In domestic adoption, birthparents choose the adoptive parents for their child. In international adoption, adoptive parents choose their child.

Domestic adoption isn't right for everyone. You may not feel 100% comfortable with the concept of open adoption. You may not be willing to agree to letters, phone calls or face-to-face visits from birthparents and wish for an absolute right to privacy. You may need to minimize the risk that an adoption could be reversed in court. Or you might wish to choose the gender or race of a child or to adopt more than one child at once. If you are an older couple with biological children, birthmothers who prefer youthful or childless parents could overlook you.

Is International Adoption Right for You?

In international adoptions, birthparents very rarely play a role in their child's adoption overseas and usually have relinquished parental rights to their child by the time he arrives at an orphanage. By the time you finalize your adoption on foreign soil, the relinquishment is irreversible. This means the adoption is final, period, end of statement.

Your family's privacy is protected from inquiry. For example in Russia, the child's adoption file is sealed by law. In China most orphaned girls have been abandoned with little information on the birthmother. (The bad news is if you change your mind later about connecting with the birthmother, you're probably out of luck.)

If you have suffered disappointment with infertility or with failed domestic placements, choosing international adoption may allow you to reassert control over your adoption journey by establishing a more concrete time frame. The sheer number of children available in the tens of thousands makes the outcome virtually certain for qualified parents. You will be parents of a child if you can pass the foreign government's requirements. You can count on that happening usually within 12 to 18 months.

With so many orphans available for adoption, you can state your preferences on the child's age, race, health and gender. If you want a larger family, sibling groups are available faster because they are harder to place. Some governments might reduce certain fees and waive mandatory waiting periods to place physically disabled kids.

However, you should not consider international adoption if you are not ready to parent a child with special needs or developmental delays. Most, but not all children adopted internationally have at least mild developmental delays.

The Risks

What are the Risks Unique to International Adoption?

You must accept that information on your child will be scarce... very scarce. Health and developmental status should be paramount on the scale of your concerns. You will have to accept opinions from sources whose reliability cannot be documented, hardly comforting for Americans who are used to cutting-edge information.

Orphanages do not have automated record keeping systems. What you may receive are head, weight and length measurements at birth and at intervals thereafter... or maybe not. And you may get test results for hepatitis, AIDS, venereal disease at various intervals... or maybe not. If you hit the jackpot, you may receive a video lasting... oh, maybe 2 or 3 or even 4 minutes long... showing how the child sits, crawls, stands, speaks and/or interacts with caretakers, hardly enough footage on which to base a lifetime decision. Or you may not get a video at all.

Historically, foreign countries hate to give up healthy children due to national pride. In some countries, medical reports are totally bogus and include fabricated or exaggerated medical diagnoses (water on the brain and stroke at birth are common in Russia) to help qualify a child to be adopted internationally. You may not have a clue which diagnoses are true or false.

It's critical you find an expert pediatrician who has vast experience evaluating institutionalized children. Look for them at international adoption clinics. These pediatricians have screened thousands of medical documents from orphanages worldwide and understand fully the risks inherent to your decision. Some doctors charge for this service; some offer their opinions at no charge in exchange for a donation to their clinic.

What health problems do internationally adopted children experience?

We most commonly see five health problems with internationally adopted children: hepatitis, AIDS, fetal alcohol syndrome or effect (FAS/FAE), attachment deficit disorder (ADD) and sensory integration dysfunction (SID). There are lots of other risks as well, including prematurity, undisclosed birth defects, cerebral palsy, autism, hyperactivity, malnutrition, rickets, to name a few.

Sometimes blood tests determine if a child has hepatitis or AIDS; you should expect this information. (Beware: that doesn't mean the child won't get these diseases the day after the test was taken, so be sure the test is recent.) However there are no conclusive tests for FAS/FAE, ADD or SID, which can be diagnosed as key developmental milestones are missed, sometimes up to age 2 or after.

You should become well-acquainted with these risks by doing a lot of homework. Two parent support websites are highly recommended: Families for Russian and Ukrainian Adoption can be found at www.frua.org and Parent Network for Post-Institutionalized Children (PNPIC) at www.pnpic.org.

