with us, but typically we tend to steer families to the traditional referral process if they ask. It's not that blind referrals don't work out, but it is much more stressful. If you are able to consult about a specific child and make your decision while still at home, it makes the adoption process less frantic for families, allows for fewer surprises, gives you time to prepare, and is overall less stressful.

The cost for our consultation services is higher for blind referrals, as well. They're considerably more difficult and disruptive for Dr. Vayman and our practice, since turnaround needs to be immediate, and families often see multiple children. The good news about the blind fee is that it covers you to consult on one or many children while on the trip. We hope (for your sake and ours) that it's just one terrific child, but if it's more, the additional reviews are included. We are, also, on-call for you for your return trip to bring the child home.

Domestic or Foster Child Adoption

While the majority of our inquiries come from families who are adopting internationally, we are, also, happy to work with families who are considering or planning a domestic adoption. Please, feel free to contact us with your questions, including a pre-adoption medical review.

The process and services for domestic or foster adoptions are the same as for international adoptions. Notable exceptions are travel preparation and having to run a myriad of lab tests on the child once they are adopted. Children adopted domestically, usually have a more complete and accurate healthcare record, so a lot of the steps necessary to determine the overall health of the child have already been done.

We can do an analysis of prenatal records when pertinent, review of medical/social history of birth family, and consultations with an obstetrician and pediatrician as it applies.

As with children that are internationally adopted, on-going care and referrals to specialists as needed are available to all patients that choose Dr. Lyudmila Vayman as their child's physician.

Pre-Adoption Consult /Medical Information Reviews

Please, contact us first to schedule a review of your information, sign a consent form, and arrange payment.

We are usually able to review your information within 2-4 days of receiving it, although circumstances may occasionally make the time slightly longer.

After reviewing available medical records Dr. Vayman will review your child's information with you in detail from unusual sounding diagnoses to growth patterns. She will, also, discuss information that you may not have and guide you in formulating questions for your agency.

Our consultation will focus on notable growth trends, explanations of foreign medical diagnoses with opinions on which are more or less worrisome, and assessment of developmental progress. We will also analyze photos and video for features of FAS or other syndromes, interaction with caregivers, and signs of developmental issues. Unfortunately, we are unable to predict the future, but we will provide a rough risk assessment of future medical or developmental special needs, based on our years of experience evaluating similar referrals and following adopted children in our pediatric practice. We're happy to answer any questions you have about your referral, travel issues, or the post-adoption adjustment period.

Dr. Vayman is then available by email to analyze any follow-up information you may gather from your agency and/or during your travel. She will then typically respond by email to updates, unless there are more concerning or complicated issues better discussed with a phone call. This has been invaluable for families faced with surprise medical or developmental concerns or illness during travel.

Fees are based on the average amount of time spent on the initial review of information, as well as, on all follow-up information. Payment is expected at the time of service, and can be made by cash, money order, check, Discover, Mastercard, or Visa. Please, contact us for current fees.

Review of Steps for Pre-Adoption Consult / Medical Information Review

1. Contact our office at 770-442-5437 to schedule a review of your information and arrange payment. INFORMATION WILL ONLY BE REVIEWED AFTER WE HAVE MADE ARRANGEMENTS WITH YOU. INFORMATION SENT WITHOUT A PRIOR AGREEMENT WILL NOT BE ACCEPTED FOR REVIEW!

2. Fill out the Adoption Client Information Sheet and the Consent for Pre-Adoption Evaluation Form and return by email, fax, or mail along with copies of your information (photos and medical information). If you have a video, mail a COPY. We will not be able to return the video or hard copies of photos. If you know you are going to be getting more information from your agency soon, please, wait until you have all your information and then send it all together. Please, make sure all materials are sent with an Adoption Materials Cover Letter.

At the same time, please, call our office 770-442-5437, (M-F 10:00 AM - 5:00 PM EST) and notify us that you have sent your initial paperwork and information. This allows us to make contact if we did not receive your email, fax, or mailed materials.

3. Our staff will call and inform you that we have received all information. No phone conferences.

4. Review the fee schedule or contact us for current fees.

Why Do We Do Pre-Adoption Consults / Medical Info Reviews?

We believe that children being adopted are best served when the families who adopt them are totally prepared to meet their unique needs. We are committed to helping prospective adoptive parents to understand the predictable needs and possible future issues of children who they consider adopting, so that they may realistically assess their abilities to meet these needs.

Pre-Adoption Medical Reviews ARE NOT intended to:

  • Screen out "bad kids" (there is no such thing!)
  • Help families to "pick perfect children" (ALL children deserve the love of a family!)

Pre-Adoption Medical Reviews ARE intended to:

  • Help prospective adoptive families to understand in general how the experiences of deprivation, abuse, neglect, prenatal substance exposure, lack of prenatal care, etc impact children over both the short and long term
  • Help families to understand the medical, developmental, and psychosocial information given to them with the referral of a particular child
  • Help families to know what additional information needs to be gathered in order to develop a reasonably complete picture of the child's potential needs
  • Help families to assess their capabilities to meet the foreseeable needs of a particular child
Post Adoption Patient Services

Primary Care or Consultation Services

Once you have your child home with you, we provide a variety of services, and are happy to work with you in whichever way is most helpful to you.

  • If our office is convenient for you and you do not already have a primary care physician (PCP) for other children in your family, we would be happy to be your child's primary care pediatrician. We are accepting new patients, and accept most major health insurance plans. Contact us for further details.

Post-Adoption Screenings and Laboratory Tests

In the USA, generalized routine laboratory screening of healthy children is not considered part of the normal standard of care. In children that are internationally adopted, extensive screening tests are performed, because of a multitude of reasons. These screening tests are recommended by the Pediatric Red Book of Infectious Disease and the American Academy of Pediatrics.

It is only through extensive laboratory testing that a physician may:

  • Uncover a medical condition that has not yet presented itself clinically.
  • Rule out a diagnosis or condition that was reported on the pre-adoption evaluation.
  • Help to confirm the adequacy of treatment of a particular ailment and/or documented cure.

