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Are You Thinking About Joining Ties Adjunct Travel Staff?

International adoptees who have traveled on a Ties Program often have a unique ability to help fellow adoptees and their families as they travel. Over the 30 years we have provided birth country experiences for international adoptees, we have consistently worked toward increasing the number of international adoptees traveling in leadership roles with our programs. They are an integral part of the  Adoptive Family Travel by The Ties Program  adjunct travel staff. We are proud to note that more than 70% of our travel staff are now international adoptees!

As we restart programs post-COVID, we are reaching out to our Ties alumni, hoping to locate just the right Ties adoptee alumni who would serve Ties families with passion and enthusiasm. Our travel staff have day jobs but take time to travel with Ties adoptees and their families to help participants process both their experiences in-country and their vast array of emotions.

In 2023, we reopened Guatemalan Ties, Korean Ties, Next Gen: Korea and are opening up China Ties, Kazakhstan Ties, Next Gen: Paraguay, India, and Vietnam in 2024! You do not need to be an adoptee from the same country to be part of our travel staff, but it can be helpful.

Here is some additional information you will find helpful if being part of our adjunct staff piques your interest. 

When adoptees and their families visit their birth countries, the staff accompanying them play a crucial role in ensuring a positive experience. They take on leadership positions while also being fully immersed in the families' activities, actively listening, and providing support. The staff's involvement is integral in creating a fulfilling and memorable trip for all involved.

Time Commitment: approximately 2 weeks per year. 

Characteristics of Our Travel Staff - Are You a Good Fit?

Here are some of the many wonderful characteristics of Ties travel staff:

A leader and team player who is calm yet energetic, highly organized, and a quick learner. Can pay great attention to detail and is a planner who also is comfortable embracing change. An outgoing, social, patient, and nurturing individual who enjoys interacting with all ages. Someone who is always punctual, responsible, passionate, and committed to excellence. Additionally, someone comfortable working in international environments and has an above-average understanding of adoption issues. Lastly, someone who is willing to learn, open-minded, mindful of confidential information, and always strives to find solutions in a diplomatic and sincere manner.

Things Travel Staff Do

• Arrive a day or two prior to the group's arrival or perhaps fly with the group.
• Meet with in-country providers to reconfirm all details.
• Welcome adoptees and their families upon arrival.
• Assign pre-reserved sleeping rooms with hotels and check on meeting space.
• Coordinate with in-country guides and providers.
• Facilitate orientation gatherings with adoptees and families.
• Interact daily (and deeply) with adoptees and families as they travel.
• Implement daily logistics, responding to both changes and needs as they arise.
• Implement important details like pre-arranged orphanage visits, foster family, and/or birth family visits, etc.
• Lead and participate in group activities.
• Take pictures and videos, posting to the group's Facebook page to engage families as well as provide pictures/videos to The Ties Program to assist with marketing.
• Facilitate Connect & Chat for the adoptees and/or Parent Talk Time.
• Communicate effectively with adoptees, families, other travel staff, and in-country staff.
• Assist families with day-to-day needs as they arise (dietary needs, need for a doctor, toiletries, items they would like to purchase, etc.).
• Assist families day-to-day with emotional needs as they arise (the need to be heard, the need for helpful resources, etc.).
• Provide feedback and evaluation to The Ties Program.

Other Things You May Be Wondering

• New travel staff will always be scheduled to travel with seasoned staff so they have a training period.
• Travel expenses, i.e., flights, hotel, meals, and transportation, are included. A stipend is paid after your second trip as staff. In some situations, we may have opportunities for interns with a different structure on travel expenses.
• Travel staff share a double occupancy room.
• Some (not all) of our staff have careers and/or educational backgrounds in social work and/or child welfare/post-adoption. Others have cultivated a deep understanding of adoption issues via other means--speaker forums, blogs, culture camps, etc.
• To learn about the countries we serve and lots of other helpful information, please explore our tabs above.
• Most of our programs run in summer and over winter break. As adoptees are becoming less and less tied to a school schedule, this may open up some other times of the year.

If you think you would be a good fit and are interested in applying, please email us at [email protected]

Transformative travel focused on building deeper connections!

Your experience doesn’t end when you come home., we believe that a child’s first visit to their birth country, what we call a heritage journey, can be a transformative, life-changing experience for every member of the family — deepening family bonds, building self-esteem and fostering meaningful cultural connections long before a birth or foster family search is initiated. designing intricate trips that are the catalyst for building connections is our specialty at motherland travel..

We design purposeful and intentional family-centered trips geared toward building connections and creating opportunities for personal and family growth. We customize EVERY trip to meet the needs of EVERY family member! 

We can design an unforgettable adventure for your family or help you create your own, what motherland travelers are saying….

Motherland Travel not only helped ease my anxiety, they thought of everything! My experience with Motherland Travel was exceptional. Prior to planning our trip, I felt anxious when I thought about our family returning to Guatemala. Motherland Travel not only helped ease my anxiety, they thought of everything!

Proud father of Jack

Bambi Wineland and Motherland Travel crafted a perfect heritage trip for our family to visit our son’s birth country of Guatemala. We were deeply moved by the personal threads and thorough work that was put into our itinerary. She was clear, accessible, and supportive throughout the process.

Salt Lake City, UT

Motherland Travel truly thought of every detail of our trip.  Bambi understood the impact that this trip would have on our son & the family as a whole. She orchestrated each day of our travel to maximize the fun, family bonding, ease of transitions and emotional impact.

Ten Mistakes To Avoid When Planning Your Heritage Journey

Grab our FREE eBook, “What NOT To Do When on a Trip to Your Child’s Birth Country. Top Ten Mistakes You’ll Want to Avoid” (and believe me, I’ve done them all). You’ll get a peek into the lessons we have learned on our own Heritage Journeys at Motherland Travel.

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Oh, the places we can go!

Motherland Travel Designs Family-Centered Trips and Heritage Journeys to the Following Countries:

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Gift of Identity

Giving every international adoptee the chance to complete the statement "i am . . . ", the need for gift.