Fetal Alcohol Syndrome or Effect

FAS/FAE is a risk prevalent in Eastern Europe and Russia; it is thought to be uncommon in China where alcohol is scarce. FAS occurs when the fetus is exposed to alcohol constantly throughout the pregnancy, whereas FAE can be tied to binge drinking at a critical stage of fetal development. Certain facial characteristics (absence of philtrum, low ears, wide nasal bridge among others) characterize the condition. Physicians at international adoption clinics are constantly on the lookout for telltale signs of FAS/FAE, another reason to have these specialists review any referral. Michael Dorris' The Broken Cord is an autobiographical account of parenting his adopted son diagnosed with FAS and gives a poignant picture of his son's challenges.

Attachment Deficit Disorder (Not to be confused with ADHD or attention deficit disorder)

ADD occurs when a neglected baby fails to bond with a loving adult. It can leave a devastating legacy. Here's the better news on ADD risk. The prevailing wisdom holds that once a child bonds with someone, usually a caretaker, the child can ultimately transfer that bond to a new parent. The risk of ADD is minimized if the ratio of caregiver to children is low. A good ratio is 1 caregiver for every 3 or 4 kids. A bad ratio is 1 to 20. There can be good and bad orphanages in the same country. Every institutional environment is unique. Be sure to look for evidence of the child's interaction with others on the video.

Sensory Integration Dysfunction

SID can result when babies are left in cribs for long periods and do not get the benefit of continuous touch of a caregiver or are unable to explore freely their surrounding environment. As a result, the body's senses interpret information inappropriately. It is difficult to tell from a video if a child has SID, which is treated with occupational and physical therapy. The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction by Carol Stock Kranowitz is an excellent, easy-to-read reference which introduces the SID concept and discusses how sensory exercises can help your child. I recommend this to parents of any post-institutionalized child. While your child may not have SID, there may be a time when the sensory stimuli of our everyday lives in America stresses your the child to the point of meltdown. This book gives tips on how to manage the stress of sensory overload and to maintain a beneficial sensory diet.

Will my Child be Developmentally Delayed?

Yes. "Let me be blunt," says renowned international adoption specialist Dr. Dana Johnson with the International Adoption Clinic at the University of Minnesota Hospital. "The chance of an institutionalized child being completely normal on arrival in your home is essentially zero... These kids are a high-risk group by any standard." Dr. Johnson's rule of thumb is that an institutionalized child loses month of linear growth for every 3 months in an orphanage. The typical institutionalized 1 year old would be expected to show the development of a 8 month old. Dr. Johnson's entire web site should required reading for any adoptive parent. (www.peds.umn.edu/IAC/).

Many children present with delays that are temporary or situational. Colds and viruses are rampant in orphanages. Your child may come home with ear infections, ruptured ear drums or hearing loss and need ear tubes. Her expressive and receptive language may be delayed or there could be some degree of hearing loss, which may lead to speech therapy and learning issues down the road.

You must be prepared to parent your child at his developmental rather than his chronological age. For example, you may consider holding your child back in school, especially if his birthday lies close to the school district's cutoff. This is especially true if your child's fine motor skills are less developed than those of his peers. Give your child the benefit of time to catch up and to fix the holes in his development caused by the orphanage experience. Let him be a leader rather than a follower in the classroom.

These developmental deficits can be addressed with early intervention, medical care, good nutrition, therapy and last but not least, love . My clients who are parenting developmentally delayed children say the rewards are enormous. No milestone goes ignored or un-celebrated!

The Country Decision

To Choose or Not To Choose... That is the Question!

Agencies have opposing philosophies on the country issue. Some believe you should choose a country at the outset and fill out your paperwork for one country only. They believe this helps you to prepare yourself as part of the home study process. Others believe the opposite, arguing you can protect yourself if your paperwork is prepared using very broad language.

The stark reality is that foreign countries have a documented history of shutting adoption borders abruptly. God forbid your paperwork is overseas when the brand-new Minister of Adoption announces a moratorium and you are within one week of picking up your child. The danger is your adoption can be postponed if not derailed. You may not be open to adopting from China. But if your home study reads "Eastern Europe or Asia," your flexibility is enhanced if your first choice country, say Russia, closes without warning.

