During the last decade, more than 200,000 families have adopted children from abroad. As joyful as these occasions are, many internationally adopted children have lived in crowded and neglectful orphanage environments without proper hygiene and nutrition. As a result, they’re at high risk for behavioral, developmental and physical problems ranging from attachment disorders, fetal alcohol syndrome and language deficits to scabies and tuberculosis. "It's critical to identify conditions such as parasites and other physical maladies immediately," says Miller Children's Hospital Long Beach pediatrician Felice Adler, M.D., an infectious disease expert who has treated internationally adopted children. "Making sure the child is adequately immunized is a major concern."

"Adoptive parents can do many things to limit the impact of early physical and emotional deprivation in their child's life" says developmental pediatrician Gary Feldman, M.D., medical director of the Stramski International Adoption Program (SIAP) at Miller Children’s Hospital Long Beach. The SIAP provides parents with the information necessary to identify potential risk factors and long-term problems common in internationally adopted children—and the strategies to address them. Services include pre-adoption consultations, post-adoption physical exams, behavioral and developmental evaluations, developmental screenings and follow-up care. "Prospective parents need to understand that children coming from foreign orphanages have lived in circumstances very unlike children born in the United States," says Dr. Feldman. "But with careful planning, parents can help rebuild their behavioral and developmental foundation."

As one of only a small number of pediatricians in the United States specializing in adoption and foster care, Dr. Feldman has helped thousands of people understand their adopted child’s background and its potential effect on development. He also assists parents in developing skills specifically adapted to the needs of their new child.

Newport Beach residents Jim and Carol Light learned firsthand how valuable SIAP services are. Last March, the couple was informed by their adoption agency that a 19-month-old girl awaited them in Tver, Russia. With only a photo and brief medical history of the child they called Georgiana, the couple made an appointment for a pre-adoption consultation with Dr. Feldman. "Medical terminology can differ from country to country, and the data given in health histories is often minimal," says Dr. Feldman, who helped the Lights interpret the report. Based on the information at hand, he shared his professional impression of the child's physical and developmental state. He also showed the Lights several "games" they could play with Georgiana to gauge her cognitive and physical development during their initial meeting in Russia.

During three, two-hour visits at the orphanage outside Moscow, the Lights showed Georgiana how to blow and burst bubbles— and noted how long it took her to grasp the concept. They also taught her how to push a toy car back and forth to see if she was visually tracking it. "The inability to accomplish these and other tasks might have indicated underlying impairments," says Dr. Feldman. But Georgiana played the games with glee, and the Lights fell in love with the spirited little girl, taking the final steps for adoption soon afterward.

Several weeks later, the Lights and their 6-year-old son, Jack, welcomed Georgiana to her new home in Newport Beach. At the same time, they began the delicate process of establishing a lifelong bond with her. "Attachment issues can be a major challenge for institutionalized children, since they typically lack consistent caregivers," says Dr. Feldman.

To establish a bond with her new daughter, Carol slept by Georgiana's side each night and never left her with a babysitter. She also spoon-fed the child so she would associate nurturing with her new mother. Today, Georgiana is 28 months old and thriving. Dr. Feldman continues to see her on a regular basis for follow-up care. During a recent visit, Carol told him that Georgiana had reached a developmental milestone. Says Carol: "Dr. Feldman was as happy and proud as we were."