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Our mission is to build a fund so ALL international adoptees have a chance to visit their birth country and explore their beginnings—accompanied by family who loves them, and supported in a way that is emotionally healthy.

The Gift of Identity Fund, Ltd. provides funding to international adoptees visiting their birth country with the goal of helping them understand their identity, heritage, and culture while traveling via Adoptive Family Travel by The Ties Program , a family-based heritage program. The Ties Program has traditionally offered family programs called Flagship and Lite.  More recently, with the ages of adoptees increasing, Ties has added Next Gen programs created especially for  adult adoptees and those who love them.

Many organizations have provided funding to families who would like to adopt a child, but cannot afford the expense. GIFT was born from the idea that regardless of a family’s financial situation, nearly all international adoptees need to connect with their birth country for many, many reasons. Some can simply not afford it. 

You can make a huge impact in the life of an adoptee. You can give the gift of identity.

As time unfolds, it becomes increasingly evident that the greatest gift an adoptee can receive is the gift of identity — the gift of reconnecting with their birth country, their culture, their caregivers, places of birth and founding, and sometimes their birth family.

It is not surprising that these adoptees, despite the immense love they share with their adoptive families, feel caught in the circumstances, and long to know, “Who am I?”

THE DILEMMA Adoptive families face enormous expenses when they adopt, followed by yet more expenses to help their children explore their birth country, heritage, and identity. The combination is indeed extraordinary and no funding source exists to help families provide adoptees with what they truly need. To get grounded and comfortable in their own skin, adoptees need the opportunity to explore where they began life.

THE SOLUTION: GIFT OF IDENTITY FUND

The Gift of Identity Fund, Ltd was created to help provide funding for international adoptees who would like to visit their birth-country, but are not financially able to do so.  International adoptees traveling with their families are awarded funds, helping defray the cost of travel. Grants up to $3,000.00 are available.  The number of grants given each cycle depends on the size of the fund.

Note: Gift of Identity is 100% volunteer run. All donations go entirely to the grant fund. 

Gift of Identity Fund, Ltd. is a non-profit 501(c)(3) sister organization Adoptive Family Travel by The Ties Program.

Your donation is tax deductible to the extent allowed by law.

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• Section 7 - Vaccine Recommendations for Infants & Children
• Section 7 - Traveling with Pets & Service Animals

International Adoption

Cdc yellow book 2024.

Author(s): Mary Allen Staat, Jennifer (Jenna) Beeler, Emily Jentes

Since 1999, >275,000 children have come to the United States to join families through international adoption. Children being adopted from other countries can have infectious (and environmental) diseases due to exposure to pathogens endemic to their birth country; they also might be underimmunized or unimmunized, have lacked access to clean water, lived in crowded or possibly unsanitary conditions, and be malnourished. Families traveling to unite with their adopted child, siblings who wait at home for the child’s arrival, extended family members, and childcare providers are all at risk of acquiring infectious diseases secondary to travel or from contact with their new family member. Clinicians can play an important role in helping families prepare to travel and welcome adoptees safely.

Preparing Adoptive Parents & Families

Prospective adoptive parents should schedule a pretravel visit with a travel health clinic. To best prepare adoptive parents and families going to meet their new child, travel health providers should be aware of disease risks in the adopted child’s country of origin, the medical and social history of the adoptee (if available), the medical and vaccination histories of family members traveling to meet the child, the season of travel, the length of stay in the country, and the itinerary. Provide prospective adoptive parents and any family members traveling with them with needed vaccinations, malaria prophylaxis, diarrhea prevention and treatment, advice on coronavirus disease 2019 (COVID-19) prevention measures and travel requirements, general advice on travel and food safety, and other travel-related health issues, as outlined elsewhere in the Centers for Disease Control and Prevention (CDC) Yellow Book.

Vaccinations

All family members should be up to date with all routine immunizations; this includes those who travel to meet the adopted child, those who remain at home, and all extended family members. Provided minimum age and dose intervals are followed, an accelerated dose schedule can be used to complete a vaccine series, if necessary.

Ensure all age-eligible people who will be in the household or in close contact with the adopted child (e.g., caregivers) are protected against diphtheria, hepatitis A virus (HAV), measles, pertussis, polio, tetanus, and varicella; include hepatitis B virus (HBV) vaccine if the adoptee has known infection or if the family is traveling to a country with high or intermediate levels of endemic HBV infection (see Sec. 5, Part 2, Ch. 8, Hepatitis B ). Make sure all eligible family members are up to date with their COVID-19 vaccines .

Before the adopted child’s arrival, immunize unprotected family members and close contacts against HAV. Because hepatitis B vaccine has only been routinely given since 1991, some adult family members and caretakers might need to be immunized if the adoptee has a known HBV infection.

Measles immunity or 2 doses of measles-mumps-rubella (MMR) vaccine separated by ≥28 days should be documented for all people born in or after 1957.

If the adopted child is from a polio-endemic area (see CDC Travelers’ Health travel health notices ), ensure family members and caretakers have completed the recommended age-appropriate polio vaccine series. A one-time inactivated polio vaccine (IPV) booster for adults who completed the primary series in the past is recommended if they are traveling to polio-endemic areas; vaccination also can be considered for adults who remain at home but who will be in close contact caring for the child. Additional polio vaccine requirements for residents and long-term travelers (staying >4 weeks) departing from countries with polio transmission could affect outbound travel plans (see Sec. 5, Part 2, Ch. 17, Poliomyelitis ).

Tetanus-Diphtheria-Pertussis

Adults who have not received the tetanus-diphtheria-acellular pertussis (Tdap) vaccine, including adults >65 years old, should receive a single dose to protect against diphtheria, pertussis, and tetanus.

Administer varicella vaccine to people born in or after 1980 without a history of varicella disease, documented immunity (serology), or documentation of 2 doses of varicella vaccine.

Overseas Medical Examination

All immigrants, including children adopted internationally by US citizens, must undergo a medical examination in their country of origin, performed by a physician designated by the US Department of State. See additional information about the medical examination for internationally adopted children and vaccination affidavit  [PDF].