This is not an idle warning. In June of 2001, Romania announced a moratorium on adoptions for at least a year and possibly much longer. While pending adoptions were not supposed to be affected, some people whose paperwork was filed in Bucharest had to replicate their entire dossiers to switch countries. Similarly, Cambodia and Viet Nam announced suspensions during the first four months of 2002.

Don't put your eggs in one basket! Prepare your paperwork using broad, inclusive language. You may have to convince your social worker to do so on the home study. But the flexibility will be worth it. If you have your heart set on adopting a baby girl from China, it doesn't mean that you have to accept consider a toddler boy from Russia. It does mean that if China were to close, you have kept your options open.

The following breakdown of international adoptions shows that 90% of 2001 placements were done from just 10 countries, with China and Russia together accounting for almost half. Chances are you'll be going to one of these 10 countries if you decide to adopt internationally. Note that Romania, Viet Nam and Cambodia have imposed moratoriums on overseas adoptions or are expected to do so shortly.

Agencies are not the same!

Choosing Your Agency: The Key Decision

In contrast to domestic adoption, Americans rarely arrange private adoptions through foreign attorneys. There are many advantages to employing an agency rather than a foreign attorney in international adoption. Most agencies have established track records and all must meet standards for conduct by licensing authorities. Some are seasoned enough to be recognized by highly-regarded experts such as the Council on Accreditation (COA) or the reputable Joint Commission on International Children's Services (www.jcics.org). The Adoption Guide of 2002 (www.adoptivefamilies.com/adoptionguide2002) provides comprehensive listing of international adoption agencies.

Not every domestic agency is good at international adoption (and vice versa). The skill sets differ greatly. Domestic social workers counsel birthmothers through their pregnancies, help obtain appropriate medical care, negotiate adoption plans, and facilitate the child's first meeting with her new parents.

International agencies have virtually no contact with birthparents. The more thorough agencies talk directly to orphanage doctors and directors. They gather whatever scarce information they can about your referral. They translate documents, arrange your air travel and lodgings and hire foreign coordinators, drivers, translators and tour guides. They try to ensure that your appearances in front of foreign officials proceed smoothly. International specialists may speak multiple languages and have foreign government connections.

It's important to comparison shop. Agencies commonly offer informational meetings to educate potential clients about their philosophies and styles. Attend as many informational meetings as you can and ask a lot of questions. Ask about the agencies length and variety of experience with international adoption. It's not important to go with the oldest agency because the overseas landscape changes rapidly and agencies have to be nimble and very informed to keep pace. But if the agency is just a few years old you should be asking some hard questions about its ability to deliver. It's not always best to go with the biggest agency measured by number of annual placements. You don't want to get lost in the system because you have people waiting ahead of you in line. Ask if the agency is not-for-profit. Does it have 501-(c)(3) tax exempt status from the IRS? Ask how the adoption professionals are compensated. Does the agency have a humanitarian mandate?

Every agency should provide a list of references, including past adoptive families, licensing authorities and even international adoption clinics. Be sure to ask for names of families who had problems or unexpected snafus. Agencies usually will give you names of folks who will praise them to the moon. Find out what went wrong in the process and what the agency did to fix it.

Inquire about the agency's parent training requirements which vary from agency to agency. Some require up to 20 hours of classes. Others require that you thoroughly read a few books and be ready to discuss them at the home study. Some require that you obtain a foster care license. Some do not. Each agency's expectation for the time you will spend becoming educated before adopting will differ - so do your homework.

Which is Better? A Home Study Agency or a Source Agency?

It depends. Ultimately, your choice will come down to a matter of trust and your need for a personal connection.

The range of services provided by international agencies can be very confusing. The agency in your hometown may run its own direct country program and can deliver the entire package to you from home study to referral to travel to post-placement visits. Sometimes, in order to offer a variety of country options, local agencies will out-source the "referral and travel phases" to a second "source" agency, which has the direct relationship to orphanage directors. You may prefer this arrangement because you prefer to deal face-to-face with your local social worker.

