When you adopt a child, you may want to take your doctor with you.

"Adoption doctor" is a specialty recognized by the American Academy of Pediatrics only since 1986. These pediatricians evaluate a child's medical records, conduct physical examinations and tests, and advise parents on childcare. They help children transition from foreign or domestic orphanages and foster care into their new permanent homes.

What is unique about Adoption Doctors is that many of them work via email or FAX. Typically, adoptive parents travel to countries like Ethiopia, China or Russia. Armed with digital and video cameras, prospective parents send images of the child to their Adoption Doctor in the USA. They also may FAX or email the child's and his or her parents' medical records. Their Adoption Doctor evaluates the information and sends the parents back his recommendations, by phone, FAX or email. Usually all the physician can do is point out potential health risks.

Adoption Doctors often work only within one country, usually one in which they know the language and culture. The reason is that every country has its own way of training doctors and creating medical records. For example, "pyramidal insufficiency" is a frequent Russian diagnosis that can mean anything from cerebral palsy to premature birth. However, Chinese and South American doctors do not use that term.

Children who are placed for adoption in foreign countries are often born at home without any prenatal care to very poor families. There may be issues like drug abuse, alcoholism, malnutrition, lack of medical care, child abuse and neglect. Some orphanages and agencies cannot provide genetic and medical histories of parents and children. The children are often at risk for problems that do not usually appear in the United States, such as rickets, intestinal parasites, hepatitis, lead poisoning, AIDS, and reactive attachment disorders.

While the majority of children come out okay with good care and good nutrition, about one in five develops permanent problems. How long the child was in the orphanage, the quality of care received and whether the child was going through critical periods of development are all factors that an Adoption Doctor considers. They look at videos and pictures for problems like Attention Deficit Disorder, severe language and motor development delays, attachment disorders, and in particular, Fetal Alcohol Syndrome (FAS). Children with FAS have certain facial features such as folds on the eyelids. Their average IQ is about 68 and 30% have heart defects.

"There are high risk factors that affect a developing brain," said Dr. Ronald Federici of the Children's Hospital in Washington. "Nutrition being one of the most important,[also] deprivation, social deprivation, isolation and other types of hazards that can affect brain chemistry and development of proper brain cells and brain function."

Once the child comes home, the Adoption Doctor continues to work with the family. Since a routine physical examination does not turn up certain conditions, Adoption Doctors often perform laboratory tests for AIDS, parasites, lactose intolerance, hepatitis, and other diseases.

Adoption Doctors advise parents not to choose children based on pictures posted on the Internet. It is better to take your time and perform a thorough investigation when you are abroad. Many parents want to make just one trip and return with several children. Adoption Doctors usually advise against doing this. It is too hard to deal with more than one child, especially if there are other children already in the family.

Even with all their expertise and medical knowledge, no Adoption Doctor can guarantee a perfectly healthy child. They only promise to help you evaluate risk factors. If you are interested in finding an Adoption Doctor, try the American Academy of Pediatrics website at http://www.aap.org/sections/adoption/adopt-states/adoption-map.html.

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