CLINICAL REPORT The Pediatrician’s Role in Supporting Adoptive Families

Each year, more children join families through adoption. Pediatricians have an important role in assisting adoptive families in the various challenges they may face with respect to adoption. The acceptance of the differences between families formed through birth and those formed through adoption is essential in promoting positive emotional growth within the family. It is important for pediatricians to be aware of the adoptive parents’ need to be supported in their communication with their adopted children. Pediatrics 2012;130:e1040–e1049 CHANGING PICTURE OF ADOPTION According to the 2007 National Survey of Adopted Children, approximately 2% of the child population in the United States was adopted, accounting for 1.8 million children.1,2 Approximately 38% of these children were adopted from foster care, another 38% joined families through private domestic adoption, and 25% were adopted internationally. Furthermore, approximately 24% of adopted children were adopted by relatives, including 17% from foster care, and 37% of children were adopted privately in the United States.1,2 Overall, 49% of adopted children were male; 39% of children adopted internationally and 57% adopted through the foster care system were male. Adopted children tended to be older than the general population, with only 14% younger than 5 years, compared with 27% in the general population. Adopted children were less likely to be white or Hispanic, but this varied by the type of adoption. Children adopted through the foster care system tended to have the highest percentage of black children, at 35%, whereas children adopted internationally had the least number of black children, at 3%. Children adopted privately in the United States were more likely to be white, at 50%, whereas children adopted internationally were least likely to be white, at 19%. The majority of children adopted internationally were of Asian descent (59%), with 33% originating from China. Adopted children were less likely to live in households with incomes below the poverty level than the general population (12% vs 18%, respectively). Conversely, 46% of adopted children live in households with incomes no higher than 2 times the poverty level. Similar to the general population, 69% of adopted children lived with 2 married parents. Eighty-five percent of adopted children were reported by parents to be in excellent or very good health, and 78% reportedly had adequate health insurance.1 Knowing the current picture of adopted children, pediatricians can play a significant role in the adoption process by providing counseling Veronnie F. Jones, MD, PhD, Elaine E. Schulte, MD, MPH, and the Committee on Early Childhood and Council on Foster Care, Adoption, and Kinship Care