Alternatively, you may choose to be a client of the "source" agency itself. In some instances it may be crucial for you to have your agency communicate directly - without a middleman - with an orphanage. The disadvantage may be that the source agency you like may not be permitted to write your home study if it isn't licensed in your home state. Another drawback is your connection with an out-of-state source agency will not be as personal and your communication will be done using phone calls, e-mail and faxes.

It's important to know who is doing what, at what time and at what cost. Find out specifically who makes the match between child and parents. Is that specific person speaking directly to you about your preferences? Can you get your questions about the child answered from the person who has the direct relationship with the orphanage? Make sure you ask whether the in-country coordinators, drivers and translators work directly and exclusively for your agency. If no, realize that the home study agency may not have complete control over your adoption referral or the quality of your outcome in a foreign country.

Can I Adopt if I'm Single? Divorced? Gay? Disabled? Have Been Convicted of a Crime or Offense?

Some foreign governments will exclude you if you are single, divorced, gay or disabled. In addition, agencies are free to decide who they will and won't represent. Some have religious affiliations or lifestyle philosophies they expect you to share. Each agency can decide who they will represent as suitable parents to the foreign government. So, you may have to do a lot of extra agency shopping and be open to alternative country programs.

Whether you will be able to adopt if you have been convicted of a crime or offense depends on many factors; the nature of the crime or offense, your State's laws, your agency's rules and the foreign countries requirements. If you have been convicted of a crime or offense and wish to adopt, consult an attorney early in the process for further information.

You may be tempted to "hide" or not disclose certain information in order to increase your chances of adopting. I cannot caution you enough to be completely honest and truthful with your agency and your attorney. If you are not perfectly honest with your agency and attorney, not only will you run the risk of a failed adoption, you may never be able to adopt.

The Costs

Why is International Adoption so Expensive?

It doesn't make sense that international adoption should cost so much. After all, there's a child in an orphanage who clearly needs a home, food, medicine and a loving family. Why does it cost $20,000 to $35,000 to get that child to his new parents? Why can't governments lessen the financial burden of adopting one of their needy children?

Here are some of the reasons that international adoption costs so much. Private in-country legal fees can range in the thousands; it can be tough to find qualified, highly reputable people to prepare the child's legal documents in the foreign country. Travel costs can be astronomical because you may be asked to travel at the last minute and be unable to use frequent flyer miles or discount fares. (If you don't have a frequent flyer account, be sure to set one up before you leave!) Part of your total cost may be an "orphanage donation" to help the feed and clothe the children who remain in the orphanage.

Don't be afraid to shop around because agency and country program fees can vary dramatically. There is no standard way in the industry of presenting agency fees so you may be comparing apples and oranges. For example, travel fees may or may not be included in the published program cost, making one agency look cheaper when it's really the other way around. Every agency you interview should readily disclose all future fees in detail.

The Process

How Long Does it Take to Adoption Internationally?

A typical time from is 12 to 18 months, sometimes longer if things go wrong. The dossier (or "paperwork") phase takes 2 to 4 months if you're organized about setting deadlines for yourself. Once you have completed your dossier, the journey becomes highly variable depending upon the country and the agency. Next comes the time when you will be asked to consider specific children who are presented to you (the "referral" phase). An agency may take anywhere from 1 to 6 months to present you with an Eastern European or Russian child. You may wait up to a year, sometimes longer, to receive a referral from China. Finally you are ready to travel. You may take one trip, two trips and yes, maybe even three trips to get your child, again depending on the program. The "travel phase" can last from one week to several months.

1. The Paperwork Phase

Hopefully, you are a methodical paper pusher who can build a dossier in 2 to 4 months. If not, it could be a year before you receive a referral. Those of you who are unorganized might consider hiring a document specialist who will order all your birth and marriage certificates, divorce decrees, etc., and affix the appropriate seals. Agencies may include this service for an extra fee or refer you to an outside consultant for assistance.

What is a "Dossier"?

A dossier is a collection of documents that are required to adopt a foreign child. It will include but is not limited to an I-600-A form approved by the INS, a home study, recently issued originals of birth and marriage certificates and divorce decrees, police clearances, letters of reference and affidavits by your doctor and bank attesting to your physical and financial well-being. Usually, there are 15 to 20 documents in a typical dossier. Every foreign country has its own checklist of required documents and authoritative seals. This checklist should be considered a moving target because the country can change its mind at anytime, even when you are on the airplane. What is required today may be entirely different than what is required tomorrow.