The explicit purpose of the overseas medical examination is to identify applicants with inadmissible health-related conditions. Prospective adoptive parents should not rely on this evaluation to detect all disabilities and illnesses a child might have. To understand more about possible health concerns for an individual child, prospective adoptive parents should consider a preadoption medical review with a pediatrician familiar with the health issues of internationally adopted children. That provider can review the available medical history and vaccination records for the child, thereby preparing parents for any potential health issues that might exist.

Prospective adoptive parents can then proactively schedule any recommended follow-up, including an  initial medical examination  that is recommended within 2 weeks of arrival to the United States. Adoptive parents might receive a copy of the overseas examination, recorded on US Department of State medical forms, to give to clinicians at the initial follow-up medical examination.

Follow-Up Medical Examination

Providing health care to internationally adopted children can be challenging for several reasons (see Box 7-05 ). Adopted children should have a complete medical examination ≤2 weeks after their US arrival—earlier than that if they have anorexia, diarrhea, fever, vomiting, or other apparent health issues. In addition, a developmental screening examination conducted by an experienced clinician can help identify if immediate referrals should be made for a more detailed neurodevelopmental assessment and therapies. Clinicians might recommend further evaluation based on the age of the child, their country of origin, developmental status, nutritional status, previous living conditions, and the adoptive family’s specific questions. Concerns raised during the preadoption medical review could dictate further investigation.

Box 7-05 Challenges to providing care to internationally adopted children

• Absence of a complete medical history
• Increased risk for developmental delays and psychological issues
• Lack of a biological family history
• Previously unidentified medical problems
• Questionable reliability of immunization records
• Variations in preadoption living standards
• Varying disease epidemiology in countries of origin

Infectious Diseases Screening

Screening recommendations for infectious diseases vary by organization. See Table 7-01 for the current panel of infectious disease screening tests recommended by the American Academy of Pediatrics (AAP) for internationally adopted children.

Table 7-01 American Academy of Pediatrics (Red Book) recommended infectious disease screening for international adoptees 1,2

Abbreviations: BCG, bacillus Calmette-Guérin; IGRA, interferon-γ release assay; O&P, ova and parasites; TST, tuberculin skin test

1 Report all reportable diseases to the state or local health department.

2 Collect a complete blood cell count with differential and red blood cell indices in addition to the disease-specific tests listed in the table.

3 Repeat testing in 3–6 months if initial testing is negative.

Eosinophilia

All internationally adopted children should have a complete blood count with differential. An eosinophil count >450 cells/mL warrants further evaluation; intestinal parasite screening can identify some helminth infections. Investigation of eosinophilia also should include serologic evaluation for Strongyloides stercoralis and Toxocara canis ; both are found worldwide. Perform serologic testing for filariasis and Schistosoma spp. in children arriving from endemic countries.

Hepatitis A

Screening asymptomatic people for hepatitis A is generally not recommended; clinicians might, however, decide to test internationally adopted children for HAV IgG and IgM to identify those who are acutely infected and shedding virus. Vaccinate adopted children against HAV if they are not already immune.

In 2007 and early 2008, multiple cases of hepatitis A were reported in the United States secondary to exposure to newly arrived internationally adopted children. Some of these cases involved extended family members not living in the household. Identification of acutely infected toddlers new to the United States could prevent further transmission. If an acute infection is found in a child, close contacts can receive hepatitis A vaccine or immunoglobulin to prevent infection. In addition, serologic testing is a cost-effective way to identify children with past infection.

Hepatitis B

With the widespread use of the hepatitis B vaccine, the prevalence of HBV infection has decreased overall, and lower rates of infection (1%–5%) have been reported in newly arrived international adoptees. In recent years, most children with HBV infection were known to be infected prior to adoption.

All internationally adopted children should be screened for HBV infection with serologic tests for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and hepatitis B core antibody to determine past infection, current infection, or protection due to prior vaccination. For children positive for HBsAg, retest 6 months later to determine if they have chronic infection. Report results of a positive HBsAg test to the state health department.

HBV is highly transmissible within households; for this reason, all members of households adopting children with chronic HBV infection should be immunized. Children with chronic HBV infection should receive additional tests for hepatitis e antigen (HBeAg), hepatitis B e antibody (anti-HBe), HBV viral load, hepatitis D virus antibody, and liver function, and should have a consultation with a pediatric gastroenterologist for long-term management.

Although not currently recommended by the CDC or the AAP, consider repeat screening 6 months after arrival for all children who initially test negative for hepatitis B surface antibody and surface antigen.

Hepatitis C

The prevalence of hepatitis C in internationally adopted children is low. Most children with hepatitis C virus (HCV) infection are asymptomatic, and screening for risk factors (e.g., having an HCV-positive mother, surgery in the child’s birth country, a history of transfusions, major dental work, intravenous drug use, tattoos, sexual activity or abuse, female genital cutting, traditional cutting) generally is not possible. But because effective treatments are available and infected patients need close follow-up to identify long-term complications, consider routine screening for HCV.

Use antibody testing (IgG ELISA) to screen children ≥18 months of age; use PCR testing for younger children. Refer children with HCV infection to a gastroenterologist for further evaluation, management, and treatment.

HIV screening is recommended for all internationally adopted children. HIV antibodies found in children aged <18 months could reflect maternal antibodies rather than infection of the infant. An HIV-1/HIV-2 antigen/antibody combination assay is used for standard screening, but some experts recommend PCR for any infant aged <6 months on arrival to the United States. A PCR assay for HIV DNA can confirm the diagnosis in an infant or child. If PCR testing is done, 2 negative results from assays administered 1 month apart, at least 1 of which is done after the age of 4 months, are necessary to exclude infection. Some experts recommend repeating screening for HIV antibodies 6 months after arrival if the initial test results are negative. Refer children with HIV infection to a specialist.

Intestinal Pathogens

Children treated for intestinal pathogens who have persistent growth delay, or who have ongoing or recurrent symptoms or unexplained anemia, merit a more extensive work-up. Notify public health authorities of reportable infections, and forward isolates for surveillance as appropriate.

