On Choosing a Child

The healthcare provider's role in reviewing referral documents

Reviewing referral documents to assess the well-being of a child is a challenging task for every healthcare provider. While ultimate decision-making power resides with the family, frequently the information we provide determines whether a child is accepted or rejected. This is viewed as a grave and often a burdensome responsibility, primarily because there is so little objective data on which to base an opinion.

Much of the information physicians would like to have at their disposal is not present in the medical abstract. Frequently absent are maternal medical history; details on the pregnancy, labor and delivery; whether the mother used drugs or alcohol; and gestational age at delivery. Many children are referred in the first few months of life. While any initiative that reduces the length of time a child remains within an institutional care setting is supported, young infants are exceptionally difficult to evaluate since developmental milestones are few and easily attained by all but the most neurologically damaged.

Most information contained in referral documents is subjective, dependent upon the interpretation of the physician collecting the information. In these situations, unless the videotape is particularly informative, a physician is totally dependent upon the ability of another healthcare provider to identify conditions such as fetal alcohol syndrome, profound developmental delays, autism, etc. As a physician often cannot rely on subjective information, objective data (particularly body measurements) assume an important role in an evaluation.

The physician occasionally speaks with adoptive families who seek children with whom to share unique gifts. Parents often desire children with their own specific disabilities, such as blindness or deafness. Other families who have parented a child with a specific medical condition feel able to face those specific challenges with another similarly affected child. Others are attached to their child's image as firmly as parents who cradle their newborn in the delivery room, and would never consider abandoning what is now their child--even facing the prospect of severe medical problems. However, most parents seek a child with a good chance of living a "normal life"--a desire no different from those who await birth children.