International Adoption

The December afternoon was brutally cold in Ust Kamenogorsk, a remote city in Kazakhstan, a former republic of the Soviet Union, and my husband and I were frantic with worry about Annie, a 6-month-old baby we had just met and planned to adopt. We phoned Jane Aronson, M.D., a New York City pediatrician who had reviewed Annie's pre-adoption medical records for us a few weeks before our trip. After listening as we described Annie's sadness, lethargy, and avoidance of eye contact, Dr. Aronson told us her behavior was typical for an orphanage baby. "An orphanage can be a dehumanizing place," she said. "This baby is depressed but doesn't know how to say it."

An unforgettable moment for us -- but all in a day's work for Dr. Aronson, who was one of the first U.S. pediatricians to specialize in international adoption medicine and arguably among its most knowledgeable. Since the early 1990s, Dr. Aronson has treated some 2,500 internationally adopted children, reviewed many thousands more pre-adoption medical records, and visited orphanages all over the world. Though the number of international adoptions tripled to more than 20,000 from 1990 to 2002, international adoption medicine remains a little-recognized specialty.

A strong advocate of adoption, Dr. Aronson adopted a 4-month-old son from Vietnam in 2000. Here, she outlines why parents who are considering adopting should be more proactive, becoming better informed about the medical and psychological issues internationally adopted children face.

A: Before you decide which country you want to adopt from, you should understand that orphans have different health risks, depending on the country they come from. In Russia, for instance, alcohol use during pregnancy is rampant, and the rate of fetal alcohol syndrome -- which may cause severe disabilities, mental retardation, and serious behavioral problems -- is much higher there than in the rest of the world. In China, because of the use of lead-containing gasoline and coal, lead poisoning, which is associated with learning disabilities and brain damage, is prevalent. One study found that 13% of children adopted from China have lead poisoning.