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Winthrop University Hospital

International Adoption Program
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What is the International Adoption Program?

Our mission is to create happy, healthy families.

The adoption of a child from a foreign country is accompanied by special challenges. Appropriate preparation, as well as ongoing care and guidance after the child's arrival help parents meet the physical, emotional and developmental needs of their new child.

Winthrop-University Hospital's International Adoption Program has been caring for internationally adopted children since the 1990s. As the longest-standing program on Long Island that provides comprehensive care to internationally adopted children from the time the parent receives the referral to the time the child arrives and beyond, we have helped countless families share their love and open their hearts to children around the world.

The adoption process can be complex. That is why our team of experts fosters close relationships with each family, helping them every step of the way. We exemplify Winthrop's motto, "Care without compromise," with the well-being of each child and every family as our top priority.

Working with adoption agencies from around the region, the International Adoption Program provides the most comprehensive medical services with a deep sense of compassion and understanding of the personal needs of both parent and child throughout the entire adoption journey.

    What the International Adoption Program offers:
  • Evaluation of the child's medical records and history once an adoption agency finds a child in need of a loving home.
  • The collective professional experience of a team of physicians with expertise in international adoptions and pediatrics, as well as sensitivity to families committed to adoption.
  • Access to pediatric experts -- from pediatric primary care physicians to infectious diseases and developmental specialists -- 24 hours a day, seven days a week.
  • Russian-speaking medical personnel on site familiar with the terminology of Russian evaluations and able to speak directly with older children, as well as fluent speakers of Spanish and Chinese.
  • An expert pediatric phlebotomist, who draws blood for tests in the office, eliminating the need for families to go to a laboratory at another location.
  • Travel recommendations and immunizations for parents and adults by experts in infectious diseases.
  • The delivery of expert medical services through Winthrop's specialized Institutes for Care. Winthrop is a major teaching hospital and Level 1 Regional Trauma Center with an internationally recognized multidisciplinary medical staff, including pediatric infectious disease specialists, pediatric cardiologists and pulmonologists, behavioral specialists and primary care physicians.
  • A centrally located Long Island office, near the Mineola Long Island Rail Road station and major highways. Free parking is available.
  • Acceptance of most insurance plans for the care of the child.
For more information, or to schedule a consultation, call (516) 663-4600, Monday-Friday from 8:30 a.m. to 4:30 p.m.

Pre-Adoption Services

The International Adoption Program's pre-adoption medical services include:
  • Physical & Developmental Assessments
    To observe any physical or developmental disabilities, a thorough review of the child's medical history and health information is performed, including examination of videotapes and photos received from the adoption agency and/or orphanage.
  • Infection Risk Assessments
    The Program's professional team specializes in evaluating diseases from other countries that may not be common among children in the United States.
  • Immunization and Medical Record Interpretation
    The Program Team assesses the children's prior medical and vaccination records to ensure they are up to date on all childhood immunizations.

Post-Adoption Services

When a family returns from overseas, the International Adoption Program Team provides the following -- usually within one week of arrival:
  • Comprehensive medical assessment
  • Complete physical examination
  • Developmental assessment
  • Immunizations, as needed
  • Testing for a variety of infectious diseases
  • Referrals to subspecialty medical or psychological services, as needed