What is an INS I-600-A? Do I have to file it right away?

The I-600-A, not to be confused with the I-600, is a form published by the Immigration and Naturalization Service (INS) of the US government. Be careful what you request because the I-600-A and the I-600 are two different forms with two different purposes. The I-600-A is a "Petition to Classify an Orphan as an Immediate Relative." The function of the I-600-A is to classify a foreign-born orphan as your child to allow her to enter the US without a US passport.

To obtain the form, you can call the INS Forms Request Line at (800) 870-3676. Or go to the INS website at www.ins.usdoj.gov to print a copy. The website shows that the I-600-A is now a "fillable form," meaning you can fill in the answers on your computer screen, print it and mail it with your payment. You will not be able to save the file to your computer, which is a disadvantage. And you will not be able to send it the INS on-line.

Do not fill out the form without talking through the "right" answers with your agency. The answers may differ depending on the program or country you select. Next make a copy of the form (both sides) for your files. Don't ever, ever mail anything without copying it first for your adoption file.

Get a certified check or money order, the INS's "preferred" method of payment. Do not even think of sending a personal check because you will take the chance that your file will be returned causing weeks of delay. (I offer this advice based on my friend's personal experience!) Make sure you verify the amount to send in with your agency. Fee hikes occur with regularity, and your file will be sent back to you unprocessed if you send the wrong amount. Make sure you include the amount per person to cover fingerprinting.

As of February 2002, the application fee for INS' I-600-A was $460 and the fingerprinting fee per person was $50. Note: If you have an adult over the age of 18 living with you (Grandma, Grandpa, a live-in sitter), that adult will have to pass fingerprinting clearance too. More information can be found at www.ins.gov/graphics/formsfee/feechart.

Within a few weeks, you will hear from the INS saying it has opened your file. You will receive a special fingerprinting card and instructions for making an appointment to have your fingerprints done at a local facility. Not any old fingerprinting location will do. The INS requires that you do this on a special machine that feeds your fingerprints and data into a central criminal database. Do your fingerprinting immediately. Then hurry up and get your home study done. Upon receipt of your home study from your social worker, hopefully your I-600-A will be approved in writing and your approval letter will be sent.

Of any document in your dossier, the I-600-A approval takes by far the longest to obtain. Some INS offices are faster than others, but you should plan on at least 4 months from beginning to completion, possibly longer if the INS office in question is ....... sloooow. And you aren't going anywhere without your beloved I-600-A approval, so do get the I-600-A done FIRST.

Is a Home Study Different for International Adoption than it is for Domestic Adoption?

Yes and no. A social worker still comes to the house and interviews you just as in domestic adoption. However, you will be asked questions like "How do you intend to keep the child's culture alive in your home?" Or "How do you feel about adopting a child from a different ethnic heritage?" Foreign adoption officials are very interested to make sure this child will know and respect the rich traditions of its proud country and will look for language to that effect in an international home study.

Before your home study, take a deep breath. This is not the inquisition! The social workers who perform home studies generally are warm, caring people who are deeply committed to the cause of international adoption. They take great satisfaction knowing they have helped a needy orphan find a home. So relax and be yourself.

What Else Do I Need?

Some agencies require a photo album of family pictures to show foreign officials. Pictures might include siblings, Grandma and Grandpa, aunts and uncles, cousins and friends to demonstrate that the child will be welcomed into a warm, supportive extended family. Show pictures of your house, the nursery, your local playground and school to assure the officials that you have a loving and stable environment to bring your child into.

Do You Really Need a Foster Care License

Technically no, because foreign countries don't mandate it. However, many agencies have chosen to require a foster care license to ensure an extra layer of parental training. It does give you some advantages if both parents can't travel at the last minute. For example, it's possible that an adoption could be finalized without both parents present. Ask your agency up front if you need to go to the extra time and expense to get one.

2. The Referral Phase

This phase can last anywhere from a few weeks to months depending upon how the child meets your expectations. After the dossier is done and before the actual referral, you should identify a fully qualified international adoption pediatrician who has experience reviewing information on thousands of institutionalized children.

