Your adopted child's health needs

Children adopted from care will have experienced trauma and loss, even if they were adopted shortly after birth. Some may have additional needs resulting from physical, mental or emotional problems or disabilities. When a possible match is suggested with you and a child, this is often an exciting time. It is important that you find out as much as possible about the child's health history and needs, so that if you decide to go ahead with the match, you will be as well informed as possible. Having realistic expectations will increase the chances of a successful adoption.

Your adopted child's health history

When children become looked after or have a plan for adoption, they are required by law to have a thorough health assessment, which ideally should include the following antenatal and birth history and early developmental history family medical history past medical history including any experiences of abuse and neglect, and a chronological list of health events, including immunisations, in!uries and common illnesses current physical health, including vision, hearing and dental care mental health and behaviour, including experiences of trauma and loss physical examination

It can sometimes be difficult to get all this information. "or example, birth parents may not want to share information about their child if they are unhappy with the plans being made. #ometimes they may be absent or the father may be unknown. $ot having full health information can make it harder to understand a child's difficulties and to predict what will happen in the future. However, the medical assessments that a child will have had throughout their time in care means that there should be existing information on their health by the time they are adopted. %nder care planning requirements for looked&after children Health assessments should take place at least every six months for children aged four and under, and at least every '( months for children aged five and over. Where possible, birth parents should be involved as they can help to provide more detail about the child's medical and birth family medical history.

)ased on the report of the child's health needs assessment, a health plan is developed, including any current arrangements for their healthcare and details of further healthcare that may be required.

*doption %+ has a useful visual tool, ,he Wall, that helps to show why adopted children need a different kind of parenting.

Increasingly, it is accepted as good practice for the adoption agency's medical adviser to meet with the prospective adopters to discuss the child's health. ,his provides them with a better understanding of the child's needs, any gaps in their health information, and an opportunity to ask questions. ,he medical adviser should then provide them with a written report, which documents what they have been told. If the adoption goes ahead, a copy of the health assessment report will be sent to your child-s ./ as well as to you. 0ou may want to discuss this with your ./, or ask your ./ to talk to the medical adviser on your behalf. ,his can happen even after an adoption order has been made. /arents of older adopted children often find post&adoption that medical appointments can be particularly difficult for the child as the sub!ect of their adoption often arises, for example, if the doctor asks about family medical history. *nything you can do to help the appointment go smoothly, such as making sure the ./ is aware of the situation in advance, will help your child feel more comfortable.

Developmental delays in adopted children

"or a child who has been taken into care, the extent to which their development may be delayed can vary greatly. ,he delay can be physical or emotional, or both 1 the child may act younger than their age, or be unable to do things most children their age can do. 2r the delay can relate to a specific area, such as their speech. 3evelopmental delays in looked&after and adopted children can be caused by the following factors ,he delays have been caused by something that happened during the mother-s pregnancy, such as heralcohol or drug use. ,his can lead to the child being diagnosed with foetal alcohol syndrome 4"*#5 or a foetal alcohol spectrum disorder 4"*#35. 6xtreme and prolonged levels of stress or anxiety during pregnancy have also been shown to be damaging to the unborn child, affecting their brain development. ,he child-s environment after they are born may affect their development, such as developmental trauma caused by abuse or neglect, or both. If they are not properly cared for and stimulated, this affects the growth and development of certain areas of their brain leading to a lack of emotional development. ,his is often referred to as 7attachment difficulties8 or 7attachment disorder8. #ome delays may be characteristic of genetic conditions, such as 3own's syndrome. 3ifferent children have different levels of resilience to delays caused by trauma in the womb or abuse and neglect after birth. ,hey also have different capabilities to overcome this trauma and 9catch&up9 developmentally. It can be difficult to predict the long&term impact of these delays. ,his means that potential adopters need to accept there may be uncertainty around whether their adopted child will need specialist support services in the future. It takes a lot of perseverance, patience and determination from parents to help children overcome their difficulties, but post&adoption support is available.

Parenting neglected children

While some children in the care system may have been physically or sexually abused at some point in their lives, many of them are being looked after because their basic needs have been neglected. #tudies show that neglect, such as being deprived of food or care, is often more damaging to the child than individual episodes of abuse. /rofessor /eter "onagy is chief executive of the *nna "reud :entre in ;ondon, which conducts research into attachment disorders and child mental health. He says 7,he more dramatic reasons for children being taken into care, such as sexual or physical abuse, have in fact been shown to be less toxic experiences than long&term neglect. 0et neglect is more subtle and more likely to be overlooked by other adults in the child-s life.8 )oth abuse and neglect can lead to psychological problems in children, including issues around trusting adults, which can take many years to overcome. /rofessor "onagy explains that this is because they are in a state of 7hyper vigilance8. He says 7:hildren who have had bad experiences, particularly in care, are on high alert and don-t believe anything anyone tells them because they don-t trust them. ,hey-re shut off. ,hey understand what they-re being told but won-t bring it into their own world as a truth, and they can-t modify their own belief that they are not loved or that they are <bad-.8 "or this reason, adopted children will need more than love and care from their adoptive parents. /rofessor "onagy, who is closely involved in a new programme to improve children and young people-s access to psychological therapies, says 7I am determined that the under&recognition of psychological problems in children who have been adopted should end, and there are good treatments available for a lot of childhood mental disorders.8 *sk your local authority or social worker about therapeutic parenting courses available to you, such as ,heraplay, life story work and ,*//s courses 4,rauma *ttachment and /reparation for placement5. "ind out more about post&adoption support.