Travel Preparation

Preparing parents for travel overseas is a major component of Winthrop's International Adoption Program. Services include:
  • Basic baby care information
  • Information on common medical problems and basic childcare needs that may arise upon arrival in the child's country
  • A list of over-the-counter medications and supplies to take
  • Prescriptions for medications, when needed
  • Immunizations against such viruses as Hepatitis A and B
In addition to the above, we offer two "preparation for travel" courses.
  • "Travel and Teach" is for parents traveling to the birth country to bring the child home. Geared to parents whose experience with child care has been limited, it provides guidance and recommendations for the trip home, with emphasis on how to take care of commonly encountered illness issues. Hardcopies of the course material, necessary prescriptions and emergency contact numbers for us while you are overseas are provided.
  • "Two-Part Travel Prep" is for parents who will meet the child at least once prior to bringing the child home. Typically, these are parents adopting from Russia, Eastern Europe and Guatemala. The first part focuses on the initial trip, and is designed to tell parents about important information that may be missing from the referral, so they can try to obtain that information during the visit. This course also educates parents about how pediatricians assess developmental status and delays in a child so they can formulate an objective and realistic opinion of the child's current developmental state. Parents are encouraged to contact us by e-mail or phone while overseas on this visit to obtain immediate feedback about any areas of concern. Our goal is to decrease prospective parents' stress and anxiety and enable them to feel comfortable and secure with their ultimate decision by giving them the appropriate information needed to make such an important decision. Before these parents take the second trip to bring the child home, they take the second part, which is the "Travel and Teach" course.


The Team

2_Slezak_kids.jpg
    Leonard R. Krilov, MD
    Chief, Pediatric Infectious Diseases and International Adoption Program
    Associate Chairman, Department of Pediatrics
    Professor of Pediatrics, Stony Brook University School of Medicine

    Dr. Krilov has had a career-long interest in clinical infectious diseases and respiratory viral infections. His post-graduate training included a fellowship in pediatric infectious diseases at Children's Hospital, Boston, MA, preceded by a pediatric internship and residency at Johns Hopkins Hospital in Baltimore, MD. He earned his medical degree from Columbia University.

    Dr. Krilov is a Fellow of the Infectious Disease Society of America, the American Academy of Pediatrics and the Pediatric Infectious Disease Society. He is an elected member of the Society for Pediatric Research and American Pediatric Society, and a member of the American Academy of Pediatrics' Section on Adoption and Foster Care.

    A native New Yorker, Dr. Krilov has received teaching awards from several institutions and is cited in America's Top Doctors and New York Magazine's "Best Doctors in New York." He recently published an article on infectious diseases and international adoption, and, with the International Adoption Program Team, has been studying the reliability of immunization records in internationally adopted children; their findings were presented at the 2006 Pediatric Academic Societies meeting.


    Paul J. Lee, MD
    Attending Physician, Division of Pediatric Infectious Diseases

    Dr. Lee spends the majority of his time at Winthrop working with adopted children and their parents. His post-graduate training included a fellowship in pediatric infectious diseases at Columbia University/Morgan Stanley Children's Hospital of New York, preceded by an internship and residency in internal medicine and pediatrics at New York Hospital-Weill Medical Center. He earned his medical degree from New York Medical College.

    A native New Yorker, Dr. Lee is a Fellow of the American Academy of Pediatrics and the Infectious Disease Society of America. He is a member of the Pediatric Infectious Disease Society and the American Academy of Pediatrics' Section on Adoption and Foster Care. A member of the Joint Council on International Children's Services (JCICS), Dr. Lee is well known in international adoption circles and has spoken widely on medical issues in international adoptions to local parent groups, adoption agencies, adoption meetings, hospitals and physicians. He is cited in the Consumers' Research Council of America's Guide to America's Top Pediatricians.


    Roy Horowitz, MD
    Attending Physician, Division of Pediatric Infectious Diseases

    Dr. Horowitz provides primary care for the adopted children, and his extensive knowledge of general pediatrics is a tremendous resource for the Program's children and their parents.

    He was in a private pediatric group practice for 29 years, where he was senior partner. In 1998, he left private practice and began a new career at Winthrop-University Hospital to teach the pediatric house staff and medical students, as well as continue his role as a child advocate and physician for the patients at Winthrop Pediatric Associates. His post-graduate training included a pediatric residency at Montefiore Hospital and Medical Center in New York, which he completed after serving in the United States Navy.

    Dr. Horowitz is highly regarded by the entire Winthrop community, as well as local pediatricians, who elected him president of the Nassau Pediatric Society. He has spoken widely on many pediatric issues, such as international adoption and child abuse.


    Maria del Consuela Alonso, PA
    Physician's Assistant, International Adoption Program

    Ms. Alonso, the International Adoption Program's Physician's Assistant, was instrumental in establishing the Program in 1997 and has been involved with the initial evaluations on over one thousand internationally adopted children. She also provides primary care services for the internationally adopted.