Gastrointestinal parasites commonly are seen in international adoptees, but prevalence varies by age and birth country. As children become older, the risk for parasitic infection and detection increases. The presence or absence of symptoms is not predictive of intestinal parasites; thus, screening is needed. In both past and more recent studies, the highest rates of parasite detection are reported among children adopted from Ukraine and from African, Latin American, and Asian countries, as compared to children coming from Russia and other countries in Eastern Europe. Unlike refugees, internationally adopted children are not treated for parasites before departure, and some clinicians opt to treat newly arrived adoptees with a single dose of albendazole.

Three stool samples collected in the early morning, 2–3 days apart, and placed in a container with preservative provides the highest yield for ova and parasite (O&P) detection. In addition, because routine O&P analysis is unlikely to include testing for either Cryptosporidium or Giardia , order the combined antigen test for these 2 parasites. Giardia duodenalis is the parasite most often identified.

Conduct additional stool testing for children with fever and diarrhea, especially acute-onset bloody diarrhea. Non-culture methods (e.g., gastrointestinal pathogen panels with PCR) commonly are used. If a bacterial pathogen is identified by a non-culture method, collect and culture samples to determine antimicrobial susceptibility and inform treatment decisions; bacterial pathogens can be resistant to antibiotics.

Routine malaria screening is not recommended for internationally adopted children. Instead, obtain thick and thin malaria smears immediately for any child coming from a malaria-endemic area who presents with fever or who has symptomatic splenomegaly (i.e., splenic enlargement plus fever or chills). Rapid diagnostic tests (RDTs) for malaria can help expedite the diagnosis, but microscopy is still required to confirm the results and to determine the degree of parasitemia (see Sec. 5, Part 3, Ch. 16, Malaria ). PCR testing can confirm the species of parasite after the diagnosis has been established by either smear microscopy or RDT.

Further evaluation also is warranted in asymptomatic children with splenomegaly who come from areas endemic for malaria, as they could be exhibiting hyperreactive malaria splenomegaly. This evaluation should include antibody titers for malaria, since asymptomatic children with splenomegaly caused by repeated malaria infections can have high titers but negative smears.

Sexually Transmitted Infections

Chlamydia & gonorrhea.

Although screening for sexually transmitted infections other than HIV and syphilis is not routinely recommended, some experts will screen all children >5 years of age for chlamydia and gonorrhea. Regardless of age, if questions or concerns of sexual abuse are present, or if HIV or syphilis are diagnosed in the child, perform chlamydia and gonorrhea screening.

Screening for Treponema pallidum is recommended for all internationally adopted children. Initial screening is done with both nontreponemal and treponemal tests. Treponemal tests remain positive for life in most cases, even after successful treatment, and are specific for treponemal diseases, including syphilis and other diseases (e.g., bejel, pinta, yaws) found in some countries.

In children with a history of syphilis, documentation is rarely available for the initial evaluation (serology and lumbar puncture results with cell count, protein, VDRL), treatment (antibiotic used, dose, frequency, and duration), and follow-up serologic testing; therefore, conduct a full evaluation for disease, and provide treponemal treatment depending on the results.

Trypanosomiasis / Chagas Disease

Chagas disease is endemic to much of Mexico and throughout countries in Central and South America (see Sec. 5, Part 3, Ch. 25, American Trypanosomiasis / Chagas Disease ). Infection risk varies by region within endemic countries. Although the risk for Trypanosoma cruzi infection is likely low in children adopted from endemic areas, consider screening.

Serologic testing when the child is aged 9–12 months will avoid possible false-positive results from maternal antibodies. PCR testing can be done for children <9 months of age. Refer children who test positive for Chagas disease to a specialist for further evaluation and management; treatment is effective.

Tuberculosis

Internationally adopted children have 4–6 times the risk for tuberculosis (TB) compared to their US-born peers. TB screening is an integral part of the pretravel overseas medical examination; check with adoptive parents or with the local health department for screening results. If results are not immediately available, screen all internationally adopted children for TB after they arrive in the United States; report any positive cases to the state health department.

Screening for TB after US arrival is important because TB can be more severe in young children and can reactivate when the child gets older. To screen, AAP recommends a tuberculin skin test (TST) for children <2 years of age. For children ≥2 years of age, use either a TST or an interferon-γ release assay (IGRA). For children previously vaccinated with bacillus Calmette-Guérin (BCG), IGRAs appear to be more specific than the TST for Mycobacterium tuberculosis infection (see Sec. 5, Part 1, Ch. 23, . . . perspectives: Testing Travelers for Mycobacterium tuberculosis Infection ). On arrival to the United States, some children might be anergic (i.e., have a false negative TB screen) due to malnutrition, stress, or untreated HIV infection, or they might have been infected just prior to travel. Thus, if the initial screen is negative, repeat testing 3–6 months after arrival.

If the TST or IGRA is positive, the child has TB infection, which requires additional evaluation to determine whether the child has TB disease. If a child has evidence of TB disease , consult with an infectious disease expert.

The US Immigration and Nationality Act requires everyone seeking an immigrant visa for permanent residency to show proof of having received Advisory Committee on Immunization Practices (ACIP)- recommended vaccines before immigration . This requirement extends to all immigrant infants and children entering the United States. Although internationally adopted children aged <10 years are exempt from the overseas immunization requirements, CDC encourages vaccination prior to travel to the United States. If an adopted child <10 years old is not vaccinated as part of their pretravel overseas medical examination, the adoptive parents must sign an affidavit indicating their intention to comply with the immunization requirements within 30 days of the child’s arrival to the United States. See vaccination affidavit  [PDF].

Vaccination Records

Vaccination record reliability differs by, and even within, country of origin. Some children might have full documentation of vaccines received and dates given, while others have incomplete or no records. MMR is not given in most countries of origin because measles vaccine often is administered as a single antigen. In addition, some children might be immune to hepatitis A, measles, mumps, rubella, or varicella because of natural infection. A clinical diagnosis of any of these diseases, however, should not be accepted as evidence of immunity.

