“It’s all right our doctor has done a medical”
Post Adoption Support by Health
Dr Mary Mather
Consultant Paediatrician
Adoption 1300 BC
On opening it, she looked, and lo, there was a baby boy, crying! She was moved with pity for him and said, "It is one of the Hebrew's children."
(Ex Exodus odus 2:5 5-6)
Moses saved from the water Palazzi Pontifici Pontifici, Vatican, Raphael 1517
Medical History of Adoption
- From Egyptian papyrus to …
attachment theory.
- From basic physical examination to …
comprehensive holistic assessment of …
health but also …
developmental education, social and …
emotional needs.
British Adoption History
1926 First British Adoption Law
- to provide legal recognition and security for the adoptive families of babies born out of wedlock and orphans of the First World War
1930
- 4,000 recorded adoptions
1950
- 14,500 recorded adoptions
1968
- 27,000 the highest number of adoptions on record
1926 -1990
- 876,601 recorded adoptions in England & Wales
-all these adults in response to a standard medical history can only say:
“I’m sorry I don’t know I’m adopted”
- adoption was largely confined to baby adoption by infertile couples
- ‘perfect’ baby -white, healthy, normal
- ‘perfect’ couple -white, healthy, affluent, married
- older children and children with disabilities were considered ‘unfit’ to adopt
- confidentiality and secrecy were essential for both adopters and children
- the past, including medical history, was deleted
- many children were simply never told
- new birth certificate
- new medical records were started
- new NHS number (still applies)
The Role of the Doctor
- brief physical examination of the newborn
- often done after placement
- any child found to have problems
- labelled “unadoptable”
- adopters given little health information
- it was assumed that all would be well
- parallels with intercountry adoption
Adoption Present
1980 -2001
- very changed population
- older children
- rejected or abused by parents
- parents affected by mental illness / drugs
- physical or learning disability
- sibling groups
- minority ethnic backgrounds
Why Adoption Fails
Information not clear or realistic
- 36% positive
- 33% negative
- 13% mixed (Murch& Lowe 1999)
- expectations compared to reality
- anticipating the wrong problems
- being deliberately misled
- problems not recognised by agencies
The Future of Adoption Work in Health
- a different type of work
Adoption Greenwich 1999
100 consecutive children presented to adoption panel
- 31 normal
- 44 significant problems
- 25 multiple problems
- 57 abuse and neglect
- 15 ‘voluntarily relinquished’
- 13 mental health problems in parents
- 9 drug abuse in parents
- 2 abandoned babies
- 60 behaviour problems
- 10 / 38 school children achieving normally at school
- 22 / 62 pre-school had developmental delay
- 36 physical problems
* 9 asthma / eczema
* 6 failure to thrive
* 5 squints
* 4 hearing loss
* 4 microcephaly
* 3 motor co-ordination difficulties
* 2 foetal alcohol syndrome
A Neglected Paediatric Specialty?
New conditions found in 5 children
- 1 spastic quadriplegic CP
- 1 pulmonary stenosis
- 1 undescended testis
- 2 HIV / Hep B tests
The Future of Adoption Work in Health
- a different type of work
- a different type of doctor
Child Protection & Adoption
- get artificially separated but in practice interlinked
- abuse and neglect followed by a lifelong series of health and management issues
- information about the past is essential
- for the sake of the child professional partnership with adopters and birth parents is essential
Skills and Competencies
In-depth knowledge of
- child health & development
- consequences of child abuse & neglect
- consequences of poor attachment
- consequences of genetically inherited illness in birth parents
- implications of parental lifestyles involving drugs and alcohol
An ability to work as part of a team with good links with
- genetic services
- communicable disease services HIV, Hep B & C
- infertility services
- child psychiatrists
- child protection services
- developmental assessment centres
- education special needs services
- ability to give social workers and adopters clear advice
- post adoption support begins with a comprehensive adoption medical
- to know is to understand
Post Adoption Support begins with the Adoption Medical
- a very comprehensive medical
- assessment of physical, emotional and educational needs
- collation of medical records is time consuming
- liaison with other health professionals essential
- there are many sources of information in health!
A 5 year old can have
- a personal CHR
- immunisations on community database
- a school health record
- community vision, hearing checks
- child mental health record
- physiotherapy, SALT, portage records
- hospital record
- GP record
To Know is to Understand
- there is still no nationally agreed policy on how these multiple records should be handled
- most contain information about birth family
- most have previous names and addresses
- legal advice is conflicting
- new NHS number adds to the confusion
Post Adoption Support begins with the Adoption Medical
- all prospective adopters should be offered an opportunity to meet the medical advisor
- all adopters helped to meet health needs in new district
- liaison after placement with new health professionals is essential
Working with the Birth Family
- medical information is collected by social workers
- birth parents are often alienated
- concerns about confidentiality
- good practice to invite to adoption medical
- most are happy to attend
- all are willing to give health details
The Genetic Revolution
- excluding major genetic malformations …
* 5% population will have a genetically inherited medical condition by the age of 25
* this rises to 60% by the age of 60
- who owns genetic information in adopted children
- screening for genetic disease
- genes for criminality, addiction or mental health?
- tracing individuals and records
- storage of DNA
Life Saving Questions to ask your Parents
- alcoholism increases risk 300%
- asthma increases risk 30-50%
- anorexia and bulimia increases risk x11
- schizophrenia & manic depression x10
- genes identified for increased risk of:
Breast cancer
Ovarian cancer
Colon cancer
Hypercholesterolaemia
Kidney disease
Diabetes
Obesity
Longevity
To Know is to Understand
“ The background information we received was excellent and accurate. It helped up make an informed decision at the time of matching.
It influenced the way we dealt with the child after placement. We felt that we understood her better.”
“ The social worker did not have time to collect a medical history, then the mother disappeared. We found out after his first fit there was a family history of epilepsy. They apparently had no time to tell us he was dyslexic.
We feel so guilty, we wasted all those years of school.”
The Future of Adoption Work in Health
- a different type of doctor
- a different type of work
- needs time
- needs training
Health Support for Life
All adopted children
- will normally regain good physical health
- will show improved pattern of health
- will show improved school progress
All children adopted after infancy
- will have been damaged to some degree in the past
- will have a blue print for survival which becomes more entrenched with age
- will test adopters to the limit and beyond
- will have some degree of resilience
- can be successfully adopted
Health (and Education) Support for Life
- in supporting parents of traumatised children
- little research on what works
(apart from parental commitment)
- therapeutic work is generally unregulated
- a plethora of different therapists, therapies
- very few outcome studies
The Mental Health Maze
- trauma affects attachment and development
- parents become lost in a diagnostic maze
- passed from pillar to post
- often given several diagnoses
- often given conflicting explanations and advice
The Future of Adoption Work in Health
- a different type of doctor
- a different type of work
- needs time
- needs training
- primary or secondary care?
- will it be resourced?
- will there be a new specialty?
And Finally
Second chances are rare both in life and in medicine.
Adoption is a provenmeans of doing this for children.
There were fewer adoptions in England in 1996 than in 1926.
What will be the number in 2026?