Some parents feel that they do not need to run comprehensive lab tests on their children, because some previous blood work was performed by the orphanage, and the child was already seen by a physician in order to qualify for a visa. While these are all good things to have done for your child, they are not enough. The Visa medical examination focuses primarily on detecting if there are certain serious contagious diseases that would make the child ineligible for entry into the USA. The procedure usually consists of a very brief physical examination and medical history. A chest x-ray is performed to look for active tuberculosis and blood tests are performed to screen for a HIV infection and syphilis. These last two tests are usually performed only if the child is older than 15 years of age. Children younger than 15 years of age are usually tested only if there is a suspicion of a medical illness. Since most children really have no available history and there are few lab tests performed, the Visa examination usually consists of documenting little more than that the child is breathing at the time of the examination and is not terribly ill with any obvious contagious disease.

As for tests performed at the orphanage, caution should be used when interpreting the results. While these tests are important in the Pre-Adoption evaluation process to assist families in making their decision, they should only be considered as a screening tool. The validity of these tests needs to be confirmed, because determination of a medical diagnosis should never be made solely on these test results.

Screening is, also, important because of the unknown medical background of the child, inadequacy of health care and poor living conditions encountered in institutional care settings. In addition, different medical problems can be encountered based on different regions where children are placed for adoption.

A physician should see an internationally adopted child within 2 weeks of arrival to the United States. A child who is ill upon arrival with either an acute or chronic medical condition should be evaluated for that problem immediately.

After the arrival of the child, the process of attachment and bonding begins. This is the time when parents and their child start to get to know one another. Some parents may feel the need to have large family gatherings and parties, go on elaborate vacations to an amusement park, and buy everything at the toy store for their child. While their intentions are good, this will only over stimulate the child and stress them out. Just like these painless, well-intentioned examples, an immediate visit to a doctor's office and multiple visits to a laboratory are other types of excursions that do not need to be made immediately, unless the child is acutely ill. Go slow and allow you and your child to become accustomed to one another, allow them to get used to their surroundings, and start to feel safe and confident that everything is going to be OK.

The initial Post-Adoption evaluation will include the following:

  • Thorough review of the child's medical history and concerns discovered on the pre-adoption evaluation
  • Complete physical examination
  • Evaluation of developmental milestones
  • Immunization status needs to be evaluated and confirmed with vaccine titers. There is no harm for a child to receive an extra vaccine, but there may be harm if the child remains susceptible to childhood illnesses for which they were not vaccinated. The doctor will use the same catch-up schedule that would be used if the child was born in the USA and was behind in their vaccines.
  • Laboratory tests and screenings for a multitude of medical concerns.

General information on what many of the typical tests screen for:

  • CBC (complete blood count) - It gives us information on the health status of the child's blood cells, pertaining to anemia, which can be caused by a multitude of reasons. Sickle cell disease, Thalasemia, anemia of chronic illness or just iron deficiency anemia.
  • Lead screen: Lead can cause anemia and developmental delay if untreated. Lead can be found in old institution walls, water supply (pipes), and the overall environment as a pollutant.
  • G6PD deficiency: An enzyme deficiency that is common in Asia, Africa, and the Mediterranean region. Screening for children from these areas needs to be performed prior to prescribing medications that may cause hemolytic (blood cell breakdown) anemia in persons lacking this enzyme.
  • Hemoglobin Electrophoresis : in Asian children to look for Thalasemia Anemia.
  • HIV Elisa: Test for the AIDS or HIV virus.
  • VDRL: Test for syphilis. This is frequently transmitted from the mother to child.
  • Hepatitis A panel: should be performed prior to hepatitis B vaccination. It tests for acute, chronic illness, as well as, vaccine status.
  • Hepatitis C: Test for Hepatitis C. A severe liver disease.
  • Calcium, Phosphorous, Alkaline Phosphatase: Screens for Rickets.
  • Urinalysis: Check the overall kidney function.
  • Stool sample: Test for intestinal parasites, Giardia is common in Institutions.
  • Stool cultures : Tests for intestinal bacteria.
  • Comprehensive metabolic panel SMA-20: Checks on overall body function, liver, and kidney.
  • TFT: Test for thyroid disease.
  • PPD: Tests for tuberculosis status.
  • Immunization Titers: to see if the child mounted an immune response in order to continue with the current vaccine schedule or restart all vaccines from the beginning.
  • State Newborn Screen (only in children less than 12 months): Checks for metabolic disorders routinely tested at birth (PKU, Biotinidase, Sickle cell)
  • Hearing and vision tests

As you can see that there is going to be a lot of blood drawn in order to perform these tests. It is a stressful time for both the child and the parents. We generally recommend that the parents schedule two or more visits to complete all the necessary tests.

New Arrival Visits (First Visit)

At your first appointment, Dr. Vayman will spend an extended amount of time reviewing your child's health information and development, as well as performing a thorough physical examination and a complete panel of screening labs. We hope this visit answers many of your questions and assists you in caring for your child. Please, be aware that unfortunately many insurance companies DO NOT cover the costs of an Adoption First Appointment. This is not a typical physical and can take as long as two hours or more to complete. There is a great deal of paperwork that, also, must be completed for specialized diagnostic tests and referrals to specialists. You will be financially responsible for the costs not covered by insurance.