ating anxieties in children who have been adopted

;ooked&after and adopted children often have food anxieties linked to their early experiences. ,hese include overeating hoarding food stealing food problems eating certain foods, such as solids and specific textures due to not being weaned properly or not given certain foods early enough "or example, if a child has experienced not being fed enough or regularly, this could lead to them overeating or hoarding food even after they have been placed with their adoptive family. ,his is because they may not fully trust that another meal will come. :aroline *rcher, author and adoptive parent of four children, has the following advice +eep mealtimes as low&key as possible and set regular meal routines. /rovide small amounts of the things your child en!oys and slowly introduce new tastes and textures. $ever demand they eat up or finish anything 1 but let them know you expect them to try.

Watch out for foods that seem to be a trigger for memories of early traumas. ,alk to your child about how it feels to be full up. *nd that feeling 9full up9 doesn-t !ust mean food, but love, caring and feeling good about themselves.

"ind out more about eating disorders.

!dopting a child with a medical condition, disability or special or additional needs

,here are lots of children with complex medical conditions needing adoptive families. ,hose with conditions such ascerebral palsy, cystic fibrosis or 3own-s syndrome need parents who can meet their needs and act as effective 9advocates9 to make sure their children get the services they need. #ome children have conditions that are related to their having been taken into care in the first place, such as foetal alcohol spectrum disorder 4"*#35, or symptoms of *ttention 3eficit Hyperactivity 3isorder 4*3H35. =any of these children will also have needs relating to trauma due to neglect or abuse, in addition to their physical or medical difficulties. *dditionally, some children may have a vulnerability to some psychological conditions, such as depression or anxiety, which can be inherited. >arer conditions that may emerge in adolescence or later, such as psychotic illnesses, may also have a genetic risk factor. "uestions to as# your child$s adoption agency medical adviser and social wor#er What is the extent of my child-s medical or physical disability 4if they have one5, and should we discuss this with a medical specialist? What services does my child use at the moment 4such asphysiotherapy or speech therapy5 and how frequent are the appointments, where are they held and who co&ordinates the medical services? How can I care for my child-s additional needs at home, as part of a daily routine? What changes will I need to make to my home and car in order to support my child-s condition? Is there funding available to make this possible? What plans have been put in place to ensure continuity of care and ensure that all their medical records are transferred to their new ./? What benefits are my child and I entitled to after placement, such as a 3isability ;iving *llowance or a carer-s allowance? 3oes my child have a statement of special educational needs 4#6$5, and if so, what provisions does the statement include? Would my child benefit from remaining in a class with younger children for a while, or even staying at home? What changes or adaptations should the school make? If my child doesn't have a statement of #6$, is that because they don't have any special educational needs or because they don't have needs that require a statement? If I think my child might have special educational needs that have not yet been identified, how should I go about getting an assessment? *re there any hereditary health conditions in the child-s birth and extended family that may appear later in their life?

How can we get further information about the child-s family and medical history in the future?

%ore information on adoption health needs

0ou may find the following resources helpful ,he "*#3 ,rust raises awareness of foetal alcohol spectrum disorders and has a helpline, while $2"*#supports people affected by foetal alcohol spectrum disorders 4"*#35, and their families and communities. "amily "utures is an adoption and therapy agency offering therapeutic help to children who have experienced trauma and are living in birth families, foster homes or adoptive families. /ost *doption :entre 4/*:5 also supports birth families and relatives as well as adopted children and their adoptive families. *doption /lus offers an adoption placement service, specialist therapy services and training and conferences. /arenting *dvice for "oster :arers and *dopters 4/*":*5 is run by clinical child psychologist 3r *mber 6lliot who specialises in early trauma, adoption and fostering. *doption %+-s .uiding you through the adoption processincludes information on adopting a child with a medical condition. ,he *dopter-s Handbook, published by )**", has information on every aspect of adoption including legal and financial matters and schooling and education. )**" also publishes a series of parenting handbooks,/arenting =atters, covering issues including developmental delay and parenting children affected by their birth parents' substance abuse. :ontact a "amily is a national charity that supports the families of disabled children whatever their condition or disability. 0oung =inds is a charity committed to improving the emotional wellbeing and mental health of children and young people. @isit the $H# :hoices sections for learning disabilities,physical disabilities and carers.
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