Bob and Karen tried for years to have a child. After six emotional miscarriages, they finally agreed to adopt. "I brought up adopting several times, and we could never agree on whether that was our next step," Karen explains. "Then one night he came home and said he thought we should adopt from China. When he pictured himself as a parent, he imagined holding a little Asian girl." So began their journey -- their 21-month labor, as she refers to it -- to finally become parents.
In lieu of sonograms and maternity jeans, Bob and Karen were overwhelmed with paperwork, research and red tape. They knew they wanted a little girl, so early in the process, they picked out a name: Kailee Nicole. They shopped for clothing and decorated her nursery. All very typical of parents-to-be, but with one major distinction: they had no due date.
Almost 18 months later, they received the call. Soon after a single picture was sent of a little girl wearing a striped shirt with the words "happy bear" embroidered on it. They taped the photo to the inside of Kailee's crib and spent the next five weeks packing, making care packages, even celebrating with a baby shower. They flew to Nanchang with suitcases of formula and diapers.
Parents who adopt from China refer to the day their child is given to them as Gotcha Day. To Bob and Karen, it was Kailee Day, which coincidentally fell on Karen's birthday. In a room filled with women from the orphanage, each holding a baby wearing a green outfit, their names were called, and a crying 14-month-old girl named Gan Xin Tian -- Kailee -- was placed in Karen's arms. They were finally parents.
Bringing a baby home is transformative under any circumstance, but adopted babies like Kailee, who are sometimes past the newborn stage when they come home, can present specific challenges. In honor of November's being National Adoption Awareness Month, we share excerpts from Karen's journal entries during her first few weeks with Kailee, along with expert advice from developmental behavioral pediatrician Lisa Albers Prock, M.D., director of the adoption program at Children's Hospital Boston, and the current chair of adoption and foster care at the American Academy of Pediatrics, to help adoptive parents navigate their baby's most anticipated homecoming.
Is She Behind?
"Her paperwork was totally off. It said she weighed 23 pounds, and she actually only weighs 18. She has the skinniest little legs and no muscle tone at all. She doesn't walk or crawl. Her bulky clothing was confining to her (typical in orphanages) and restricted her mobility. I know she is behind developmentally."
Expert Advice: It's not uncommon for children who have lived in an orphanage to have developmental delays. Over time, many improve on their own with developmental experiences and nurturing. "It's important to ensure that adopted children have normal hearing and vision when they first arrive home," recommends Prock. "Parents should also interact with their child verbally and nonverbally and try to engage in play. Within the early months post-adoption, many children may benefit from involvement with local early intervention programs. These are home-based developmental and behavioral support programs for children under the age of three. Health providers can refer children, or parents can Google 'early intervention program' for their state."
"Last night she had a major meltdown. We couldn't put her down for even a minute, and she would not sleep at all. She was inconsolable, and I was beside myself. I just kept rocking her, and every time I put her down into her crib, she would cry again. The only thing that seemed to calm her was the rocking. So that's what I did. She finally fell asleep on top of me out of utter exhaustion."
Expert Advice: Getting a baby to fall asleep and stay asleep is the Holy Grail for all new parents, but adjusting to new sleep habits can be particularly hard for adopted babies, who may never have slept alone. If your child was in an orphanage, she may have shared a crib with another baby; if she was in foster care in a foreign country, it's possible she shared a bed with an adult. In addition to adjusting to everything else, she now has to learn to sleep independently, which might be difficult since adopted children often have anxiety symptoms that come out at night.
If possible, parents should try to learn as much history in regards to the child's pre-adoption sleeping habits. "If she was not sleeping alone, having her sleep in her room by herself the first night might not be best," notes Prock. Mom and dad can sleep in the same room as she does (the American Academy of Pediatrics recommends that infants sleep on their backs on a separate sleep surface from their parents) as a first step to independent sleeping, and then gradually move farther away over time as the child tolerates separation from the parents. At the end of the day, families just want to get a good night's sleep, and there are many ways to do that.
"She absolutely loves to eat; it's like she can't get enough. I wonder if the amount she is eating is normal? She won't take formula any more, only regular table food. When she really likes something, she gets a big smile on her face. I am sure her diet was pretty limited, so she is really enjoying all the different tastes. She loves sweet stuff, like yogurt and applesauce. I can't wait to give her ice cream!"
Expert Advice: Changes in environment, time zone, nutritional intake and level of stimulation can absolutely impact eating habits. Sometimes babies deal with the change by not eating very much, but often babies who had limited access to food overeat or have hording tendencies. Babies in orphanages are not usually fed on demand (as recommended in the U.S.); they're fed on a caregiver's schedule and without regard to whether they are hungry or full.
Once she's home, feeding your baby should not just be about nutrition¬ -- it's also a great way to bond with her, demonstrate your love for her and win her trust. "Infant and toddler feeding problems generally improve on their own as they learn that food is available consistently," says Prock. "If after two months, she is still overeating (or under-eating), ask the advice of your pediatrician."
That Special Bond
"I can see she needs me, but I'm not sure if or when she will understand that I am her mommy. She seems so at peace when I am meeting her needs -- when I feed her, change her diaper and respond to her cries. I hope my friends understand why no one else should do these things for her but me. It is important that she learns that I am not just another caretaker.
"I, on the other hand, am overwhelmed with maternal feelings. It feels like the past 21 months were my labor, and she is finally here. I know she is my daughter. I cannot imagine loving her any more than I do right now. It's like I gave birth to her."
Expert Advice: Adoptive parents often suffer from the misconception that bonding with a biological child is effortless. Not true! Most parents would probably agree that attachment isn't forged in an instant, but over time. The initial connection between a parent and child is bonding, and it sets the groundwork for a solid attachment. A long-term relationship takes thousands of interactions. It's the routine daily activities like feeding, bathing, dressing and comforting that eventually translate into true love. As you do these tasks, your baby develops trust and comes to associate you with meeting her needs.
It's important that early post-adoptive caretaking responsibilities are limited to nuclear family members to help the child differentiate between family and non-family during the first few months. "Even if your child is not a newborn or even an infant, the first few weeks should be akin to a newborn's homecoming," Prock says. Families should have few guests so that baby can get to know the parents and vice-versa. It's likely she had numerous caregivers before, especially if she was in an orphanage; now it's time for her to have full-time parents who are ready and willing to nurture and care for her for the rest of her life.
Finding Dr. Right
"Kailee had a visit with the pediatrician last week. All of her tests came back great! She is very healthy. On Monday, she had the first of some necessary vaccinations. Poor kid had four shots! She screamed like crazy. I have gone back and forth over whether I will actually go to the appointment I made for the adoption medicine specialist at the hospital. So far I seem to be getting everything I need from our regular pediatrician."
Expert Advice: If you adopted your baby abroad, try to have her initial evaluation done by a pediatrician who has experience with internationally adopted kids, like an adoption medicine specialist, who knows how to interpret foreign medical records, which health tests to run and how to address possible developmental delays and immunization needs. To find a specialist in your area, visit: aap.org/sections/adoption.
Many families who adopt in the U.S. don't have access to adoption medicine specialists, who are usually clustered in metropolitan areas. So it's important to find a good pediatrician for longitudinal care. Ask for recommendations from friends and interview a few physicians before the baby arrives, so you can find one with whom you feel comfortable.