  • SCHEDULE NEW-ARRIVAL VISITS AS SOON AS YOU KNOW YOUR TRAVEL DATES, in order to have the appointment time most convenient for you. Call 770-442- 5437 to schedule your child's appointment.
  • If another physician is to be your child's PCP, you may need a referral for this visit to be covered under your health insurance. Talk with your PCP about this prior to the visit.
  • New arrival visits are ideally scheduled 7-14 days after the child's arrival home. This timing gives parent(s) and their child time to catch up on sleep, and to have a bit of time to get to know each other. Both of these things make the visit much more productive!
  • New arrival visits provide a detailed, thorough review of the child's medical, developmental, and psychological needs, a comprehensive physical exam, laboratory testing, Tuberculosis testing, vaccines as indicated, and coordination of any necessary referrals or additional testing. This visit is very comprehensive, usually lasting 60-120 minutes. Please, plan accordingly.
  • Children who are ill upon their arrival home should be seen sooner by their primary care physician. If that is to be us, call us at 770-442-5437 to schedule a sick visit. If another physician will be your child's physician, call their office to schedule a sick visit. In either case, we will still use the pre-scheduled visit for a thorough new-arrival assessment.
  • Children who have known urgent medical concerns prior to their adoption may need to have the new-arrival assessment scheduled sooner after their arrival home.

    IMPORTANT : Please, be aware that this initial visit is many times not covered by insurance plans completely. This appointment can take up to two hours and many HMO and POS insurance plans cover this visit as a typical physical, which it is not. This is a comprehensive adoption visit, which will take hours to complete and several more hours for referrals and review of the extensive labs and tests that will be needed. Parents will be responsible for payment of fees not covered by insurance for this visit.

These are services that will be provided at New Arrival Visits

  • Comprehensive medical assessment
  • Complete physical examination
  • Developmental assessment
  • Immunizations, as needed
  • Testing for a variety of infectious diseases
  • Referrals to subspecialty medical or psychological services, as needed

Recommended Screening Labs

It is critical that all children adopted overseas be screened for multiple illnesses:

    Blood Tests:
  • Syphilis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • HIV
  • Thyroid function
  • Lead
  • Complete blood count
  • Comprehensive metabolic panel (a general screen for liver and kidney function)
  • Other tests may be drawn for specific situations.
  • Several of these tests take up to a week to come back from the lab. We will be in touch as soon as all the labs are back.

    Skin Test:

    Tuberculosis test (PPD)
  • This test must be read in 48-72 hours by a medical professional who has experience reading PPDs. There is much unnecessary confusion among lay and medical professionals in reading and interpreting PPDs in international adoptee's. I prefer that my staff read the PPDs.
  • If you live far away and would prefer to have the PPD done locally that is fine, but be sure that it gets done. If you are told the PPD test doesn't need to be done or can't be interpreted because your child had the TB vaccine (BCG), be sure to have someone else perform the test.

    Stool Tests:
  • You will be sent home to collect at least 3 different stool specimens to look for parasites. Be sure there's enough stool in each jar to raise the fluid to the line marked on the side. For the containers with no fluid fill them half way. If your child is having persistent diarrhea we will request a "fresh" specimen and give you separate instructions. Once you have all your specimens drop them off at our office. We only receive specimens during the office hours of M-F 10:00am to 1:00pm and 2:00pm to 5:00 pm.

Recommended Specialist Referrals

  • We recommend all internationally adopted children receive an audiology screening. This is to provide them the same level of care that all newborns in Georgia receive (all newborns in GA have a hearing test performed in the newborn nursery).
  • We, also, recommend that a pediatric ophthalmologist see all international adoptees. This is to screen for the higher incidence of strabismus ("lazy eye") seen in post- institutionalized children.
  • Depending on your child's situation, we often recommend an in-depth developmental evaluation from a team of experts (psychologist, speech therapist, occupational therapist, and physical therapist) at a developmental evaluation center. These government-funded centers exist in most counties to screen children who are at risk for developmental delay and plug them into appropriate services such as speech or physical therapy. There are, also, private developmental pediatricians available.
  • Depending on your child's age and dental condition, we may recommend a pediatric dental evaluation.
  • Lastly, many families ask about circumcision. We can discuss options and make a referral to an urologist if you would like.
  • If you live locally, we will be happy to make these referrals (except for the dentists who typically don't require a referral). If you are planning on receiving care in your hometown, we suggest you have your pediatrician or family doctor make these referrals in your area.

Second Visit

Your child's second appointment is scheduled 48 - 72 hours after the first one to allow for proper timing of reading the TB skin test (PPD). It is typically shorter than your first, extended appointment. At this appointment, you will drop off any stool samples you have collected. We will review any lab data that has returned (we usually have only some of the labs back at this point). Lastly, we typically start your child's immunizations at this visit. There are varying opinions on whether to simply re-start vaccines or draw levels (titers). We will discuss the pros and cons of either option. This is a typical physical appointment and it is usually fully covered by insurance.

Once the remainder of your child's labs are received, we will contact you by phone with results.

Subsequent Visits

Timing of subsequent appointments depends on your child's age, vaccination status, and any other issues we may have diagnosed. Most infants and toddlers are seen every 2 months after the first 2 appointments for 2 to 3 times in order to get vaccinations caught up and to monitor development and growth.

Consultation Visits for Children with On-going Special Needs

  • As a result of malnutrition and deprivation early in life, some internationally adopted children continue to struggle with medical, developmental, behavioral, and/or learning difficulties over time.
  • A consultation visit to discuss these concerns can help families find out the underlying causes of their child's particular difficulties and link families to appropriate evaluation and treatment resources in the community.
  • Call 770-442-5437 to schedule a visit.
  • Depending upon your insurance, you may need a referral from your child's Primary Care Physician for this visit. Contact your physician about obtaining any necessary referral. If we are your child's physician, then we will take care of all referrals.
  • If your child has already had other professional evaluations for these problems, please, let us know that at the time that you schedule your appointment. Please, send us copies of the reports prior to your visit, so that we may make the most of our face-to-face time.

For those who live near us, we hope you will consider us your new pediatric home. For those further away, Dr. Vayman is happy to answer any questions your local physician may have regarding your child.

We appreciate the opportunity to participate in this exciting time of your family's life!

Congratulations!

Travel Preparation

Parents should prepare prior to traveling to a foreign country to bring home their child.

