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Adoption for Clinicians

Learn more:

Thank you for showing up for your patients. This page discusses considerations for clinicians around caring for adopted patients. We'll discuss overall principles as well as specific, actionable examples of language to use in the clinic.

 

Here's a page overview:​
  1. Adoption Takeaways
  2. Adoption Principles
  3. Adoption Stereotypes
  4. Using Adoption Language
  5. Best Practices for Documentation
  6. Inclusive Medical Interviewing around Adoption
  7. Listen to Adopted Patients' Stories
  8. More Resources on Adoptee Health

Adoption Takeaways

1. No adoption or adoptee is the same.

2. Adoption is a life-long experience with healthcare implications.

3. Although rarely acknowledged, adoption involves multiple losses as well as gains.

Adoption experiences may affect relationships, identity, mental health including substance use disorders, depression and attempted suicide.

 

Explore Key Adoptee Health Issues.

Adoption Principles

So what can we do? As a clinician, you have enormous power as a respected professional to validate or amplify marginalization of your patients. Take the opportunity to recognize and normalize that families are incredibly diverse. While there have always been diverse families, there’s been increased recognition and representation of more types of families than the nuclear family with a heterosexual couple with biological children.

 

While each adoption, adoptee, and how they think about their adoption may be different, here are some general principles around adoption to stick to.

  1. Recognize the enormous diversity of adoptees

  2. ​Normalize adoption & diverse families

  3. ​Listen to your patients and from other adoptees.​

  4. Consider any self-disclosure carefully​

Adoption Language & Terminology

Language in adoption can be very clunky and difficult to find consensus. While preferred terminology varies enormously among all the people involved in adoption, here are a few terms that many would find offensive:

Avoid Using
Use Instead
Reasoning

Put up/gave away for adoption

Made an adoption plan; relinquished
• Ignores agency of biological parent(s) • Implies adopted children are inferior and commodities • Replicates specific history of auctioning children

Children of your own

Biological children
• Implies adopted children are not really their child and inferior

Adoptive Parent/Mother/Family/Family

Parent/Mother/Family *unless discussing both adoptive and biological families and clarification is necessary
• Presumes adoptive families are unnatural • Negates parenting and connection between parent and child via adoption

Real/Natural Parent

Biological/Birth/First Parent
• Presumes adoptive families are unnatural • Negates parenting and connection between parent and child via adoption
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Adoption Stereotypes

Adoption Stereotypes

Although adoption is not uncommon, adoption stigma—bias and prejudice against adoption and the people most affected by adoption—is unfortunately pervasive in the United States.


Adoption stigma refers to the way society communicates that adopted people, families formed through adoption, or biological parents who made an adoption plan, are less worthy, inferior, or damaged. These include adoption stereotypes—untrue or grossly oversimplified beliefs about categories of people—and microaggressions—subtle, often unintentional manifestations of these discriminatory beliefs. 

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Remember that for many adopted people, adoption is an important experience that is important to their intersectional identity alongside other things like race, gender, sexuality, and ability that affect how they are perceived and move through the world. Thus, microaggressions around adoption often go hand-in-hand with other issues of structural discrimination like racism, xenophobia, sexism, classism, and infertility stigmatization. Additionally, people adopted from foster care or through international adoption are also more likely to be people of color adopted by white parents, which adds more layers of complexity.​

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Encountering these stereotypes and microaggressions, though seemingly minor, can cumulatively wear on people, impacting their self-esteem, sense of belonging and safety, and reinforcing feelings of marginalization.

 

Recognizing and addressing the harm perpetuated by these beliefs is an important part of showing up for ourselves as well as for the adoptees, adoptive parents and biological parents in our life and in the clinic.

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Below, we'll address some often encountered but harmful adoption stereotypes:

"real" child/parents or a "child of your own"

What it is:

Referring to biologically related parents or children as "real", "your own", or specifying "adopted" unnecessarily.

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Examples:

  • “Do you have any real children?"

  • “What about your real parents?"

  • “Don't you want a child of your own?"

  • “Where do you really come from?"


Why is this harmful?

  • Invalidates the validity of the parent-child relationship formed through adoption in favor of purely genetic ties.

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There is also an inversion of this that asserts adoptive parents as "real parents" in an effort to dismiss biological parents as inconsequential because they were not able or didn't chose to parent.

