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Temper Tantrums 101

Q: My youngest daughter lived with a foster family for two years before we adopted her. The adoption, however, wasn’t finalized until she was 4 years old, so she lived in limbo for quite some time. I’ve read about adopted children’s tendencies to push your buttons and then gather you close, and my daughter seems to be going through this. I believe it’s a result of leaving her foster family. Lately, her temper tantrums are becoming extreme. How do I calm and comfort her in the midst of one?

A: Instead of sending a child off to a bedroom or another isolated room until they’ve finished a tantrum, we find that the best way to reduce tantrums is for a parent to stay with the child throughout the messy ordeal. If you stay with her, hold her, talk to her, and try to comfort her, she will eventually run out of steam. At that point, you will be in a position to offer even more nurturing, and she will be in a receptive mode.

Another strategy involves what’s called a paradoxical intervention. When your daughter is about to have a tantrum, try instructing her to do so. As in, “Honey, I think that it must be time for a real loud tantrum—lots of screaming, kicking, and so forth (whatever she ususally does).” This kind of approach almost always causes the child to refuse to comply. This, along with a parent sometimes joining in by screaming, kicking, rolling on the floor, and so forth, can be quite effective.

You will find many more suggestions in Parenting the Hurt Child, the book Regina Kupecky and I wrote. (Available at

—Gregory Keck, Ph.D., Attachment and Bonding Center of Ohio, Cleveland, Ohio

Adoption Medicine

Q: Is there a certification process for physicians who specialize in international adoption?

A:Adoption medicine is a relatively new field, and currently there is no specific training or certification for those who specialize in it. Many doctors in this kind of practice are members of the American Academy of Pediatrics (AAP) Section on Adoption & Foster Care, a special-interest group committed to sharing information and educating other physicians. These physicians can be identified through the AAP Web site: Frequently, physicians become involved in this field, as I did, after becoming an adoptive parent. This specialty has developed in the last six years through a list-serv for adoption medicine professionals. This forum allows newer doctors in the field to learn from those who have been seeing internationally adopted children for many years.

What criteria should you look for in an adoption medical specialist?

  1. Make sure that the doctor is board-certified in the specialty in which he practices (i.e., family medicine, infectious diseases, developmental and behavioral pediatrics). How do you know? Ask!
  2. Inquire as to how long (and how often) the physician has cared for adopted children. What type of care is provided? Specialty (initial evaluations and one or two follow-up exams) or comprehensive evaluations and ongoing care?
  3. Ask other parents for recommendations.
  4. Ask your agency for several recommendations.
  5. Send your adoption referral to several doctors. The second (or third) doctor may have an insight into something seen in a video, or she may have actually been to the orphanage.
  6. Ask the doctor if he belongs to the AAP Section. If so, this shows a commitment to adoption medicine.

The number of doctors practicing adoption medicine is relatively small, and it is unlikely that a formal certification process will be set in place soon. If you know a doctor who shows a special interest in adoption medicine or sees many adopted children, encourage her to join the AAP Section if she does not already belong.

—Debbi Borchers, M.D., adoption pediatrician in Cincinnati and mom to three daughters through adoption

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