Services that we can assist with include:

  • Basic baby care information
  • Information on common medical problems and basic childcare needs that may arise upon arrival in the child's country
  • A list of over-the-counter medications and supplies to take
  • Prescriptions for medications, when needed
  • Immunizations against such viruses as Hepatitis A and B

Important Note on Prescriptions
Families that consult with us will receive a page of prescriptions for the child they are traveling to adopt. If necessary, we can include a note to the pharmacist explaining the situation. Unfortunately, you will not be able to use insurance for these, since they are for a child that is not yet in this country, let alone on your insurance. But most of these are available in generic form to minimize costs.

Travel Advice

For additional resources, visit www.cdc.gov/travel

General Travel Medicine advice is provided here, but you may wish to see a specialist in Infectious Diseases about travel immunizations and preventive medicines prior to your departure.

In general, the biggest real risks in international travel are not exotic diseases, airline accidents, or terrorism but much more ordinary things like:

  • Automobile accidents - Auto accidents are the leading cause of serious injury and death during international travel. Wear your seatbelt (if the car has one!). If you feel your driver is being unsafe, say something or get another driver. If you are able to take a child car seat that's great, but it's extremely inconvenient to tote through the whole trip and the car may not even have seatbelts. Consider obtaining medical evacuation insurance (usually $25-$50 per person for a 2-4 week trip). This covers your air evacuation back to the U.S. in case of an extreme emergency.

  • Traveler's diarrhea is one of the main risks in international travel.

    TAP WATER IN UNDER-DEVELOPED FOREIGN COUNTRIES = POISON!

    This is not exactly accurate, but you have to admit that it definitely makes an impression. If you get traveler's diarrhea, then you may feel like you have been poisoned! Please, Please, Please, do not drink, wash food, or brush teeth with tap water.

    Drink only factory-sealed bottled water.

    Be aware that counterfeit bottled water (tap water put in recycled water bottles) is big business in some countries (make sure the lid is tight and completely sealed)!

    Be paranoid. A healthy dose of paranoia will increase your odds of not contracting a very nasty bug.

    You can, also, treat tap water with "Potable Water" iodine tablets . If you do this, then make sure that you take a container that is the correct size for measuring out water for treatment and get the neutralizing tablets that come with some Potable Water kits. The neutralizing tablets remove the brown iodine color as well as most of the iodine taste. Mixing this water with Crystal Light, Gatorade or other drink powder, also, masks the iodine flavor. You can find the potable water kits at Wal-Mart, Target, K-mart and other stores in the camping section. This water is great for brushing your teeth with so you don't have to buy as much bottled water.

Water

  • Don't use tap water to rinse your toothbrush and don't open your mouth in the shower.
  • Carbonated soft drinks or water are safe since the carbonation acidifies things enough to kill most bacteria.
  • Use a straw or at least wipe the can/bottle with alcohol swabs or antibacterial wipes really well.
  • Hot beverages are safe as long as they are very hot! Extreme heat kills bacteria.
  • Do not drink beverages with ice - remember the ice was made with tap water!
  • Do not wash cuts and scrapes with tap water.
  • If you have minor cuts or scrapes on your hands, then consider using antibacterial wipes not water.

Foods

  • "Cook it, peel it, or leave it!"
  • Do not eat fresh vegetables (like salad), because you will never remove all the dirt, plus it was most likely washed with tap water.
  • Eat fruit only if you peeled it yourself. Be sure you've washed it well (wiping with alcohol or antibacterial wipes is a good idea too) before you peel it. Do not cut through or peel an unwashed fruit as this will simply drag bacteria from the peel down into the fruit you eat. Lastly, no matter how good the foods sold by local, street-side vendors look, do not eat them!

Use these guidelines on any flights within foreign countries and for the air flight home. Airline food is usually prepared in the country the flight originates in, not the U.S.

  • Usual illnesses (colds, etc.) - These common illnesses are usually not life-threatening, but they can make your trip less than ideal.
    • Get enough rest.
    • Consider taking vitamins.
    • Some countries and areas it may be prudent to wear a mask.
    • Avoid contact with individuals and anything in their immediate vicinity that are coughing or sneezing.
    • Use antibacterial wipes frequently and liberally.
    • Cover minor scrapes and cuts with bandages and antibacterial cream at all times.

    Checklists of Medications and Supplies to Take

    For your child
    Prescription medications/creams:

    General antibiotic for ear infections, pneumonia, sinusitis, etc. (e.g. Zithromax) Cream for scabies (permethrin)

      Over-the-counter medications/creams:
    • Benadryl liquid (anti-histamine)
    • Benadryl Cream for bites
    • Tylenol/Motrin (age appropriate sizes)
    • Regular diaper rash ointment (Triple Paste)
    • Lotrimin cream (for yeast diaper rashes)
    • Topical antibiotic for cuts and scrapes (Neosporin)
    • Pedialite or Gatorade (powder)
    • Nasal saline drops or spray for older children
    • Moisturizing lotion/cream (e.g. Eucerin or Aquaphor, etc.)
    • Bandaids/Gauze
    • Hydrocortisone 1.0% for various rashes
    • Mylicon "gas drops" for infants
    • Nix or Rid for head lice

    Other:

    Digital thermometer (with K-Y jelly or Vaseline for rectal temps)

    For Parents
    Travel vaccinations are something to consider. You should discuss this with a specialist at a travel clinic and look at the CDC's website. Start early! Some of these shots require multiple doses spaced apart by months (e.g. Hepatitis B). If you're too late to get a full set prior to traveling at least get started - some protection is better than none. Also, be sure to budget for these - they're not cheap and most adult insurance policies do not cover them.

    • Tetanus/Diphtheria booster (unless you've had it < 5 yrs ago)
    • Measles/Mumps/Rubella (MMR) booster (if not already up-to-date)
    • Hepatitis B (3 given over 6 months)
    • Hepatitis A (2 dose)
    • Typhoid
    • Polio booster ( injectible form)
    • Chicken Pox (if you've never had the disease)
    • Shingles (if you have had Chicken Pox)
    • Influenza (if in flu season where you're going)
    • Yellow fever
    • Ask about need for malaria prophylaxis

    Visit www.cdc.gov (the U.S. Centers for Disease Control) to find out specifics about the region you will be visiting. This is an excellent resource for region-specific vaccines and any recent outbreaks!