ASrealchild

associating adoption as bad or lesser than / "are you sure you're not adopted?"

ASadoptioninferior

What it is:

Referring to adopted people as inferior, traumatized, unstable, or pathological. There's too many examples to count that use adoption as a source of plot twists. Once you start noticing this in TV and film, you won't be able to stop.

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Examples:

  • The Avengers (2012):
    Thor: He is of Asgard and he is my brother!
    Black Widow: He killed 80 people in 2 days.
    Thor [deadpan]: He's adopted.

  • The Bad Seed (1956): - adopted child gleefully murders other children.

  • Dune: Prophecy (2024) - adoptee gleefully and brutally murders several including a child, ascribes his adoption as motivation
    ​

Why is this harmful?

  • Reduces adopted people to caricatures and villains and only shows adoption as a source of trauma
     

Read more:​

  • “When ‘You’re Adopted’ Is Used as an Insult", Ashley Fetters, The Atlantic, 7/25/2019.

"well, you can just adopt" / adoption as second-choice or backup

ASjustadopt

What it is:

Referring to adoption as a back-up or inferior plan to dealing with infertility (which may be a traumatic experience in and of itself).  There may also be trivialization of both infertility issues and the legal process of adoption.

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Why is this harmful?

  • Trivializes struggles with infertility

  • Encourages people to move forward with adoption before confronting grief and trauma around infertility

  • States adopted kids are inferior replacements for biological children

not recognizing adoptive families as families 

ASmisrecognizingadoption

What is is:

Not recognizing the adoptive family as family. This is especially common for transracial adoptions. This presumes that all families are biologically related and monoracial.

Examples

  •  “Whose child is that?"

  • “Is she really yours?"

  • [accusations of kidnapping]

  • “Are you the nanny?"

  • “Are you two dating?" [especially after puberty with adoptees and their adoptive parents or siblings]

 

Why is this harmful?

  • Invalidates adoptive families by presuming families must be biologically related (and often only monoracial)

ASapsavior

adoptive parents are saints

What it is:

Presumes that adoption is an act of charity and frames adoptive parents as noble, charitable, and saintly—capable of no wrong. May also replicate the White Savior trope and often seen along with disparaging comments about where the adoptee is presumed to come from.​​

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Why is this harmful?

  • Doesn't reflect reality and may make it more difficult to recognize abuse or neglect

  • Creates an obligation for adopted people to be eternally grateful

  • Reinforces that adoptees are lesser-than replacements for biological children

adoptees should be grateful for charity/lucky

ASgratefuladoptee

What it is:

Adoptees that adoption is an act of charity and frames adoptive parents as noble, charitable, and saintly—capable of no wrong. Often intersects with assumptions that biological parents are bad people (see below) and, for international adoptees, assumptions about the birth country.​

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Examples:

  • “You are so lucky to [be adopted/be here/not be there]."

  • “You should be so grateful to your parents for adopting you!"

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Why is this harmful?

  • Doesn't reflect reality and may make it more difficult to recognize abuse or neglect

  • Creates an obligation for adopted people to be eternally grateful

  • Replicates adoptees as lesser-than children compared to biological children.​

biological parents are bad people

ASbiobad

What it is:

Presumes that biological or birth parents are bad people or made bad decisions and did not deserve to parent regardless of the reality of each circumstance. These beliefs often intersect with myths about addiction that do not recognize it as a medical disorder, myths about poverty, and beliefs that also have embedded racism and misogyny. These may often conflate involuntary termination of parental rights with voluntary relinquishments. 

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Examples:

  • “Your parents were probably using drugs or neglecting/abusing you"

  • “Your birth mom was probably a prostitute."​​

  • “Your biological parents didn't care about you/threw you away."

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Why is this harmful?

  • This broad assumption does not reflect reality for many

  • Erases individual cases and complex reasons why adoption was the outcome

  • Can be used as an excuse to dissuade adoptees from seeking contact or reconnecting with birth parents

  • Reinforces harmful myths about poverty, sex work, substance use, and foster care

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There's an inverted version of this that frames birth parents as people who were unfit to parent (due to age or poverty) but who should be celebrated for choosing an adoption plan.

"well, you can just put the child up for adoption" / adoption as simple alternative to abortion

ASadoptionaltabortion

What it is:

Referring to adoption as easy alternative to abortion. Often as a reason to obstruct access to abortion.

