Adoption is defined as a creation of a parent-child relationship by judicial order between two parties who usually are unrelated. This relationship is brought about only after a determination that the child is an orphan or has been abandoned, or that the parents’ parental rights have been terminated by court order. Adoption can be local or international, adopting as a same sex couple, adoption of a relative, or of a step-child. In India only agencies recognized by the government can deal with adoption placement. Direct placement by hospitals or maternity homes is not permitted. After adoption pediatrician helps parents deal with challenges in rearing adopted child and helps child dealing with differences and losses associated with adoption process. Postadoption family concerns are also discussed briefly in this chapter.