    Medications, etc. (for parents):

      Traveler's diarrhea treatment:
    • Antibiotic (Ask your physician for prescription)
    • Imodium
    • Pepto Bismol
    • Gatorade powder
    • Potable Water Iodine tablets with collapsible water jug (camping store, K-mart, or Wal-mart)
    • Alcohol swabs (for wiping off drinks, fruit prior to peeling, etc.)
    • Alcohol-based hand washing gel (carry everywhere; use frequently!)
    • Straws (to avoid dirty drinking containers, glasses)
    • Laxative

    Motrin/Tylenol
    Sleep aid (Benadryl; Ambien - talk to your physician about jet-lag)
    Extra of your own medications stowed in different luggage as well as carry-on
    Extra glasses/contacts if they are critical
    Sunscreen depending on where you're going
    Mosquito spray (depending on where you're traveling - DEEP WOODS variety with higher percentage of DEET)

    For additional resources, visit www.cdc.gov/travel

    Adoption Consultations Fee Schedule

    All checks should be made out to The World of Pediatrics. We, also, accept Cash, Visa,Mastercard, and Discover.

    All payments are required in advance of services. Checks should be mailed to: The World of Pediatrics, 3005 Royal Blvd. S. STE 110, Alpharetta, GA 30022.

    If you choose to turn down a referral and request consultation for another child the same fees will apply again.

    Pre-Adoption Assessment

      1. International Adoption Review and Consultation: $425.00. Additional services will be charged in 15-minute increments.

      a. Evaluation of referral information and parental education prior to travel. This will include:

        i. Review of medical/social information prior to acceptance of referral. Discussion of health assessment as possible based on information available. Recommendations for requests of additional information which may aid parents in making a decision.
        ii. Review of medical information found while on trip
        iii. Parental education on how to gather information for child assessment while visiting child.
        iv. Parental travel advice and information from the CDC
        v. Provision of list of appropriate medications and/or prescriptions for travel.
        vi. Anticipatory guidance on transitioning the child from the orphanage to the family
        vii. Letters to Orphanage/Ministry and Notary Services (provided that we will be the child's Primary Care Physician) re: need for rapid adoption/health concerns, etc.

      2. International Adoption Expanded Review and Consult (including blind referrals): $500.00

      a. Evaluation of referral information and parental education prior to travel. This will include:

        i. Access via phone, fax, and email to Dr. Lyudmila Vayman in order to review medical information during overseas trip (particularly for blind referrals).
        ii. Review of medical/social information prior to acceptance of referral. Discussion of health assessment as possible based on information available. Recommendations for requests of additional information which may aid parents in making a decision.
        iii. Parental education on how to gather information for child assessment while visiting child.
        iv. Parental travel advice and information from the CDC
        v. Provision of list of appropriate medications and/or prescriptions for travel.
        vi. Anticipatory guidance on transitioning the child from the orphanage to the family
        vii. Letters to Orphanage/Ministry and Notary Services

        Note: $100.00 per each additional child will apply for Blind Travel Adoptions

      3. Domestic or Foster Adoption Expanded Review and Consultation: $250.00

      a. Evaluation of referral information and parental education. This will include:

        i. Review of medical/social information prior to acceptance of referral. Discussion of health assessment as possible based on information available. Recommendations for requests of additional information which may aid parents in making a decision.
        ii. Parental education on how to gather information for child assessment while visiting child or birth parents.
        iii. Anticipatory guidance on transitioning the child from the orphanage or foster care to the family as is applicable.
        iv. Letters and Notary Services as deemed necessary (provided that we will be the child's Primary Care Physician)

      Post-Adoption Assessments, Labs, Referrals, and Consultations

      NOTES on Charges:

      • New Arrival (First Visit) charges - We will file with your insurance company for the typical examination portion, immunizations and labs, but not for the paperwork, education, consultation and/or discussion portions of this first visit. You will be directly responsible for these costs -$420.00.

        Unfortunately, many insurance companies DO NOT cover all the costs of an Adoption First Appointment. At this time, insurance companies do not have a separate billing code that takes into account the length and depth of this type of appointment. This is not a typical physical and can take as long as two hours or more to complete. There is a great deal of paperwork that, also, must be completed for specialized diagnostic tests and referrals to specialists. Therefore, we have had to adjust for the time spent that insurance refuses to compensate physicians for.
      • Second and Subsequent Visits will be charged directly to insurance.
      • If there is no insurance coverage then all services and procedures will be charged at the standard rate per our fee schedule. The following information is not valid for Self-Pay patients. Please call our front office for a cost breakdown of services.

      1. New Arrival - First Visit (usually between 1-4 weeks from arrival in US): $420.00 over the cost of insurance coverage.

        a. Complete medical examination including assessment of issues related to growth, physical development, psychosocial development, infection, immunization status, nutrition and birth defects.
        b. Laboratory assessment including blood work, stool testing and testing for tuberculosis
        c. Age appropriate occupational therapy assessment to assess neurological (motor and sensory function), social development, attachment and other parameters.
        d. Referral for vision/hearing screenings
        e. Referral for special services including early intervention, school based services, developmental, psychiatric or psychological assessment and/or therapy.
        f. Implementation of immunizations as needed and development of a plan for completion of required immunization in conjunction with primary care providers
        g. Promotion and education of attachment, bonding and emotional development.

      2. Follow-up Visits (Second and Subsequent Visits)

      a. Review deficits identified in previous visits and address progress in those
      b. Complete medical assessment to review issues and repeat tuberculosis or other testing based on national recommendations.

    Frequently Asked Questions about Adoption

      What country should I/we adopt from?

      This question is best discussed with your agency and/or case worker. The decision is an individual one, based on many factors, such as desired gender, age of child, preferences for a specific ethnic background and your time frame.