Catch-Up Vaccinations

Most international adoptees arrive to the United States already having been vaccinated against diphtheria, hepatitis B, measles, pertussis, polio, tetanus, and tuberculosis (with BCG) in their country of birth. Because Haemophilus influenzae type b (Hib), hepatitis A, human papillomavirus, meningococcal, mumps, pneumococcal conjugate, rotavirus, rubella, and varicella vaccines are not given routinely in low- and middle-income countries, however, >90% of newly arrived internationally adopted children need catch-up vaccines to meet ACIP guidelines.

Vaccination Plan

Providers can choose 1 of 2 approaches for developing a vaccination plan for internationally adopted children. The first approach is to revaccinate regardless of the child’s vaccination record from their birth country. The second approach, applicable to children ≥6 months of age, is to perform antibody testing and to revaccinate accordingly. One exception to this second approach is pertussis; Bordetella pertussis antibody titers do not correlate with immune status, although higher protective antibody levels for diphtheria and tetanus could be extrapolated to mean that a child has protection against pertussis, as well.

Hepatitis B is another exception. Anti-HBs as a correlate of vaccine-induced protection has only been determined for people who have completed an approved vaccination series. To be considered immune, ACIP recommends that children with positive hepatitis B surface antibody have documentation of 3 appropriately spaced doses of hepatitis B vaccine. For children with positive hepatitis B surface antibody and positive hepatitis B core antibody, vaccination is not required, as they are considered immune after natural infection.

For children ≥6 months of age, perform testing for diphtheria (IgG), hepatitis B (as outlined above), Hib, and tetanus (IgG). For children ≥12 months of age, also perform testing for hepatitis A, measles, mumps, rubella, and varicella. Since April 2016, many resource-poor countries have used bivalent oral polio vaccine; for children born on or after this date who do not have documentation of receiving IPV according to an approved (US or World Health Organization) schedule, administer the age-appropriate vaccine series. Revaccination with pneumococcal vaccine is recommended because the vaccine has 13 serotypes, and antibody testing would not be cost-effective.

Once the vaccination record has been assessed and antibody level results are available, give any indicated vaccines according to the current ACIP catch-up schedule. If an adopted child is <6 months old and uncertainty remains regarding their vaccination status or the validity of the vaccination record, administer vaccines according to the ACIP schedule.

Noninfectious Disease Screening

Several screening tests for noninfectious diseases should be performed in all or in select internationally adopted children. All children should have a complete blood count with a differential (as previously noted), hemoglobin electrophoresis, and glucose-6-phosphate-dehydrogenase (G6PD) deficiency screening. Measure serum levels of thyroid-stimulating hormone, and obtain a blood lead level in all internationally adopted children. Consider testing for serum levels of iron, iron-binding capacity, transferrin, ferritin, and total vitamin D 25-hydroxy. Perform vision and hearing screening and a dental evaluation on all children. Consider neurologic and psychological testing if the child’s clinical presentation raises concern.

The following authors contributed to the previous version of this chapter: Mary Allen Staat, Simone Wien, Emily Jentes

Bibliography

American Academy of Pediatrics. Immunizations received outside the United States or whose immunization status is unknown or uncertain. In: Kimberlin D, Barnett ED, Lynfield R, Sawyer MH, editors. Red Book 2021–2024: report of the Committee on Infectious Diseases, 32nd edition. Elk Grove Village (IL): American Academy of Pediatrics; 2021. pp. 96–8.

American Academy of Pediatrics. Medical evaluation for infectious diseases for internationally adopted, refugee, and immigrant children. In: Kimberlin D, Barnett ED, Lynfield R, Sawyer MH, editors. Red Book 2021–2024: report of the Committee on Infectious Diseases, 32nd edition. Elk Grove Village (IL): American Academy of Pediatrics; 2021. pp. 158–9.

American Academy of Pediatrics Committee on Infectious Diseases. Recommendations for administering hepatitis A vaccine to contacts of international adoptees. Pediatrics. 2011;128(4):803–4.

Centers for Disease Control and Prevention. CDC immigration requirements: technical instructions for tuberculosis screening and treatment: using cultures and directly observed therapy 2009. Available from: www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/tuberculosis-panel-technical-instructions.html .

Mandalakas AM, Kirchner HL, Iverson S, Chesney M, Spencer MJ, Sidler A, et al. Predictors of Mycobacterium tuberculosis infection in international adoptees. Pediatrics. 2007;120(3):e610–6.

Marin M, Patel M, Oberste S, Pallansch MA. Guidance for assessment of poliovirus vaccination status and vaccination of children who have received poliovirus vaccine outside the United States. MMWR Morb Mortal Wkly Rep. 2017;66(1):23–5.

Staat MA, Rice M, Donauer S, Mukkada S, Holloway M, Cassedy A, et al. Intestinal parasite screening in internationally adopted children: importance of multiple stool specimens. Pediatrics. 2011;128(3):e613–22.

Staat MA, Stadler LP, Donauer S, Trehan I, Rice M, Salisbury S. Serologic testing to verify the immune status of internationally adopted children against vaccine preventable diseases. Vaccine. 2010;28(50):7947–55.

Wodi AP, Ault K, Hunter P, McNally V, Szilagyi PG, Bernstein H. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger—United States, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(6):189–92.

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Moscow Travel Guide: Best Things to Do + More [2023]

· everything to know about visiting moscow, including the best things to do and how to get around. ·.

Moscow is Russia’s vibrant capital city, and it also happens to be the largest city in all of Europe. The city’s long and infamous history makes it one of the most unique places we have ever visited.

The architecture ranges from centuries-old palaces to uniform, gray concrete buildings. The people range from cold and private to warm and welcoming. Moscow is a city is strong juxtapositions, and we learned a lot during our time there.

This post will break down all you need to know about visiting Moscow, including the best things to do, how to get there, how to get around, and more.

The Best Things to Do in Moscow

1. explore the red square.

The Red Square is the heart of Moscow. Most of the city’s top attractions can be found here, including just about everything on this list. The Kremlin, St. Basil’s Cathedral, and Lenin’s Mausoleum are all located here, and the State Historical Museum and GUM are not far from here, either.