​

Examples:

  • Supreme Court Justice Amy Coney Barrett's direct comments during proceedings for Dobbs v. Jackson​ (2022), the decision that overturned the federal right to pre-fetal viability abortion established in Roe v. Wade (1973). 

  • “Would you rather have been aborted?", often in response to an adoptee disclosing difficulties with adoption

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Why is this harmful?

  • Trivializes the decision to make an adoption plan

  • Erases the complexity, trauma, and secondary infertility some biological parents experience after relinquishing a child to adoption

  • Dismisses the complexity and loss ingrained in adoption for the adopted person

  • Used as an argument against comprehensive health care including abortion care.

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Read more:

assuming everybody is biologically related to those who raised them

ASbiocaregiver

What it is:

Presuming family has to mean adults with biologically-related children.​​

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Why its harmful?

  • Invalidates families formed without biological kinship

  • Erases the reality of thousands of people including those with experiences of adoption, foster care, and other caregivers

assuming everybody knows their biological family's medical history

ASLFMH

What it is:

Presuming that everyone has access to information about their biological family's medical history.​​

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Examples

  • Clinicians who to do not specify biological family when asking about family medical history

  • Patient intake forms that do not allow patients to indicate adoption or limited family medical history

 

Why its harmful?

  • Erases the reality of thousands of people including those who have experienced parental estrangement, foster care, adoption or were donor-conceived (egg or sperm donation).

  • May result in inaccuracies in medical records and miscommunications between clinicians that have the potential to delay care

love is all you need

ASloveallyouneed

What it is:

​Referring to the idea that a successful adoption only requires that the parent love the child. Raising an adopted child is different from raising a biological child.

​​​

Examples

  • May be used as an excuse to minimize or avoid addressing

    • an adopted person's pre-adoption history (potentially trauma, neglect, or abuse)

    • an adopted person's desire to contact with birth family or connect with birth culture

    • identities and cultures that differ from the adoptive family, including race​

​

Why it's harmful?

  • Oversimplifies the complexities of raising and being an adoptee

  • May not address trauma in adoption or acknowledge the losses encountered in adoption, including loss of biological family, connection to birth culture and language

  • Transracial adoptees have spoken about how difficulty navigating racism as a person of color is without guidance or preparation

    • Adopted children of color grow up into adults of color who engage with the world independently outside the context of their parents. Regardless of the family's preference regarding acknowledging race, adoptees of color, like other people of color, will encounter racism. However, they will be left to understand and manage racism without support from the family.​

commodification of adoptees

AScommodified

What it is:

Referring to children as objects or commodities. While there are absolutely market forces of demand and supply operating in the adoption industry in the United States, there are appropriate times to discuss this. Outside that specific, nuanced discussion, it is not appropriate to refer to adopted people as objects and language should reflect that.​

​

Examples:

  • “How much did you cost?"

  • Juno (2007): “You should've gone to China, you know, 'cause I hear they give away babies like free iPods. You know, they pretty much just put them in those t-shirt guns and shoot them out at sporting events.”​

​

Why it's harmful?

  • Adopted people are people.​

adoptees as forever children

ASinfantilization

What it is:

Not recognizing that adopted children grow up to be adults whose lives continue to be shaped by adoption. Adopted adults have every right to express agency that other adults have.

​

Examples:

  • Adoptees only exist in the U.S. Census and in many research indices as “adopted minors." At 18, the U.S. Census ceases tracking adopted people and no MeSH (medical subject heading) research terms exist for an “adopted person/people", “ adopted adult," or “adoptee."

  • News articles featuring the voices of adoptee advocates often depict family photos with adoptees as children rather than professional accomplishments in adoption or social work.

​

Why it's harmful?

  • Erases adult adoptees and their needs including post-adoption and mental health resources

  • ​Prevents conceptualizing adoption as a lifelong experience

  • Discounts adopted adults' agency and validity of their voice

angry adoptee

ASangryadoptee

What it is:

Stereotype that adopted people who discuss loss in adoption or advocate for changes to adoption policy are simply angry because of negative personal experiences with adoption. Failing to value the perspectives of adoptees who are also adoption professionals.

​​​​

Why it's harmful?