      Can you recommend an adoption agency that I/we can use?

      It is important to use an agency accredited for the country of your interest. You and your child are our primary concern, not a specific agency or agencies. The most important thing is that you feel comfortable with the agency, its personnel, and its programs. A listing of accredited agencies can be found on the Joint Council on International Children's Services.

      When you review a referral of a child for adoption, what do you look for?

      We review the paperwork for information on the child's birth and medical history, the physical examination(s), developmental assessment, immunization history, and laboratory testing. Much of this information is often incomplete or missing. We then try to assess the child's particular risks for physical and infectious problems, as well as, developmental delay. Our practice is to form our opinion solely on the facts presented and our experience, and give you a risk assessment, based on the anticipated level of intervention and services needed for the child. We, also, discuss any specific questions or concerns you have.

      Are there specific medical differences or advantages between countries?

      Yes, but you should not be making a decision solely on that basis. This topic should be part of your initial discussion with your agency.

      How quickly would I be contacted, once I submit the child's medical record for review?

      Turnaround time is usually 2-4 days.

      What fees do you charge for the services you provide?

      Please, contact our office at (770) 442-5437 for the current fee schedule.

      Do you accept insurance?

      Insurance companies do not reimburse for services prior to the child's adoption. However, once the child is legally adopted, medical insurance for the child is retroactive to this day, and should cover the child's services thereafter with the exception of the first visit. We accept most major insurances. Please, contact our office at (770) 442-5437 to determine if your insurance covers our services.

      When I bring my child for the initial evaluation, what should I bring with me?

      Bring all the paperwork you received, so we can review it. Even if we did the initial referral, there may be some updated or more recent information enclosed. Most importantly, we need to have the child's immunization record. For an infant or toddler, you may need to bring an extra bottle and diapers, because this is a long appointment.

      Why do I need an infectious diseases and/or adoption specialist?

      While all pediatricians are certainly capable of doing an initial assessment, they may not have the experience to understand some of the terminology used by medical personnel in other countries, diagnose unusual infectious problems, know which laboratory tests or immunizations are necessary and which are not, accurately interpret the test results, or be up to date on the latest developments in international adoption medicine. The purpose of our initial assessment is to utilize our expertise in this area to ensure that your child has a thorough evaluation and quickly identify any problems that need to be corrected. We then work together with you to establish the best plan of action and immediate treatment recommendations.

      Can you recommend a pediatrician for my child's ongoing care?

      We provide primary care services, and many parents choose to continue with us. However, if distance is an issue, you may want to choose a pediatrician closer to you.

      Can you diagnose mental retardation from review of the child's medical records?

      This is a difficult diagnosis to make based on a medical information review alone, since mental retardation is a somewhat vague term. Children from orphanages usually have some degree of developmental delay. Although any developmental delay could technically be called "mental retardation," this term is usually reserved for the presence of severe developmental and cognitive delays. If a child has such delays, she or he would likely be clearly classified as a "special needs" adoption. Diagnosing mental retardation requires seeing the child in person over a series of visits to determine the degree of delay and whether development is progressing or static.

      Our child's medical history has some disturbing diagnoses listed. Are these typical for specific countries?

      Yes, medical reviews from the Russian Federation and Eastern Europe often contain scary sounding terms such as "perinatal encephalopathy of the newborn" or "psychomotor delay/retardation." The overwhelming majority of the time we find there is no basis for these diagnoses. However, it is important to look at and utilize all of the given information before coming to this conclusion.

      How is Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE) diagnosed?

      FAS and FAE are the older terms for what is now called Alcohol Related Neurodevelopmental Disorder (ARND), a range of developmental delays resulting from the unborn baby being exposed to alcohol use by the birth mother. So far, it is primarily seen in some children from Eastern Europe and the Russian Federation, although it can occur in any country. The diagnosis is made on the basis of four criteria: likelihood the birth mother drank (no risk, unknown, some risk, high risk), the degree of growth failure (none, mild, moderate, significant), the degree of brain dysfunction (unlikely, possible, probable, definite) and whether the child has certain facial and physical features seen in babies exposed to alcohol pre-natally (none, mild, moderate, severe). The most difficult part of the diagnosis is judging the presence of the ARND facial features. It is rare for people and pediatricians to completely agree on the presence and degree of ARND facial features.

      I've heard or read about rickets. What is it and is it treatable?

      Rickets is a disorder that affects bone development, causing bowing of the legs, and frontal bossing (a prominent forehead with "squaring" of the head). Rickets results from calcium and Vitamin D deficiency. There are a variety of causes, including genetic; in Chinese girls, it is usually caused by insufficient calcium and Vitamin D in the diet. Furthermore, even if intake of Vitamin D does occur, the body must be exposed to sunlight for it to be converted into a form that the body can actually use. Many of the children we see show minimal to mild rickets, which requires nothing more than a good diet and indirect exposure to sunlight. If the condition is more severe, this is still treatable with Vitamin D therapy. Rickets is diagnosed clinically by the presence of the aforementioned physical findings, as well as by blood tests, which are part of our initial evaluation.

      If my child has a positive skin test for tuberculosis (positive PPD) does that mean my child has tuberculosis?

      A positive PPD means the child has been infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis. However, this does not mean the child is sick or has tuberculosis disease. Infection means the bacteria is present in the body; disease means the bacteria are now harming the body and causing symptoms. For tuberculosis, years might pass from the time of infection until the time disease develops in the lungs. We have found about 20% of our internationally adopted children have a positive PPD, meaning they have latent tuberculosis infection. All of these children have had negative chest x-rays, telling us they are free of disease. Tuberculosis at this stage is not dangerous, does not affect the child's health in any way and is completely curable with an antibiotic. The child is also not contagious to others at this time and no restrictions or special precautions are indicated.

      If my child received a tuberculosis vaccine (BCG vaccine) in the country of origin, won't that cause a false positive skin test for tuberculosis?