    Ms. Alonso graduated from the St. John's University Physician Assistant Program in 1980. She is adjunct faculty at Pace University-Lenox Hill Hospital and has co-authored four medical papers about internationally adopted children. Fluent in Spanish, she is co-founder and treasurer of Pediatricians for Central America's Children, Ltd, a non-profit organization.

    Claudia Sena
    Office Manager, International Adoption Program

    Ms. Sena, the first person many people speak with when contacting the Program, has a special ability to put people at ease. At Winthrop since 1997, she is originally from Brazil and is fluent in Portuguese and Spanish.

    She has a Bachelor of Arts degree in education from UNICAP-PE Brazil.

    Frequently Asked Questions

    1. What country should I/we adopt from?
    2. This question is best discussed with your agency and/or case worker. The decision is an individual one, based on many factors, such as desired gender, age of child, preferences for a specific ethnic background and your time frame. We have seen children from many different countries and would be happy to share our experiences with you.
  1. Can you recommend an adoption agency that I/we can use?
  2. It is important to use an agency accredited for the country of you interest. You and your child are our primary concern, not a specific agency or agencies. We have had extensive experience with the majority of local New York agencies, but have also worked with many others in the United States. The most important thing is that you feel comfortable with the agency, its personnel and its programs. A listing of accredited agencies can be found on the Joint Council on International Children's Services. We would be happy to share our experiences with specific agencies, if you desire.
  1. When you review a referral of a child for adoption, what do you look for?
  2. We review the paperwork for information on the child's birth and medical history, the physical examination(s), developmental assessment, immunization history, and laboratory testing. Much of this information is often incomplete or missing. We then try to assess the child's particular risks for physical and infectious problems, as well as developmental delay. Our practice is to form our opinion solely on the facts presented and our experience, and give you a risk assessment, based on the anticipated level of intervention and services needed for the child. We also discuss any specific questions or concerns you have.
  1. Are there specific medical differences or advantages between countries?
  2. Of course, but you should not be making a decision solely on that basis. This topic should be part of your initial discussion with your agency. Again, we would be happy to share our experiences with children from different countries with you.
  1. How quickly would I be contacted, once I submit the child's medical record for review?
  2. Turnaround time is usually 48-72 hours. An expedited service (with a guaranteed response within 24 hours) is available for an additional fee.
  1. What fees do you charge for the services you provide?
  2. Please contact our office at (516) 663-4600 for the current fee schedule.
  1. Do you accept insurance?
  2. Insurance companies do not reimburse for services prior to the child's adoption. However, once the child is legally adopted, medical insurance for the child is retroactive to this day, and should cover the child's initial evaluation and services thereafter. The Winthrop-University Hospital International Adoption Program accepts most major insurances. Please contact our office at (516) 663-4600 to determine if your insurance covers our services.
4_Dickey_kids.jpg
  1. What does the initial assessment involve?
  2. Our initial comprehensive assessment includes a review the child's history and paperwork. We perform a complete physical examination and a formal Denver Developmental Screening evaluation. We then perform the necessary blood work in the office, and give any necessary catch-up immunizations. This generally takes about 60 - 90 minutes. As part of the evaluation, we collect urine from the child. For an infant or toddler, you may need to bring an extra bottle and diapers.
  1. When I bring my child for the initial evaluation, what should I bring with me?
  2. Bring all the paperwork you received, so we can review it. Even if we did the initial referral, there may be some updated or more recent information enclosed. Most importantly, we need to have the child's immunization record. For an infant or toddler, you may need to bring an extra bottle and diapers.
  1. Is it important for you to see the child before my regular pediatrician?
  2. While we would like to be the first to evaluate the child, there is nothing wrong with having your child evaluated by your own pediatrician, if you already have one. We would recommend that no immunizations be given until our evaluation, so we can accurately determine if the previous immunizations can be counted, or whether any need to be repeated. We would also recommend that any non-urgent laboratory tests be deferred, so we can obtain all the necessary tests at one time.
