The orphanages of EE recently surpassed Korea (FY94 n=2,196 v 1,757) as the principal international source of children adopted in the US. Counseling prospective adoptive parents about medical needs of these children is challenging since little is known about their health status. Over a 24-month period, referral documents were evaluated for 252 orphans from EE(f/m-60/40-76%-Russia, 17%-other former USSR, 4%-Romania, 2%-Bulgaria, 1%-Poland. Low birth weight <2500g was common (48%) and could be accounted for by prematurity (27%) and nutritional insufficiency (mean birth weight-by-length z-score = -1.04±1.0, n=68). The child represented the fourth pregnancy or greater in 46% of cases (range 1-14). There was a significant relationship between increasing maternal parity and lower birth weight-by-length z-scores (p<0.01 by ANOVA). Reasons for children being available for adoption included death of both parents (4%), termination of parental rights (16%), foundling (5%) and voluntary relinquishment of parental rights (75%). Maternal alcoholism was noted in 17% and fetal alcohol syndrome in 2.4% of referrals. Children were referred at a mean age of 28.9±25.7m (range=0.75-125m) and had been living in orphanages for an average of 21.9±20.6m (range=0.75-100m). Stature was profoundly affected, with children falling behind one month of linear growth for each 3.4 months in the orphanage (r=0.68, p <.001). Head growth was also impaired in this population (mean OFC z-score = -1.1±1.9; 20% ≤-2.5). Because of the prevalence of low birth weight, alcohol exposure, high-risk social circumstances, long-term institutionalization, and linear and head growth failure, classifying children from EE orphanages as an “at-risk” group, with possible special needs (e.g., delays in motor, speech and social skills, behavioral and attachment issues) may assist prospective adoptive parents in their decision-making process.