      No. If the skin test reaction is equal to or greater than 10 mm in size, this indicates infection, regardless of a history of BCG vaccination, if the child comes from a country with a high incidence of tuberculosis. The World Health Organization reports 22 countries account for 80% of global tuberculosis in 2006, and the list includes the Russian Federation, China, Vietnam, Cambodia, the Philippines, India and Pakistan. Tuberculosis continues to be a global epidemic problem and many other countries not listed still have a high incidence of TB in their populations. To prevent future disease and complications, it is important to accurately identify those who have tuberculosis infection and treat them appropriately.

      What is the likelihood of my child having parasites when she or he comes home?

      Intestinal parasites occur in some children. Most commonly, it is a microscopic parasite called Giardia lamblia, which are found in about 19% of those tested. Curative antibiotic treatment exists for all of the parasites.

      Do you have any specific recommendations for adults or children who will be traveling to the birth country?

      We recommend you speak with your primary care provider(s) to discuss any specific travel recommendations applicable to your own unique medical history. We do offer general travel recommendations, as well as, appropriate immunizations for parents, other adults, and children who may be traveling with you. Please contact us for additional information and fee schedules for these options.

      Will I receive a formal written evaluation?

      No, our phone conversations and/or office consultations are extensive, often lasting 30-45 minutes, depending on the complexity of issues involved. We think you'll find us to be patient, thorough, informative, and happy to answer questions that you have about the child or the adoption process in general. We've chosen to spend our time in discussion with you rather than typing long reports about your child.

      You're welcome to take notes, or have other family members join the phone call / office consultation if that helps. If you need later clarification of something that was discussed, just contact us. We do keep consultation notes for our own records, which helps when follow-up information or overseas requests come in.

    Foster Care Transitions

    Tips for helping children in foster care transition to a new family:

    • Have the current foster parent request photos of the new family to show the child frequently.
    • Ask what kind of laundry soap and fabric softener the new family uses and have the current family start to use them (or have the new family use what the current family is using for at least a while).
    • Have the new family send a blanket, stuffed animal, scarf, etc to the current family so that the child can start to use it now and take it to the new home with her.
    • We would have the new family attempt to use as many of the same comfort items as possible that are sent with the child and not be in a big hurry to change them over or to wash them.
    • Have the families exchange information on schedules, foods, soothing techniques, favorite music, favorite books, toys, and so forth. Are there certain songs, and so forth that the child finds soothing or comforting? What do they use for eating utensils; does the child sit at the dinner table in high chair, or booster seat? As much information as possible that can be shared, the better the transition.
    • In an ideal world, we would have the transition last 3-4 weeks with short visits in the current home, then out in public with both parents there, then at the new home with the current parent present and so forth.
    • If that's not an option, make sure to have the exchange of information, use of photos now and in the new home to maintain connections, and the use of common items, smells, textures, foods, schedules and so forth.

    Rudimentary ideas that somehow seem to get overlooked:

    • Unless the child is in immediate danger, moving a child without preparing them ahead of time is NOT a good thing. By ahead of time, I mean well before the car is pulling up in the driveway. Losing a familiar family and home without preparation can be truly traumatic.
    • Never, ever move a child by putting their things in garbage bags. Kids are literal, and "Your belongings are garbage to me" is hardly a nice message to send to a distressed child.
    Ink Test for Scabies

    Ink Tests are a simple test that you or your doctor can do when you're asking the "Is it scabies?" question. First, look carefully for fresh itchy bumps or thin grayish squiggly lines (burrows) in the skin, especially at hands, inner wrists, finger-webs, elbows, armpits, ankles, feet, diaper area, belt-line, and abdomen. Infants and young children can get scabies on the face, scalp, and neck, unlike older folks. A magnifying glass and bright light can help.

    Take a dark washable wide-tip marker, and rub it around the suspicious bumps or burrows. Then take an alcohol wipe or alcohol-soaked gauze and wipe away the ink. If there is a scabies burrow under the skin, the ink often remains, showing you a dark irregular line. Occasionally, a tiny dark dot is visible at the end of the burrow - that's the mite.

    At your physician's office, they might use mineral oil and a scalpel to scrape the burrow and a fresh bump or two onto a microscope slide, to look for the mite, or its eggs and feces, but the ink test can be done at home. In children with intensely itchy skin rashes, recently adopted from institutional care, we will usually treat for scabies even without evidence.

    International Adoption Challenges

    All families should be aware of the medical issues facing internationally adopted children. Although this information may make you pause or may sound negative, that is absolutely not our intention. We firmly believe that all families need to be aware of this information to make fully informed decisions that result in a loving, healthy, and bonded family. Our practice is a staunch advocate for adoption, but we firmly believe all families need to be aware of all the possibilities so that they can be prepared.

    First of all, it is important to consider some of the reasons why children are in orphanages. Very few children are truly orphans without any living parents. Most children are relinquished due to hardships of birth mothers living in poverty. This raises the odds that the birth mother did not have great prenatal care, may not have had good nutrition, and may have abused substances to relieve the stress of poverty. Other reasons include parental neglect or social pressure (the one child law in China or social prejudice against children with deformities). The bottom line is that the very reasons children are in orphanages often put them at higher risk for developmental, behavioral, and medical problems.

    Add to this difficult start, any length of stay in an orphanage and the detrimental effects can add up. Most orphanages are at the bottom of the ladder in terms of government funding, so nutrition is often marginal. Study after study in various countries all show predictable weight, height, and sometimes head circumference deficits depending on how long a child has lived in an orphanage.

    Rates of infectious diseases are, also, high. There can be gastrointestinal parasites, latent tuberculosis, and hepatitis B infection in internationally adopted children. Hepatitis C and syphilis rates are less than 1%. Fortunately, there have been very few cases of HIV infection found in internationally adopted children.