  1. Why do I need an infectious diseases and/or adoption specialist?
  2. While pediatricians are certainly capable of doing an initial assessment, they may not have the experience to understand some of the terminology used by medical personnel in other countries, diagnose unusual infectious problems, know which laboratory tests or immunizations are necessary and which are not, accurately interpret the test results, or be up to date on the latest developments in international adoption medicine. The purpose of our initial assessment is to utilize our expertise in this area to ensure that your child has a thorough evaluation and quickly identify any problems that need to be corrected. We then work together with you and your pediatrician to establish the best plan of action and immediate treatment recommendations.
  1. Can you recommend a pediatrician for my child's ongoing care?
  2. We provide primary care services, and many parents chose to continue with us. However, if distance is an issue, we can help you chose a pediatrician closer to you, based on our experience.
  1. Can you diagnose mental retardation from review of the child's medical records?
  2. This is a difficult diagnosis to make based on medical review alone, since mental retardation is a somewhat vague term. Children from orphanages usually have some degree of developmental delay. Although any developmental delay could technically be called "mental retardation," this term is usually reserved for the presence of severe developmental and cognitive delays. If a child has such delays, she or he would likely be clearly classified as a "special needs" adoption. Diagnosing mental retardation requires seeing the child in person over a series of visits to determine the degree of delay and whether development is progressing or static.
  1. Our child's medical history has some disturbing diagnoses listed. Are these typical for specific countries?
  2. Yes, medical reviews from the Russian Federation and Eastern Europe often contain scary sounding terms such as "perinatal encephalopathy of the newborn" or "psychomotor delay/retardation." The overwhelming majority of the time we find there is no organic basis for these diagnoses. However, it is important to look at and utilize all of the given information before coming to this conclusion.
  1. How is Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE) diagnosed?
  2. FAS and FAE are the older terms for what is now called Alcohol Related Neurodevelopmental Disorder (ARND), a range of developmental delays resulting from the unborn baby being exposed to alcohol use by the birth mother. So far, it is primarily seen in some children from Eastern Europe and the Russian Federation, although it can occur in any country.
    The diagnosis is made on the basis of four criteria: likelihood the birth mother drank (no risk, unknown, some risk, high risk), the degree of growth failure (none, mild, moderate, significant), the degree of brain dysfunction (unlikely, possible, probable, definite) and whether the child has certain facial and physical features seen in babies exposed to alcohol pre-natally (none, mild, moderate, severe).
    The most difficult part of the diagnosis is judging the presence of the ARND facial features. It is rare for people and pediatricians to completely agree on the presence and degree of ARND facial features.
  1. How does the Winthrop program assess the presence or degree of ARND facial features?
  2. To overcome the subjectivity of this assessment, we utilize a facial photographic analysis software program created at the University of Washington that has been shown to be a valid means of quantifying the presence and degree of ARND facial features. Please contact our office if you would like further information about this service.
  1. I've heard or read about rickets. What is it and is it treatable?
  2. Rickets is a disorder that affects bone development, causing bowing of the legs, and frontal bossing (a prominent forehead with "squaring" of the head).
    Rickets results from calcium and Vitamin D deficiency. There are a variety of causes, including genetic; in Chinese girls, it is usually caused by insufficient calcium and Vitamin D in the diet. Furthermore, even if intake of Vitamin D does occur, the body must be exposed to sunlight for it to be converted into a form that the body can actually use. Many of the children we see show minimal to mild rickets, which requires nothing more than a good diet and indirect exposure to sunlight. If the condition is more severe, this is still treatable with Vitamin D therapy. Rickets is diagnosed clinically by the presence of the aforementioned physical findings, as well as by blood tests, which are part of our initial evaluation.
  1. If my child has a positive skin test for tuberculosis (positive PPD) does that mean my child has tuberculosis?
