Adoption: a forgotten paediatric speciality.

OBJECTIVE To study the medical, emotional, and developmental profile of children being considered for permanent substitute care. DESIGN A retrospective analysis of 100 adoption/permanency medicals. SETTING All children considered by the adoption and permanency panel in Greenwich, south east London, between 1994 and 1998. OUTCOME MEASURES Analysis of medical reports completed using the British Agencies for Adoption and Fostering form C (under 5 years) or form D (over 5 years). These include the details of a physical examination, including vision, hearing, height, and weight; emotional and behavioural concerns expressed by the foster carer and school progress. RESULTS These children have complex needs. Only 31 of the 100 children were considered unlikely to have significant medical, developmental, or emotional problems. CONCLUSIONS Adoption medical work is becoming more specialised. Healthcare commissioners should establish minimum standards for the doctors involved in this work. As the NHS moves towards becoming a more primary care led organisation, this small service must not be forgotten. The NHS devotes few resources and little training to adoption. The medical input required to support adoption and fostering services should be recognised as a specialist paediatric service and adequately resourced.