  • Does not reflect reality

  • Many adoption advocates advocate for adoption policy changes even if they had positive adoption experiences and vice versa.

  • Negative personal experiences should not be used to discredit or excuse cases of adoption corruption, abuse or neglect.

  • Discredits professional expertise​

  • Assumes that people cannot separate out personal experience from view of overall adoption industry.

Best Practices for Documentation

While learning about adoption and limited family medical history (LFMH) is certainly commendable, it is also necessary to take specific steps to promote an inclusive environment (other staff, office spaces, and electronic health record system) for adopted patients and patients with limited family medical history (LFMH). Adopted patient narratives often comment on patient intake forms or experiences with multiple healthcare professionals that marginalize them. Clinicians should also recognize that many patients believe that their biological family's medical history is predictive of their own health. For patients with limited or unknown family medical history, questions around family medical history (and the reminder of their lack of knowledge) can be stressful. Learn more about LFMH.

Inclusive Patient Intake Forms

At the beginning of the Family Medical History section:

  • Add an “Unknown” checkbox

  • Unknown should be applicable to both the patient and any biological family members of the patient

  • Add an “Adopted” checkbox
  • Add a free text box, allowing a patient to tell you what they wish you to know
Limit asking about family medical history to what is necessary

  • For patients, consider designating 1 clinician to ask per office visit​

  • This may require discussing adopted and patients with limited family medical history ahead of time with other staff who interact with patients (e.g., front desk staff and staff that may room patients beforehand).

  • This may also require developing an agreed-upon system of gently alerting staff to these patients (e.g., utilizing a “pop-up" or “sticky note" feature in the electronic health record​​).

Considerations for your notes

  • Avoid putting “adoption" as a #problem in the problem list, utilize “limited family medical history" if it is a more accurate descriptor ​

    • With patients able to access to clinical notes readily under the 21st Century Cures Act, recognize how patients may interpret #adoption on the problem list as offensive.​

Inclusive Medical Interviewing:
Adoption & Limited Family Medical History

In this section, we'll give an overview of the general principles to keep in mind when discussing adoption status and/or limited family medical history with a patient. Learn more at our Limited Family Medical History page, including our recommendations for inclusive family medical history-taking and how to respond to adoption and LFMH disclosures, including suggested phrasing and a flowchart.

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These recommendations were developed from a literature review of adopted patient narratives and utilizing insights from a qualitative study of primary care physicians around their approach to adopted patients with limited family medical history.

 

Recommendations

  1. Use open-ended questions with universal phrasing.

  2. Use adopted patient’s terminology.

  3. Acknowledge adoption and LFMH disclosures nonjudgmentally.

    • Disclosures can be emotionally difficult and triggering for adopted patients.

    • Avoid making patients restate their adoption & LFMH.

  4. Ask permission before delving into adoption and LFMH.

  5. Clarify the degree of LFMH

    • Recognize adoption and LFMH as often related, but distinct.

    • Recognize that patients often have limited access to FMH involuntarily.

  6. Normalize adoption, LFMH, and any associated complex feelings.

  7. Offer to discuss the health implications of adoption and LFMH.

Listen to Adopted Patients

Thank you for being open to listening to adult adopted patients and recognizing opportunities to expand your knowledge. Fortunately, adopted adults have been speaking about their experiences as patients for many years and created several resources beyond this one. This is by no means an expansive list, but a start.​​​

 InterCountry Adoptee Voices (ICAV), a global international adoptee organization, produced a video series in 2021 for various service professionals including doctors, discussing their lived experiences. The project included adult adoptees in Australia ranging in age from 20s-40s and countries of origin included Brazil, Colombia, Ethiopia, Haiti, South Korea, Sri Lanka, and Taiwan. The project was funded by Relationship Matters (RM) and The NSW Committee on Adoption & Permanent Care (COAPC) and supported by the Australian Government Department of Social Services in recognition of the need to improve post-adoption resources available to adoptees in Australia.​ Learn more about the ICAV video series.​

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More Resources on Adoptee Health

Looking to learn more? Here's a few recommended articles on adoptee health. Adoption medicine has long been thought of as a pediatric issue, reflecting the U.S. Census and other disciplines of research that have overlooked adult adoptees. While there are several resources aimed at pediatric adoptees, they have been included as helpful context for the care of adoptees throughout the lifespan.

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