The Red Square is a common home for parades, protests, and seasonal celebrations. There are massive Christmas celebrations here, with food vendors and carnival rides set up in numbers.

2. Check Out the Ziferblat

The Ziferblat is a café in Moscow that is unlike any café we have ever been to. While most cafes charge you for your drinks and food, the Ziferblat charges you for your time.

Upon arrival, you are given a clock. When you leave, the barista calculates how much time you spent in the café and charges you accordingly. This concept was created to help visitors to be more intentional with their time, and the cafe itself is incredibly charming.

For a detailed look at everything you need to know before you visit, make sure you read my post about visiting the Ziferblat Cafe in Moscow .

3. Marvel at St. Basil’s Cathedral

St. Basil’s Cathedral is one of the most iconic churches in the world, and it was the single thing we were most excited to see while in Moscow. Built almost 500 years ago, St. Basil’s Cathedral is recognized by its colorful domes and whimsical style. The church is of the Russian Orthodox faith, and the inside is just as wondrous as the outside.

St. Basil’s Cathedral is located on the edge of the Red Square, making it incredibly convenient to visit. Entrance for non-worshippers costs 800 rubles, and tickets can be bought at the church

4. Explore the Kremlin

The Kremlin is the largest active fortress in Europe, and it is the site of most of Russia’s government affairs. In addition to government buildings, the Kremlin Complex is filled with courtyards, towers, and museums that are open to the public. If you have the time, you could spend a couple of days fully exploring all that there is to see in the Kremlin.

5. Walk Through Lenin’s Mausoleum

Vladimir Lenin is one of the most important figures in Russian history, and his body is located perfectly embalmed in a mausoleum in the Red Square. The Mausoleum is open to the public to visit, and as long as you are willing to go through a few security checks, it is easily one of the best things to do in Moscow. Its convenient location in the Red Square makes it a can’t miss attraction.

There is absolutely no photography allowed inside the Mausoleum. Do not test this rule.

6. Wander Along Arbat Street

The Arbat is a very popular street in Moscow that is lined with stores, cafes, and other touristy attractions. It is one of the oldest streets in the city, dating back to the 1400s. This street is both quaint and trendy, and there are many walking tours that introduce tourists to the neighborhood’s wonders and highlights.

7. Catch a Show at the Bolshoi Theatre

As a lover of the arts, it is hard to think of Moscow and not think of ballet. Russia has always been a top dog in the world of fine arts, and Bolshoi Theater is one of the best places to catch a performance. We were lucky enough to attend an Opera here, and it is a venue that you don’t want to miss out on if you enjoy opera, ballet, or orchestral performances.

8. Visit the State Historical Museum

The State Historical Museum is one of the most respected museums in Moscow. Despite its name, it is not really focused on the history of Russia as a nation. Rather, it contains a collection of artifacts from all throughout Russia’s history.

The museum’s collection is very broad in nature. It houses some items from indigenous tribes that used to occupy the region, pieces collected by the Romanov family, and more.

9. Wander Around GUM

GUM is an absolutely massive mall within walking distance of the Red Square. It isn’t just the size that draws visitors here; it’s the sense of luxury. The mall is so beautiful inside, much like the metro stations.

While visiting a mall might not sound like it belongs on a bucket list, this mall does. You will not want to miss out on visiting GUM while in Moscow.

10. Admire the Cathedral of Christ the Saviour

While St. Basil’s Cathedral is the most iconic church in Moscow, it isn’t the only one. The Cathedral of Christ the Saviour is absolutely stunning, with massive golden domes. It is the tallest Orthodox church in the world, and it is the seat of the Orthodox Patriarch of Moscow.

It is located just about a mile from the Red Square, just south of the Kremlin Complex. You can walk to it from the Red Square in about 20 minutes.

How to Get to Moscow

Flying to moscow.

Moscow has three major international airports: Sheremetyevo (SVO) , Domodedovo (DMO) , and Vnukovo (VKO) . All three of them are directly connected to downtown Moscow by the Aeroexpress trains, which leave every 30 minutes throughout the day. By Aeroexpress train, you can expect to get to the city center in 25-45 minutes depending on the airport that you fly into.

Sheremetyevo is the biggest and busiest of the three airports, and it is the one you are most likely to fly into – especially if you are coming from outside of Europe or the Caucus region. We flew into Sheremetyevo on a direct flight from New York City.

I usually provide backup airport options, because flying right into the city isn’t always the cheapest way to get where you’re going. Unfortunately, when it comes to Moscow, don’t really have a choice other than to fly right into Moscow. It is a very remote city, and it is usually the cheapest place to fly into in Russia as a whole.

Since Sheremetyevo is so busy, you will probably find a great flight option anyway. I wrote in  my post about finding cheap flights  that using hub airports will lead to more affordable airfare, and the same logic applies here. Even though Russia’s national airline, Aeroflot, is no longer a member of the SkyTeam Alliance, Moscow is still a major hub connecting passengers from all over the world.

READ OUR CHEAT SHEET

Train or Bus to Moscow

Trains and buses are one of the most popular ways to get around Europe. However, they’re of very little use when you’re trying to get to Moscow.

Moscow is hundreds of miles from the nearest major cities. The only major European city that can even be reached within 8 hours on the ground is St. Petersburg, and even the Baltic capitals of Riga, Vilnius, and Tallinn are over 12 hours away.

If you want to get to Moscow, the best option is almost always to fly. While the train routes to Moscow are scenic, they simply take forever.

How to Get Around Moscow

METRO | TROLLEYS | TRAMS | BUSES

Moscow has one of the most memorable metro systems in the world. Its metro lines are very deep underground, and the stations are absolutely stunning. Each station has its own unique style, but all of them contain escalators that seem to go on forever.

The system was built in an effort to showcase the power of the Soviet Union and its bright future. The plans were a form of propaganda, but they resulted in what is still one of the most visually appealing subway systems on earth.

Moscow’s metro system isn’t just pretty. It is also very useful and accessible. The system has 17 lines that connect the city and its surrounding area.

But wait; there’s more!

