Over the Ural Mountains, in distant Siberia, two-year-old Ksenia — blonde, blue-eyed, cute as a button — was living in an orphanage and waiting for a home. For the Suddeth family of St. Louis, who adopted her in 2006, it was love at first sight. But what of their small daughter's health, they wondered? Were there any underlying problems they should deal with as she began her new life? "We weren't concerned about anything in particular," says Kim Suddeth, reflecting on her daughter's institutional past, "but you never know."

SOUTH KOREA Thomas Sholtis, with occupational therapist Carol Finkes and his mom, Gina (ready with pacifier), was the first child seen at the International Adoption Center

A few weeks after Ksenia's arrival, they took her to the International Adoption Center, a joint effort of St. Louis Children's Hospital and Washington University School of Medicine, for a thorough evaluation. Since its founding in December 2005, the center and its team of specialists, headed by pediatrician Rachel C. Orscheln, MD, has seen a stream of young patients like Ksenia from China, Guatemala, Vietnam, Ethiopia and South Korea.

"If you look around our community, there are lots of families who have come together through international adoption," says Orscheln, an infectious disease expert. "Many of these children were in resource-limited or institutional settings that put them at risk for various problems: physical, developmental, psychological. So we thought, 'What if we came together as a multidisciplinary center to evaluate these kids?'"

With several colleagues, she began laying the groundwork for such a center, first surveying local agencies to discover what medical services adoptive families need. Then occupational therapist Carol Finkes was granted an 11-week, part-time sabbatical from Children's Hospital to visit other institutions — the University of Minnesota's pioneering international adoption center in particular — to develop a model of care.

They also gathered a team of professionals with experience in this kind of work. Children's Hospital social worker Karla Jacquin had done home studies for agencies that place overseas children in St. Louis families. Stephanie Lutter, a fellow in infectious disease, had done medical mission work in Central America. And pediatric infectious disease coordinator and nurse Lisa Robertson was easy to enlist; she is an adoptive parent herself, as is her twin sister, Teresa, also a Children's Hospital nurse.

The staff of the International Adoption Center assess the health status and needs of new arrivals. Left to right: Lisa Robertson, RN, Carol Finkes, OTR/L, Karla Jacquin, MSW, James J. Schroeder, MD, Rachel C. Orscheln, MD, and Mary Michaeleen Cradock, PhD.

"I admire parents who choose to adopt, since I know the process can take quite a while and is difficult," says Robertson, whose children are now 14, 12 and 5. "Even though my children were adopted locally, I feel that all adopted children go through the same kinds of adjustments with a new family, and I thought I might be able to ease those adjustments a little by sharing my experiences."

The program devised by Orscheln's team is triggered when a family, having heard about the center through its own pediatrician or adoption agency, makes an appointment to come in. First, Orscheln does a basic screening by phone and e-mails the results to her group. Then Jacquin calls the family to do a psychosocial assessment.

"Do they have any concerns?" says Jacquin. "Sometimes they just want to get the child checked, but other times there are developmental issues. One child was not meeting his milestones — not pulling up and walking when he should. And children who have spent time in orphanages may have behavioral issues, such as hoarding food."

When the family arrives for the visit, Jacquin greets them and escorts them from one specialist to another. The visit includes a meeting with Orscheln and Lutter, who test for a variety of infectious diseases, including viral infections, latent tuberculosis and parasitic infections. A careful evaluation of the vaccination history, which is often incomplete, also is performed. The family then continues on to see Finkes for an occupational therapy evaluation, Mary Michaeleen Cradock for a psychological screening, and audiologist Robin Hudson for a hearing test.

If the child is healthy, they return him or her to the care of the referring doctor, but if there are problems, they can send the child on to other Children's Hospital physicians. One child with a cleft lip and palate underwent plastic surgery, while another with a serious heart defect had successful cardiac repair. A third, with severe scoliosis, has had several operations and will need continuing follow-up.

In these cases, the family knew in advance that the problems existed, but occasionally a child has unexpected health issues.

"We had a family from a rural area who adopted a little girl," says Jacquin. "One day, the mother was vacuuming in back of this child and realized that she didn't even flinch. She started putting two and two together, and brought the child to us for diagnosis of hearing impairment."

Always verify the credentials of your medical personnel: Thomas Sholtis checks out Rachel C. Orscheln, MD

The center has translators available, but for the most part it hasn't needed them. While adoptive children of any age are eligible for the clinic, most so far have been in the infant to 3-year-old range. Helping these children get off to a strong start has been very rewarding, say staff members.

"We saw an adorable little one, about six months old, who had some movement patterns that weren't appropriate for his age and some challenges with eating, as well as waking/sleeping cycles," says Finkes, who has five children of her own. "When they came in, we could show them ways to help him eat from the spoon and ways to hold the baby that promote better posture and quality of movement."

Institutionalized children often display fine and gross motor skill delays, she adds. Typically, for every three months in an orphanage they have one month of developmental lag. But the happy news is that, thanks to the resilience of childhood and the eager attention of their new parents, many catch up within a year or two.

"It has been fabulous to see these children adopted into families, some of which have biological children or previously adopted children, while for some this is their first child," says Orscheln, who has three young children herself. "We've seen single parents and married couples; some have been through infertility and other issues that have made parenthood long sought after and difficult to attain."

In one of these new families, the adoptive mother was a nurse/midwife who had helped bring other people's children into the world but had never had any of her own. She and her husband adopted a baby boy from Russia, says Robertson, "and it seemed to me that the family was extra blessed."

The Suddeth family is another such family — now happily complete with parents Nate and Kim, Christopher, 7, and Ksenia, now 4. At the center, they received the reassuring news that Ksenia was fine, except for a minor problem with low muscle tone. Today, she loves books, loves Disney characters, "loves life," says her mother. "You'd think she had been here a million years."

"Every time we see one of these families, it puts a big smile on my face," says Orscheln. "It's amazing to be a part of caring for these children."