When Bridget Lahti’s second daughter, Caroline, arrived in America, she had problems that Lahti had not expected. Meanwhile, the problems she had anticipated turned out to have already been addressed.

“I had requested a child with special needs and was told that she had bilateral club feet and would need extensive correction for that,” says Lahti, of Cincinnati, Ohio. “When she got here, we realized that her feet weren’t a problem but she did have speech delay and sensory integration issues.”

According to Sandra Iverson, a certified pediatric nurse practitioner and co-founder of the International Adoption Clinic at the University of Minnesota, Lahti’s experience is typical of foreign adoptions. “In the last couple of years, we’ve continued to have the largest numbers of adoptions from countries where they use institutions,” says Iverson. “At the same time, the amount of information we receive on the children has declined and may vary from a few lines to a complete medical report with a photo or video. Sometimes we just have to take a leap of faith.”

Taking the Leap
When having a child by any means, whether it’s by adoption or biologically, the outcome is always unknown. But the time, anxiety and financial considerations of foreign adoptions seem to raise the stakes.

In 2001, according to U.S. Immigration and Naturalization Service (INS) statistics, there were more than 19,000 foreign children adopted by families in the United States. Often, because of the distance, expense involved and a country's adoption rules, prospective parents may meet the child once, twice or not at all before they arrive in the United States. By the time they meet them, the adoption is already a done deal.

Complicating the decision is the fact that children from Russia and other East European countries generally have only spotty medical histories, and if the adoptive parents are lucky, a snippet of video. Other countries give even less information.

Even when the prospective parents do have medical information, it can be confusing, unreliable or even downright grim. Iverson explains that a prospective parent can’t necessarily take a negative report as a reliable guide. “Medical reports can have information that needs to be placed in the context of the country of origin," she says. "For example, I’ve seen cases where a child was reported to have a serious heart condition when it turned out to be a rather minor heart murmur. In the case of a video, we have to keep in mind that it’s just a moment in time, and the child could be feeling unwell that day. It’s hard to make an informed decision based on two minutes of that child’s life.”

This was the experience of Rob Sederholm and his wife, Susan Susang, of Export, Penn. When they first saw their prospective son, Andrew, on an eight-minute videotape sent from Russia in 1998, it was a little unsettling. Although the 16-month-old was walking well and seemed to have good motor skills, he never smiled. Their pediatrician, Dr. Sarah Springer, an expert in the field of international adoptions, urged them to get another tape. The second one was a little better, but Andrew still didn’t speak or smile. They also had a confusing, two-page, single-spaced medical report. Still, Sederholm says they felt a powerful connection to Andrew and went ahead with the adoption. Within just a few months of arriving at their home, he was a normal, happy 2-year-old chatterbox.

The Medical Language Barrier
In retrospect, Andrew’s behavior on the tapes and his medical background were baffling. When he was in Russia, Andrew was sent to an array of specialists for one supposed problem after another. In fact, he never seemed to have any of those problems. Even the doctor at the American embassy, upon examining him, said the Russian medical report made absolutely no sense at all.

Andrew’s case is an excellent example of what Dr. Jerri Jenista, a pediatric infectious disease expert from Ann Arbor, Mich., calls the uninterpretable Russian medical system. "Videotapes are important, even with supposedly healthy or normal children, simply because the Russian system has no relation to ours at all," says Jenista. "If we get a medical report from Ethiopia that says a child is spastic, that means the child is paralyzed and stiff. If we get the same term from Russia, it may mean the same thing.”

However, depending upon the country the child is coming from, there are specific problems that adoption agencies and health professionals look for. In Eastern European countries, such as Russia, the Ukraine and Romania, where there is a high incidence of alcoholism, doctors look closely at videos and medical information for clues to fetal alcohol syndrome and other alcohol-related birth defects. Alcohol use is also on the rise in Korea. There is a great deal of attention paid to children from countries where children awaiting adoptions are raised in orphanages rather than foster care. There are well-documented problems associated with institutionalized children, such as attachment disorders, speech delays and sensory integration issues.

All of these concerns are complicated by the fact that videotaping, which was seen as a great leap forward in international adoptions just a few years ago, is now waning because many countries are no longer allowing it as part of the process.

Adoption agencies, prospective parents and the pediatricians that work with these agencies are finding creative ways around new restrictions. For example, the Ukraine does not “assign” a child to prospective parents the way that most other countries do. Instead, the parents travel there to choose their own child. Although it seems like an ideal situation, it’s actually one that is extremely stressful. The parents don’t have a lot of time to choose, and they have virtually no medical guidance on site. As Iverson puts it, they are kind of “flying blindly.” What her organization has done to try to help parents in that situation is arrange for live video feeds or digital pictures sent via computer. The parents may narrow it down to one or two children and then the physician, thousands of miles away in Michigan, can help them make a final decision based on the pictures coming over the computer.

The Happy Ending
Caroline Lahti still has some speech and sensory integration issues, but overall she is a happy, normal 3-year-old. Andrew Sederholm is a well-adjusted 5-year-old with no developmental delays at all. This, says Iverson, is more the norm. “We just finished a huge joint survey with the University of Minnesota called the International Adoption Project that surveyed the parents of nearly 3,000 internationally-adopted children,” she says. “All kinds of questions were asked and an incredibly high percentage were completely happy with their adoption. The bottom line is that most adoptions turn out very successfully.”

Want to see more?

• Culture Combo: Adopting a Baby of Different Nationality
• Transracial Adoption: Parent’s Wish List and Child’s Bill of Rights
• International Adoption: Building Families Without Borders
• Talk about it!