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Adopting Again With PAE in the Family, Part III

August 11, 2011

It is hard to sugar-coat the truth: only infrequently is prenatal alcohol exposure an adopted child’s only risk factor.

It is ironic that families who adopt tend to be more functional than average. Most adoptive parents don’t have personal experience with food insecurity, addiction, incarceration, illiteracy, interpersonal abuse, untreated mental health issues, no support system.

Yet it is rare that a mom with a college degree –in a stable marriage, who can afford to carry a mortgage, own two vehicles, and pay office visit co-pays, who has the leisure to research the safest car seats on the market and can afford to serve her family organic produce –drinks alcohol during pregnancy and places the affected child for adoption.

(Unfortunately, it is true that alcohol-affected children are born to middle and upper-class women in the United States who consumed alcohol during pregnancy. However, the exposure often goes unacknowledged and the child grows up in his birth family.)

In terms of economic, social and personal stability, parents who desire and who can afford to adopt are among the most privileged people in the world. Yet this puts us at significant disadvantage when we are considering adoption in general and a referral in particular. Without understanding the sense of entitlement bred by our own relative wealth (in all senses) we believe we can confer that entitlement on the children we adopt.

After all, one of the most common ways to re-frame an adoption story goes like this: “Your birth mom made an adoption plan because she loves you and wanted you to have a better life than you would have in [place of birth].”

Defacto, adoptive parents tend to see themselves as Good Fairies with the power to make Birth Mother’s (assumed) wishes come true. Why adopt a child if you have no desire to parent and to share all the privileges that have accrued to you? Few among us undertake the stress and the expense of the adoption process without the conviction that we can help a child.

That conviction validates a hidden motive: our deep desire for a(nother) child. The chance to see ourselves making a meaningful difference in the life of another human being. To be the kind of person, who when praised by an outsider for giving an orphan a home, modestly protests, “Adoption is such a wonderful thing! She gives us so much more than we give her!”

We cannot imagine it any other way. Those are the rose-colored glasses that blind us from seeing the plain truth in front of us: children in need of adoption come from hard places. Even after they join our family, they will still be children from hard places.


I was reminded of this recently by, of all things, toothbrushes. Not Dorothy’s toothbrush story, as apt as it is for this post. Rather, a discussion about sending toothbrushes in care packages to waiting children.

Now that children are coming home old enough to have substantial numbers of teeth, adoptive parents  sometimes find they are facing oral surgery within months of homecoming. Tooth extractions are never fun and missing teeth impede a child’s acquisition of important skills like speaking, biting and chewing.

Naturally, that raises questions for waiting parents like, “Do foster mothers brush kids’ teeth?” “If I include a toothbrush in a care package, will it be used as intended, not just as a chew toy?”

Our assumption, drawn from our own life-experience, is that kids whose teeth are brushed regularly have fewer dental issues. Therefore, we send toothbrushes in the hope our child’s foster mother uses them as diligently as we will once our child comes home. After all, we’ve heard it since elementary school when we chewed pink tablets that disclosed the plaque on our teeth: frequent brushing and flossing prevents cavities.


The chances are much higher if the child’s mother had optimal nutrition during her pregnancy, while her baby’s tooth buds were developing.

The majority of the children available for adoption in the world are born to mothers who did not have even adequate, much less optimal, nutrition.

By the time we arrive on the scene, it is too late for the prenatal vitamins and the prenatal medical care and counseling that might have made a real difference in our kids’ teeth.

So we send toothbrushes.

The message is slowly getting out: for better or worse, the state of your child’s baby teeth may tell you more about his birth mother’s nutritional status than his referral did.


For better or worse, how your child actually develops will tell you more about the state of his mental health than the hints in his referral did.

That is the danger of over-focussing on PAE and the possibility of FASD in a referral.

And that’s where I’ll pick up in Part IV of this series.

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