    Another issue, particularly in Russia and the former states of the Soviet Union, is maternal alcohol use during pregnancy. Diagnosing children with fetal alcohol exposure or fetal alcohol syndrome (FAS) is difficult. The criteria includes a history of maternal alcohol use, signs of brain injury (developmental delay and/or small head circumference), poor growth (including small size at birth), and several facial features. The facial features of FAS (such as a thin upper lip and no normal groove - called the "philtrum" - between the upper lip and nose) can be subtle and somewhat subjective. The problem with diagnosing FAS in children in orphanages is that a large portion of children in orphanages have no maternal history, are somewhat developmentally delayed, and have poor growth whether they have FAS or not.

    Even more concerning than the nutritional, infectious, and substance exposure risks these children face is the lack of emotional attention and cognitive stimulation they receive while in the orphanages. Families who have completed their adoptions routinely respond that they have more issues regarding their adoptive child's emotional/cognitive health than their medical problems. The longer children reside in orphanages the higher their risk for more emotional/cognitive issues. Even in the best of orphanages, it is difficult to give adequate affection and language stimulation to individual children. With many different caregivers involved, children often do not learn to attach appropriately to specific adult "parent" figures. Because of this lack of attachment, many newly adopted toddlers will go to any stranger without anxiety. This is often misinterpreted as friendliness, when in fact it is an abnormal lack of stranger anxiety. For most children who spend less than 2 years in an orphanage, this lack of attachment resolves without major problems. In some children, particularly older children, who spend more than 2 years in an orphanage, attachment issues may be more severe and require professional assistance. There are occasional examples of children adopted as infants developing attachment problems, but they are uncommon.

    GREAT NEWS! Of the tens of thousands of children who are adopted into the U.S. each year, the majority of them have done well and their parents would consider adopting internationally again. Some of these families have had few if any medical or behavior problems with their children. Others have needed special educational services or medical care, but since they were prepared and supported they have had an overall positive experience and would consider adopting again. Several factors play into such excellent outcomes from such difficult early infancies. First, most of these kids are survivors and are quite resilient. The majority respond well to the nutrition, affection, and attention that their new families lavish on them. Second, more and more pediatricians are screening these children for medical and/or emotional issues and initiating proper therapies such as state-sponsored early intervention services. Lastly, as mentioned above, I think parents are better educating themselves about international adoption and are thus better prepared to deal with the issues that might come up with their child. I hope this brief overview will assist you in this education process and allow your family to prepare to welcome your new child!

    Adoption and Attachment Reading Suggestions

    Adoption Books

    • The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers by Laurie C. Miller
      This book was written for pediatricians and practitioners, but accessible enough for the ambitious parent. A wonderful, exhaustively researched textbook on adoption medicine.

    • Nurturing Adoptions: Creating Resilience After Neglect & Trauma by Deborah D. Gray
      The "required reading in adoption" list just got longer, and shorter. Nurturing Adoptions is several long-awaited books in one: a deft overview of neglect and trauma's effects on children and families, a collection of practical pearls for adoptive parents, a best practices primer for child welfare professionals, and a lovely illustration for child therapists of Deborah Gray's state-of-the-art therapeutic approach.

    • The Connected Child by Karyn B. Purvis, David R. Cross, Wendy Lyons Sunshine
      This is a practical primer that covers some of the same ground as Nurturing Adoptions, but is more quickly read. Information on practical ways to parent fostered and adopted kids using high nurture and high structure.

    • Adoption Parenting: Creating a Toolbox, Building Connections by Jean MacLeod, Sheena Macrae
      This is a compendium of adoption parenting advice.

    • The Complete Book of International Adoption: A Step by Step Guide to Finding Your Childby Dawn Davenport
      A place to start for families exploring international adoption. The author interviewed a lot of individuals in the field, and put together a collection of country charts, as well as, advice on choosing an agency, worksheets for the paper chase, travel tips, and information about common transitional issues for adoptive families.

    • Toddler Adoption: The Weaver's Craft by Mary Hopkins-Best
      A book covering the unique challenges of adopted toddlers.

    • Raising Adopted Children, Revised Edition : Practical Reassuring Advice for Every Adoptive Parent by Lois Ruskai Melina
      Solid parenting advice, covers the gamut of unique issues involved in adoption.

    • LifeBooks : Creating a Treasure for the Adopted Child by Beth O'Malley
      Children need a safe, loving way to revisit their life story, again and again. A life book really can be simple (sometimes simple is best), so don't let scrap booking performance anxiety get in the way.

    • A Love Like No Other: Stories from Adoptive Parents by Pamela Kruger
      Essays by 20 adoptive parents on various aspects of the adoption experience.

    • Adoption Nation: How the Adoption Revolution Is Transforming America by Adam Pertman
      A book about adoption and contemporary America ... compelling evidence and arguments about open versus closed adoptions, the role of money in adoption, and other hot topics.

    • The Family of Adoption : Completely Revised and Updated by Joyce Maguire Pavao
      Overview of adoption that addresses adoptive parents, birth parents, and their children. Covers the developmental stages in adoption and "normative crises" along the way.

    Attachment Books

    • Attaching in Adoption: Practical Tools for Today's Parents by Deborah D. Gray
      A really good attachment resource.

    • Parenting From the Inside Out by Daniel Siegel, Mary Hartzell
      A great resource for parents who find that raising their children is, also, bringing up issues from their own childhoods. Resolving your own issues, so that you can respond, instead of react to your children is an essential component of attachment therapy and therapeutic parenting.

    • Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children by Daniel A. Hughes
      A therapeutic parenting approach. A bit "old-school" in parts, but an important update on the author's website outlines how his approach has evolved (less holding, less provocative, more emphasis on parental attachment histories), and lists what you should NOT be doing in attachment therapy.

      UPDATE: This book is now in its second edition, and I believe it now reflects the author's more modern approach to attachment work.

    • Theraplay : Helping Parents and Children Build Better Relationships Through Attachment-Based Play by Ann M. Jernberg, Phyllis B. Booth
      A book with a detailed, technical description of play-based attachment therapy. Consider starting with Playful Parenting, and follow with this book for techniques that are specific to children with disordered attachment.

      Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This website does not constitute a physician patient relationship

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