The Moscow metro system is also incredibly affordable, with each ride costing less than a dollar. The metro is by far the best way to get around Moscow, as it is almost impossible to beat the connection times and the low cost to ride.

Tickets can be bought at electronic, English-speaking kiosks in stations, or directly from ticket counters at certain larger stations. There are also day passes available, which are a very solid option if you plan on riding the metro several times per day.

The metro is by far the best way to get around Moscow.

In addition to the metro system, Moscow also has a network of buses, trams, and trolleys. This system is nowhere near as convenient or well-connected as the metro, though, and is likely of little use to you during your trip. There is no Uber in Moscow, but a similar app named Yandex is available if you need a ride in a pinch.

How Many Days Do You Need in Moscow?

Moscow is the biggest city in all of Europe, and it is absolutely loaded with things to do. You could spend weeks in Moscow and still find new things to do. Of course, most travelers don’t have that kind of time to spend in one place!

I recommend spending no less than three full days in Moscow, and ideally closer to five or seven.

Moscow is very spread out, and it can take some time to get from one major point to another. There are also so many places that are nice to just sit back and relax, which is hard to do when you’re in a hurry trying to cram activities into just a few days.

If you only have a week to visit Russia, I’d advise spending all of the time in one city. If you decide to split your time between Moscow and St. Petersburg, I recommend not trying to squeeze in any day trips beyond those two cities.

When Is the Best Time of the Year to Visit Moscow?

There are two different ways to approach this question. Personally, I think the best time to visit Moscow is around Christmas and New Year’s Day. While the weather will be absolutely freezing, Moscow is a surreal winter wonderland in December and January.

We were in Moscow right before Christmas. While it was very cold, you can always bundle up. Exploring the Christmas markets and pop-up ice skating rinks throughout Moscow is one of my favorite memories from anywhere I’ve traveled, and I dream of going back to do it again.

If you aren’t fond of the cold, Moscow is beautiful in the summer. It tends to get pretty cold in the shoulder seasons, so if you want warm weather, you should plan to visit in the summer. Moscow actually gets pretty warm in July and August, and there are a bunch of fantastic places to soak up the sun within the city.

The best time to visit Moscow is either around Christmas or from late May to August.

Is Moscow Safe to Visit?

While Moscow is a truly wonderful city, there’s no denying that visiting Russia comes with risks. As the country is run by an infamous communist dictator, concerns about visiting are valid. While we didn’t experience any sort of threat or negative treatment during our time in Moscow, we visited in a peaceful time.

In our experience, Russia doesn’t seem to detain normal Americans or Westerners to use as pawns. As a regular person, as long as you don’t commit any crimes, there is a slim chance you will run into any issues. However, Russia will not hesitate to enforce its laws against foreigners, and illegal behaviors will likely land you in a very compromising position.

Russia will not hesitate to enforce its laws against foreigners, and illegal behaviors will likely land you in a very compromising position.

To make matters worse, Russia has a bad reputation for gang violence. While the Russian mafia has very little interest in normal Western tourists, they won’t hesitate to pick a fight with anyone who ventures into their sphere of influence. If you seek out illegal substances or activities, you could be a target of the mafia.

If you seek out illegal substances or activities, you could be a target of the mafia.

Finally, since Russia’s invasion of Ukraine, things are all very different. Russia is currently at war, and there are battles raging within 8 hours of Moscow. While it is still relatively safe to visit, that could change at any time as the war with Ukraine continues.

Is Moscow Worth Visiting?

Without a doubt, Moscow is worth visiting. It is one of the most unique major cities we have ever visited, and we hope to make it back one day. The Russian Orthodox churches are stunning, the city’s history is unlike any other, and the food is to die for.

While many visitors prefer St. Petersburg to Moscow, I think Moscow deserves a lot of hype of its own. Moscow is the beating heart of Russian culture and history, and it’s a place I highly recommend checking out if you have the chance.

That’s all we have for you about Moscow! I hope this post was helpful as you plan your trip to Russia’s capital.

Have you been to Moscow? Or is this your first time visiting? Comment below if you have anything to add to our travel guide!

Hi, I'm Greg. I'm an avid traveler who has traveled to over 50 countries all around the world with my wife and kids. I've lived in Italy, Mexico, China, and the United States, and I dream of moving abroad again in the future. With this blog, I provide my audience with detailed destination guides to my favorite places and pro-tips to make travel as stress-free as possible.

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Adoptive Families

Join archives adoption guide state laws directory april 23, 2024, domestic adoption travel 101, if you're adopting domestically, the call that says your baby is on the way often comes on a moment's notice. will you be ready.

• Preparing for Parenthood
• The Process

Your bags are packed and you’re ready to go, right? More likely, you just got the call that your child is being born on the other side of the country, so you’re frantically tossing clothes in a suitcase while you book your flights and try not to burst with excitement and nervousness.

For domestic adoptive parents, the call to travel to meet their child doesn’t often come with much warning. In a recent AF poll of domestic adoptive families, 18 percent of you said you had less than one week to prepare, and 28 percent had to travel at a moment’s notice , because the call came after your child was born. But last-minute travel logistics aside, it is an overwhelmingly emotional time. Will this match work out? Will we really be parents in a few days? How do we care for a newborn? Prospective parents often admit to being reluctant to prepare for the trip, for fear of jinxing the situation or getting their hopes too high.

“We were very nervous when we got the call, because we had made previous attempts for a newborn,” says an AF reader. “In fact, we were ready to give up when we got the call that a boy had been born that day and the birth mother had chosen us. So we drove as fast as we could to the hospital to meet her and our new son.”

When you do get that call, you’ll be in emotional overdrive. As Julie, of Littleton, Colorado, recalls, “It was frightening, exhausting, and magical.” We asked parents who have been through the process to share their best tips for traveling and caring for a new baby during that exciting, nerve-wracking time.

Packing List

You’ll probably have at least a few days before the birth to buy the essentials — more than half of AF survey respondents said they were matched before the baby’s birth. Parents say it’s easier to have basic baby gear on hand than to shop while you travel. But if you’re traveling on the spur of the moment, or don’t want to buy in advance, they share their back-up plans, too.

