Since 1996 there have been 18 fatalities of internationally adopted children (17 families) in which abuse and/or neglect by their adoptive parents was suspected or proven. Seven girls and 11 boys (14 adopted from Russia, 2 from China, and 2 from Guatemala) have died from causes related to head trauma, suffocation, or neglect. In 12 of these cases, the mothers were directly accused in the deaths of their children; and in 4 cases, fathers were directly accused (1 of the fathers committed suicide after killing his wife and 2 children). In the remaining two cases, both parents were accused. The victims were 3 years old or younger in 12 of the 18 cases; the other victims were between the ages of 5 and 11 years. Nearly one-third of these children died within 6 months of their adoptive placements, and more than one-half of the deaths occurred within the first year after adoption. These 18 cases of abuse and neglect resulted from extreme circumstances and do not reflect the norm among families of internationally adopted children; however, pediatricians and other professionals who care for internationally adopted children must be especially vigilant in identifying parents who may show signs of depression, stress, or extreme disappointment. "Postadoption depression" is becoming more widely recognized and may be more common than postpartum depression. 39 references