What is a "Referral"?

A "referral" is made when you are formally presented with a child. What's in a referral package and who makes the referral differs by agency and by country. For example, in China the government selects and refers the child to you. In Eastern Europe, your agency selects and refers the child to you. You may receive a video lasting a few minutes, some photographs at different ages, and a translation of the medical record.

What Information Do I Receive about the Birthparents?

None or almost none. If you receive a great deal of information, consider yourself lucky. Maybe you'll get a name. Maybe you'll receive evidence on paper about birthmother's test results for hepatitis, AIDS, CVS and venereal disease. Maybe not. Maybe you'll even receive information on the birthfather but don't count on it. So unlike the domestic process, you will not meet the birthmother or be able to monitor her standard of obstetric care. You probably will not know if she drank alcohol or did drugs during her pregnancy (a statement you may not be able to make for the domestic birthmother either).

Will I know specifically why my child was placed for adoption?

You may never find out your child's early history. Orphanages exist in third-world countries because there is a significant part of the population that cannot afford to take care of their children. Birthmothers in some countries have access to abortion but choose instead to give life and a shot at a better future to their babies, however small the odds may be. In other countries birth control isn't readily available. Some children become wards of the state if their parents die and their relatives can't take them in. Some parents have debilitating problems with drugs or alcohol. You may never know.

Baby Versus Toddler: The Age Decision

It is rare that you will adopt an infant under 4 months of age from a foreign country. Generally, it takes several months after his birth for a newborn to become eligible for an international adoption.

There's a tradeoff between adopting a baby from 3 to 12 months and a toddler over the age of 1 year. It's a dilemma, and one you need to talk to your agency about in some depth before you accept a referral. Some professionals believe that adopting under 12 months is the only way to go because there is less developmental damage from being institutionalized. The other view is your agency will have gathered more developmental information on a child who is over 12 months of age. For example, his age for demonstrating sitting, crawling, standing, walking and talking. Recognize that children who will have permanent disabilities such as FAS/FAE, cerebral palsy and autism are diagnosed as late as 2 years of age. So, with the benefit of more information you may learn that your referral presents above average health risk.

Do as much reading as you can. Adopting the Toddler: The Weaver's Craft by Mary Hopkins Best, Ed.D. is an excellent resource. The workbook With Eyes Wide Open: A Workbook for Parents Adopting Internationally Over Age One by Margi Miller, M.A. and Nancy Ward, MA, L.I.C.S.W. comes highly recommended.

Adopting the Older Child

The older child will surely present with developmental issues. Before you leave US soil, be fully prepared to address the child's undetermined special needs. Explore the special education services offered by your school district. They can be outstanding or legally minimal, depending upon your district's financial commitment to special education. Learn about "Individual Education Plans" (IEP's) which legally entitle a special needs child to special therapies at school (www.wrightslaw.com).

Call your insurance company to find out what outside therapies may be covered. In the absence of good insurance coverage you will rely on your school's ability to deliver a package which can help your child catch up. This may include but is not limited to speech and language therapy, occupational therapy for fine motor skills, physical therapy for gross motor delays, vision therapy, tutoring help, and extra attention from a psychologist or social worker to help the new little immigrant assimilate his new environment. Read all you can including Our Own: Adopting and Parenting the Older Child by Trish Maskew. If you can accept these challenges, then you may have the privilege of making a real difference in a child's life.

Call an International Adoption Clinic Right Away!

This is the third time I've stressed the importance of finding a fully qualified pediatrician at an international adoption clinic to review your referral. IT BEARS REPEATING. These doctors are used to looking at what is intrinsically a high-risk population and sifting out the gems of information that point to risks you and your local pediatrician may not pick up. Many have traveled extensively to observe and train orphanage staff and are passionately devoted to the cause. They have a mandate to spell out all the possible risks so you can make a rational judgment on a child before you fall in love with the pictures. You can find these specialists through your agency and on the web.