• Car Seat Most hospitals won’t release a newborn to you if you don’t have a car seat, so you’ll have to bring one with you.

Infant car seats can be tricky to install, so, if you’re driving, it’s a good idea to have the seat installed before you leave home, suggests Jamie Hibbs, of Winfield, Kansas. “There’s nothing worse than trying to figure out how to put it in the car right before you leave the hospital . My husband had to go to a nearby fire station for help,” she says. If you’re flying, most airlines will let you gate-check the car seat on the way out. It’s also the safest way to transport the baby on the flight home.

No Time? If you’re renting a car, you can rent a car seat, too. But rental companies don’t always guarantee car seats, so be prepared for the chance that they’ll run out and you’ll need to buy one at your destination. Sally Claffey, of Glenview, Illinois, didn’t want to tote a car seat on the plane to California, so she researched her options in advance and bought a car seat/stroller combo when she arrived.

• Portable Crib or Pack and Play Annie Simpson, of Tulsa, Oklahoma, is glad she bought a portable crib before she and her husband adopted daughter Eden. They tossed it in the car, and “didn’t have to worry about getting one at the hotel,” she says.

No Time? Many hotels have cribs available to rent. Call the one you book to ask.

• Outfits, Burp Cloths, and Bottles Most domestic adopters recommend booking a hotel with on-site laundry facilities, but they agree it’s better to pack extras than to spend time away from the baby doing laundry. Elizabeth Swire Falker, domestic adoptive mom, adoption attorney, and author of The Ultimate Insider’s Guide to Adoption , recommends bringing at least two outfits for each day you expect to be away, in a variety of sizes. “You may have a teeny baby, so make sure you’ve got at least one preemie outfit, just in case,” she says. Bring extra bottles, as well, so you don’t find yourself constantly washing bottles in the hotel sink (not an easy feat).

No Time? Parents relied on Target, Walmart, and similar stores to stock up on basics, like dishwashing soap and mild laundry detergent. One reader found a way to simplify hotel bottle-prep: “I bought microwavable sterilizer bags from Target — they cost about $5 for a pack of 10, so you can throw them away when you’re ready to head back home.”

• Camera and Laptop Computer “I took pictures of everything — the hotel that we stayed at, the room we were in, the places where we ate or visited,” says Lisa Smith, of Belmont, North Carolina. “They help me remember what the baby did in those first few days.” If you can, book a hotel room with free Internet access, and bring a laptop to send pictures and keep in touch with family.

No Time? While it’s worth dusting off the “real” camera to take quality shots during your first days with a new little one, most cell phones’ cameras these days take perfectly respectable photos. Be sure to set it to the highest size/quality setting or turn on the HDR (high dynamic range) option.

Before You Bring Your Baby Home

As much as we’d like to head home with our baby immediately, parents adopting across state lines must wait until Interstate Compact on the Placement of Children (ICPC) clears. “The ICPC is a law that is invoked whenever a baby or child is adopted between two different states, and it ensures that the adoption is legal in each of the states involved,” says Swire Falker. It can take a few days to a few weeks for both states to “sign off” on the adoption. “Some states have slow ICPC offices, so check with your adoption professional as to how long you will need to reside out of state,” adds Swire Falker.

In addition to waiting for ICPC clearance, “Each state has its policy on what is an appropriate period of time to give a birth parent to consider or reconsider their decision to make an adoption plan,” says Swire Falker. “Some states provide a very short window of time for a birth parent to both consent to the adoption and to revoke that consent. Others feel that birth parents should be given a longer time, to ensure that they have made the right decision.”

You may be permitted to travel home during the relinquishment waiting period. In that situation, your adoption professional will file a document stating that you are accepting a “legal risk” placement, meaning that you understand that the birth parent could still choose to parent.

The Sibling Situation

Parents often wonder whether to bring older children on an adoption trip. Common concerns include the extra expense, the feeling that they’ll do better at home than in an unfamiliar place, and wanting to focus on the newest member of the family. But it’s hard to disagree with the AF reader who said, “It’s not just my husband and I who are bringing a baby into the family.”

Ginger, of Austin, Texas, brought along her three-year-old when she and her husband traveled to adopt their newborn. She says their preparation made all the difference. “Make sure that the child is comfortable meeting new people, and has fun things to do during the long hours at the hospital and hotel.” Parents suggest looking for a hotel with on-site entertainment, like a pool, and staying in a suite with a room where the older child can play or watch movies while the baby is sleeping.

Home Away from Home

You’ll be living in a hotel for a while — most domestic adopters who took our survey said they had to stay in their child’s birthplace for one to two weeks — so you might as well get comfy. Parents recommend booking an extended-stay, suite-style room, with a kitchenette. Hotels designed for business travelers often have free Internet access, on-site laundry facilities, and free coffee (critical for sleep-deprived parents!). If you know you’ll be staying for several days, consider booking a larger suite, with a separate bedroom and living area, suggests Michelle Ostler, of Yakima, Washington. “We should have booked a bigger room. The room feels smaller each day you wait for the interstate travel clearance,” she says.

While it’s not easy to live in a hotel for weeks, new parents say the stay has an unexpected bonus: a honeymoon with your new baby. “Since we couldn’t go anywhere with a newborn, we bonded with our daughter by spending 24/7 with her in the hotel room,” says Ann Hannah, of Morganville, New Jersey. “My husband and I took turns holding and feeding her, and we let her sleep next to us on the bed, swaddled up.” Domestic adoptive parents enjoy the laid-back time, relaxing in the hotel room together. “Plan on hanging out and cuddling,” says Michelle Oxman, of Evanston, Illinois. “We spent a lot of time on the couch, reading while the baby slept on my chest. It’s a sweet memory.”

Some parents will have family or friends in the area to stay with, which can cut costs significantly. Liz Como, of Lovell, Maine, found friends of friends, who were happy to share their guest house. “They were excited to welcome us into their home. It was Thanksgiving and we had dinner with the family — a fantastic celebration!”

Adoption Agencies with U.S. Newborn Adoption Programs

See all adoption agencies with U.S. newborn adoption programs >

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