When I traveled to adopt my children, I witnessed firsthand the conditions in which they spent their early lives. As a mom, I saw the caretakers' love. As a pediatrician, I saw crowded living quarters and lack of sanitary conditions. Before we came home, I treated lice and scabies passed to my daughter from her caretakers. But by the time of her first doctor's visit in the United States, my daughter was clean and free of skin diseases and had begun to adjust to her new surroundings.

Most pediatricians treating newly adopted children can't judge potential risk factors based on firsthand observation. They must rely on what parents tell them about their children's early lives. After a child's placement in an adoptive home — whether via a domestic or an international adoption — there should be a review of all medical records, a complete physical examination and diagnostic testing, all taking into consideration the child's past. Because children change between the time of adoption and the first medical evaluation, health-care workers need to be reminded about the child's previous home and circumstances.