  2. A positive PPD means the child has been infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis. However, this does not mean the child is sick or has tuberculosis disease. Infection means the bacteria is present in the body; disease means the bacteria are now harming the body and causing symptoms. For tuberculosis, years might pass from the time of infection until the time disease develops in the lungs. We have found about 20% of our internationally adopted children have a positive PPD, meaning they have latent tuberculosis infection. All of these children have had negative chest x-rays, telling us they are free of disease. Tuberculosis at this stage is not dangerous, does not affect the child's health in any way and is completely curable with an antibiotic. The child is also not contagious to others at this time and no restrictions or special precautions are indicated.
  1. If my child received a tuberculosis vaccine (BCG vaccine) in the country of origin, won't that cause a false positive skin test for tuberculosis?
  2. No. If the skin test reaction is equal to or greater than 10 mm in size, this indicates infection, regardless of a history of BCG vaccination, if the child comes from a country with a high incidence of tuberculosis. The World Health Organization reports 22 countries account for 80% of global tuberculosis in 2006, and the list includes the Russian Federation, China, Vietnam, Cambodia, the Philippines, India and Pakistan. Tuberculosis continues to be a global epidemic problem and many other countries not listed still have a high incidence of TB in their populations. To prevent future disease and complications, it is important to accurately identify those who have tuberculosis infection and treat them appropriately.
  1. What is the likelihood of my child having parasites when she or he comes home?
  2. We published a study in 2001 looking at 504 children we evaluated over a two year period (1997-98). We found intestinal parasites in a little over one-quarter of the children (26%). Most commonly, it is a microscopic parasite called Giardia lamblia, which we found in 19% of those tested. Curative antibiotic treatment exists for all of the parasites.
  1. Do you offer any pre-travel services?
  2. Yes! In addition to the medical review, we have two different "preparation for travel" courses.
    • "Travel and Teach" is for parents traveling to the birth country to bring the child home. Geared to parents whose experience with child care has been limited, it provides guidance and recommendations for the trip home, with emphasis on how to take care of commonly encountered illness issues. Hardcopies of the course material, necessary prescriptions and emergency contact numbers for us while you are overseas are provided.
    • "Two-Part Travel Prep" is for parents who will meet the child at least once prior to bringing the child home. Typically, these parents adopt from Russia, Eastern Europe and Guatemala. The first part focuses on the initial trip, and is designed to tell parents about important information that was missing from the referral, so they can try to obtain that information during the visit. This course also educates parents about how pediatricians assess developmental status and delays in a child so they can formulate an objective and realistic opinion of the child's current developmental state. Parents are encouraged to contact us by email or phone while overseas on this visit to obtain immediate feedback about any areas of concern. Our goal is to decrease prospective parents' stress and anxiety and enable them to feel comfortable and secure with their ultimate decision by giving them the appropriate information needed to make such an important decision. Before these parents take the second trip to bring the child home, they take the second part, which is the "Travel and Teach" course.
  1. Do you have any specific recommendations for adults or children who will be traveling to the birth country?
  2. We recommend you speak with your primary care provider(s) to discuss any specific travel recommendations applicable to your own unique medical history. We do offer general travel recommendations, as well as appropriate immunizations for parents, other adults, and children who may be traveling with you. Please contact us for additional information and fee schedules for these options.


What Parents are Saying about Winthrop's Program

"While the adoption process can be a bit overwhelming at times, we felt we were in wonderful hands with the International Adoption Program...we're not just another family there, the children are treated just as special as they are."
Erica Slezak, who adopted two sons, Christian and Marc from Guatemala

"The support is just incredible. Someone from the program was always right there to help us through the adoption -- even when we called from China. The program coordinators really do advocate for the adopted child."
The Dickeys, who adopted son Liam from Korea and daughter Suxian from China

"Having someone understand what you're going through is an invaluable resource."
Mindy Baldinger, who adopted 23-month-old Olivia from Bulgaria



Contact us:

3_Little_girl.jpgInternational Adoption Program
Division of Pediatric Infectious Diseases
Winthrop-University Hospital
120 Mineola Blvd., Suite 210
Mineola, NY 11501

(516) 663-4600
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