Saying "No" to a Referral

There may come a time when you just do not feel comfortable with the referral you've received from your agency. This can be the hardest moment along the international journey because you may have to grapple with saying no to a living, breathing child. All I can say is that if in your heart of hearts you can't envision yourself being a fully committed parent to this child, you owe it him to say no. Every kid deserves a parent who is willing to put him first. If your agency has a lot of waiting families, there may be yet another possible home for him in the future.

3. The Travel Phase

Why do I have to take Two or Three Trips to get a Child?

Country programs differ in many ways, such as the age, gender, health and race of the children available. The travel requirements can also differ greatly. Quite frankly, these countries set guidelines to ensure the safety of their children; they are not concerned about making your journey to parenthood as easy as possible.

Few countries offer escort service, so you should be prepared to travel overseas. China remains one of few large one-trip programs among the top 10 countries. Some Latin American countries require one trip but perhaps an extended stay of up to several weeks or months. In Eastern Europe, two trips are usually the status quo.

Russia used to be a one-trip program. However, in Spring 2000, President Putin required parents (not the agencies) to introduce themselves to the court system before the child's paperwork could be initiated (the first trip) . Then the parents return to finalize the adoption in court many weeks later and possibly to pick up their child; this trip last as long as 3 weeks (the second trip). Some agencies prefer that their clients leave the country immediately after the court decision is finalized and then return in two weeks to pick up their child (the third trip).

The First Trip -- You See the Children

Don't set your expectations for a storybook rendezvous. The first encounter may be rocky because the child is asked to separate from a trusted worker and play with complete strangers. The separation anxiety can be viewed as a healthy sign that the child has learned to attach with someone. Your second visit on this trip probably will proceed more smoothly once the child warms up to you.

Men, be prepared for a cool reception. Most kids have only been around female caregivers and may balk when they see you. Give it time. Adoptive Families Magazine (www.adoptivefamilies.com) published an article which recommended "therapeutic holding" as described by author Martha Welch in the book Holding Time.

Prepare yourself for the emotionally-draining orphanage visit. It's a sobering realization that you'll be leaving children behind, and you may wish to bring them all home too. You are witnessing a very sad reality.

The Second or Third Trip -- Count on the Airplane Trip From Hell

Imagine you think you have been kidnapped. You have been swept up in the arms of strangers who sound and smell different than the caretakers who have held and fed you throughout your whole short life. These strangers don't even understand the basics of the only language you've managed to pick up in your first year. You have a bad cold and probably an ear infection. You are being offered really weird food and you have diarrhea. And to top it off your favorite caregiver is nowhere to be found. NOW these strangers strap you to a chair, the plane lifts off and your ears start to ache. You are angry, scared, confused and grieving the lose of the only existence you have ever known.

As parents you will have to demonstrate great patience and endurance on the return flight home. Count on a tough trip and be pleasantly surprised when it's really not too bad. Your child may not sleep for the entire plane ride and you will have to count on the kindness of strangers to go to the bathroom if you're traveling alone. First-time parents be careful to keep your children well-hydrated but do not overdo the juice... or you will be sorry!

Plan the airport scene before your return. You may dream about 100 friends and family members wildly cheering, waving signs and bearing flowers. However, remember your child has just flown thousands of miles for the first time in her life. Your new daughter is probably exhausted and sick. (One little girl burst into tears the minute she saw family and friends at Customs!) None of you may be ready for a raucous welcome home party at your home. Your child's needs should take priority during this very stressful time.

After the Homecoming

First Things First, the Visit to the Pediatrician.

I betray myself as a paranoid mom! Before you leave home on your last trip, get an appointment with your pediatrician for just after your projected return date. You want to have your child examined right away in case she needs medicine to combat common orphanage problems: ear infections, bronchitis, colds, chest congestion, flu, fevers, etc. Make sure you find a doctor who is sympathetic because the first winter home you may have more sick visits than you would like. A post-institutionalized child usually has a compromised immune system due to lack of vitamins and proper nutrition. Choose a pediatric practice that offers same-day visits for sick children.

Next, the Lab Tests

Horror of horrors, you will have to subject your child to routine blood tests to rule out various diseases. Dr. Dana Johnson recommends a battery of tests that your pediatrician should order on www.peds.umn.edu/IAC/. You will be asked to collect a stool sample to test for intestinal parasites; this is a must since parasites can be passed easily in an orphanage and can impede growth and nutrition.

