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Caring for kids new to Canada

A guide for health professionals working with immigrant and refugee children and youth

International Adoption: Enhancing attachment between adoptive parents and children

Key points

  • All international adoptions are “special needs” adoptions.
  • Parent education and anticipatory guidance are essential.
  • Attachment between a newly adopted child and adoptive parents can take anywhere from a few months to more than a year, depending on pre-adoption risk factors and parental commitment. Information on pre-adoption risk factors is available in this resource.

Transition for newly adopted children

The long-anticipated arrival of a new child is a very emotional time for parents. Meeting is often combined with long distances travelled, jet lag, fatigue and changes in culture and climate. However, a child does not share the same anticipatory experience as new parents. Understandably, a child may grieve the loss of familiar people and places and be frightened by people who are often racially different and do not speak her native language. Parental preparation can ease this emotional transition and help to alleviate the strain on all involved.

Newly adopted children may exhibit the following behaviours while transitioning: 1,2

  • Extreme passivity or seeming to “shut down”
  • High activity or hypervigilance
  • Excessive or desperate crying to express loss
  • Disruptive or disordered eating, sleeping and toileting
  • Rocking, head banging, hair pulling or twisting, staring at hands. These are stereotypical “orphanage”-associated behaviours
  • Reach for other people or search for previous caregivers
  • Avoid eye contact, arch when held, or resist close parental contact.

Encouraging attachment

Attachment describes the enduring relationships that are formed over time and experienced by members of a family.3 Attachment is distinguished by feelings of affection and emotional security that persist over time and distance. Adopted infants and younger children typically show progress with attachment during the first few weeks and months with their new family.  Older children progress more slowly. Children understandably grieve the loss of their birth family, home, country, language and culture.

Tips for facilitating attachment while transitioning in the new home:1

  • Parents, not other family or friends, should meet all of the child’s routine needs (e.g., feeding, changing, consoling)
  • Avoid passing the child among multiple caregivers (i.e., do not promote indiscriminate friendliness)
  • Foster physical contact (e.g., carry an infant, do a massage after bathing using  nonperfumed moisturizer, or try foot massage with a firm or deep pressure)
  • Encourage skin-to-skin contact (i.e., by bathing or swimming with the child, hand-piling, fingerpainting, or sharing hand lotion, whipped cream, mud pies, or any medium you can play with together)
  • Provide high levels of nurturing, routine and structure
  • Parent the child as if he were younger than his actual age
  • Maintain eye contact during bottle-feeding
  • Talk and sing to a baby or toddler. Talk to the child while caregiving
  • Playing games: Peekaboo or patty cake can ease initial interactions. Progress to water games, dancing in the rain, playing with sand.  Be careful of overstimulation: the newly adopted child has been sensorily deprived and can experience ‘overload’ quickly or easily.
  • Help with sleep issues (e.g., a child may need to co-sleep [share a bedroom] or have a parent close by at night until he feels more secure)
  • Limit the number of visitors in the first 8 weeks at home
  • Avoid watching TV in the first months following adoption: read and do things together instead
  • Keep negative emotions (e.g., anxiety, anger) in check to minimize transmission to, or impact on the child.
  • Tell adopted  children their own story, from the beginning
  • Make a special ‘memory box’ for objects and documents from the child’s past.
  • Build attachment in a structured setting:  develop nurturing, protective, predictable family routines.

Information for parents about attachment is available from the Canadian Paediatric Society.

Suggested resources

Web resources, handouts and further reading on international adoption.


  1. Chambers J. Preadoption opportunities for pediatric providers. Pediatr Clin North Am 2005;52(5):1247-69.
  2. Miller LC. The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. New York, NY: Oxford University Press, 2005.
  3. Gray DD. Attaching in Adoption: Practical Tools for Today’s Parents. Philadelphia, PA: Jessica Kingsley Publishers, 2012.


  • Cecilia Baxter, MD

Last updated: February, 2023