Foster care is a service for children who cannot live with their families. There are many reasons for foster care, the most common of which is parental neglect and/or substance abuse. At any one time, more than 400,000 US children are in foster care. Although 59% are eventually reunited with their parents, some end up in other situations, including adoption. Children should undergo a physician evaluation within 72 hours of entering foster care, a comprehensive evaluation within 30 days, and a follow-up visit within 60 to 90 days, followed by routine care. Adoption occurs for 1 of every 50 children; approximately 1% of adoptees are from other countries. There are many forms of adoption, including open (birth parents have contact with the adopted child), closed (contact is not permitted), and kinship (adopting parents are relatives of the child). Approximately one-quarter of adoptions are transracial/transethnic. Adoptions by LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender, and other identities) people also are common. Parents planning adoption should talk to the physician who will care for the child to review the child’s health records, and continue with routine care after adoption. For international adoptions, numerous infectious disease tests are required before and after the child’s arrival in the United States. Adoptees also should undergo developmental evaluation and screening for adverse childhood experiences and mental health issues.