Start Your Immunizations... and Reimmunizations

There is no guarantee that if your child's medical record shows she has been vaccinated for various diseases that the immunizations actually worked. Adoptive Families Magazine quotes a study by Dr. Johnson's clinic that 60% of tested children showed no immunity to DTP (diphtheria, tetanus and polio) even though their medical records showed evidence of the shots. Sometimes the quality of immunizations overseas pales by comparison to the standard of care in the US So, don't be surprised if your pediatrician recommends starting from scratch with your child's immunization schedule.

Post Placement Visits by Home Study Agency

Expect your home study worker to visit you a few times after your homecoming. Remember that, by law, your agency is required to look out for the best interest of your child, so she will ask many questions about your new son's adjustment, health, and impact on the rest of the family. Don't forget the follow-up reports you HAVE to file with your agency. If you don't file these, a foreign judge could decide to reject someone else's adoption because your paperwork isn't done. (It's happened.)

Do I really need to readopt in the State of Illinois?

While it isn't mandatory that you re-adopt your child in the State of Illinois, it is HIGHLY recommended. The re-adoption process is simple and relatively inexpensive. Upon completion of the re-adoption, you will have an Illinois Judgment Order for Adoption and will no longer need to produce the foreign Judgment and translation. You will also receive an Illinois "birth certificate" or Record of Foreign Birth - listing you as the birth parent of your child and listing the name of your child as the name you have chosen for her - not her birth name. With those two documents, you will also be able to obtain a social security card for your child.

What about American citizenship?

AARGH! The paperwork jungle is NOT DONE! Effective 2/27/01 all adopted foreign-born kids automatically are American citizens if they meet certain requirements. But proof of citizenship isn't given, so I highly recommend that you apply for a certificate of citizenship or a passport with the US State Department upon your return to the US Learn about passports on the US State Department's website (www.travel.state.gov/) .

Suggested Reading

The Adoption Book Catalog put out by Tapestry Books at www.tapestrybooks.com presents a comprehensive collection of books on adoption and infertility. Some are also available at www.Amazon.com. I find the big discount bookstores' selection compares unfavorably to these sites. Beware of dated material; the rules and regulations change all the time.

To learn about prevalent health risks for internationally adopted children, you need to do your research. For information on FAS/FAE, read Michael Dorris' The Broken Cord. Even though your post-institutionalized child may not suffer from Sensory Integration Dysfunction, I strongly recommend you read the following book prior to your child's homecoming: The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction by Carol Stock Kranowitz.

If you adopt over the age of 12 months, read Adopting the Toddler: The Weaver's Craft by Mary Hopkins Best, Ed.D. The workbook With Eyes Wide Open: A Workbook for Parents Adopting Internationally Over Age One by Margi Miller, MA and Nancy Ward, MA,L.I.C.S.W. Is often required reading by home study workers. For a child above the age of 2, read Our Own: Adopting and Parenting the Older Child by Trish Maskew. Therapeutic holding is described by author Martha Welch in the book Holding Time.

Suggested Websites

Dr. Dana Johnson is a nationally-renowned pediatrician who runs an international adoption clinic at the University of Minnesota Hospital. His outline of risks should be required reading (www.peds.umn.edu/IAC/).

The Joint Council on International Children's Services at www.jcics.org can help you identify reputable agencies. Another listing is published in the Adoption Guide of 2002 at www.adoptivefamilies.com/adoptionguide2002, published by Adoptive Families Magazine (www.adoptivefamilies.com), an informative periodical.

Two parent support websites are helpful: Families for Russian and Ukrainian Adoption can be found at www.frua.org. The site for Parent Network for Post-Institutionalized Children (PNPIC) is www.pnpic.org.

For an introduction to your child's rights for special treatment at school under an Individual Education Plan, try www.wrightslaw.com.

The US State Department's website (www.travel.state.gov/) issues travel advisories and information on the adopted child's citizenship status. For INS information and forms, download www.ins.usdoj.gov.

Agency links include International Children's Alliance (www.adoptica.org), a source agency based in Washington D.C