Family health history is often discussed in medical and other clinical settings as a practical tool for understanding disease risk. But for adopted children, these conversations can also intersect with complex feelings surrounding identity, belonging, grief and cultural understanding. Helping your child take ownership of their health and identity and establish healthy boundaries with others is a skill integral to adopted child mental health.
This article is the fifth and final installment in an educational series aiming to improve health literacy and empowerment for adoptive families when assembling a biological family health history for their adopted child(ren).
What Emotional Challenges May Adopted Children Experience When Learning About Their Biological Family Health History?
As children grow older and learn more about their adoption story and biological family health history, more complex emotions and questions may begin to arise. Learning new information can bring up a wide range of emotions such as curiosity, sadness, confusion, fear, anger, relief or connection. For some children, receiving new information may help fill in missing pieces of their personal story. For others, discovering serious illnesses or difficult family histories may feel overwhelming.
There is often a struggle with uncertainty when information is missing or incomplete. In both medical and social settings, these feelings can be triggered or exacerbated by who asks the questions, when they are asked and how they are phrased. Guiding your child in how to address and cope with these feelings is incredibly important from an early age, as it will equip them with tools and strategies that will grow and adapt with them as their thoughts about their adoption grow more complex as they get older. Here are some important points to keep in mind when having tough conversations with your children.
- Start early: Having early conversations about tough emotions and grief shows your child that your family is a safe place to discuss difficult topics. It also helps them feel comfortable coming to you with questions about their biological family, adoption and identity.
- Choose words carefully: The words you choose to discuss adoption play a big role in how your child may perceive themselves and their biological and adoptive family. Using adoption-positive language can help empower your child and reduce stigma surrounding adoption and complex families. Additionally, it can help foster compassion and deeper understanding for their biological family and the circumstances they were in.
- Keep a respectful and truthful focus on the biological family: Your child’s biological parents are a crucial part of your child’s story. While there may be negative or traumatic experiences associated with them, it’s important, especially for younger children, to recognize the biological connection between them and their biological parents, such as their role in bringing the child into the world.
- Be mindful of your reactions: Children learn how to react to situations from their parents. Talking about your child’s background can be incredibly emotional, but it is important to try to remain calm when discussing your child’s family history. For example, if a parent becomes visibly distressed, shuts down or begins to cry when talking about their child’s biological family history, this may unintentionally signal to the child that this topic upsets the parent and that they shouldn’t bring it up to keep them happy. However, you can be truthful while still remaining calm by saying things like “This can be hard to talk about, but I’m glad we can talk about this together and that I’m here to help you.”
- Discuss hardship and trauma appropriately: It is important to approach discussing difficult topics in an age-appropriate manner. Details are often unnecessary at early developmental stages and can sometimes be harmful for children to hear. Emphasizing your dedication to making your home and family a safe and loving place for your child, alongside acknowledging that very sad or hurtful things were done to them in the past, is an important part of ongoing conversations with your child. These conversations are complex and nuanced, so seeking guidance from an adoption-competent professional such as a social worker, counselor or therapist can help you navigate these important discussions.
How Can Adoptive Families Build Cultural Humility When Learning About Racial or Ethnic Health Disparities?
Being an adoptive parent allows you to reflect on your own biases and privileges, regardless of whether your adoptive family is transracial. A nationwide survey performed by the National Council for Adoption (NCFA) in 2021 garnered over 4,200 responses on the demographics of adoptive parents in the U.S. from three broad categories of adoption: private domestic, intercountry and foster care. While adoptive parents who adopted from foster care were the most diverse in terms of race, income and education, adoptive parents across all three types of adoption were, on average, more educated, had higher incomes and were more likely to be white than the general U.S. population.
When it comes to transracial adoptions, parents have a responsibility to engage in and understand their child’s cultural background, as well as to help their child take pride in their identity. If your child has a marginalized racial or ethnic identity, it’s important to learn about the specific challenges people of color face in all aspects of their life, including in the healthcare system.
For example, some communities have experienced unethical medical practices, discrimination in healthcare systems or reduced access to culturally responsive care. Hispanic, Black, and American Indian and Alaska Native (AIAN) people fare worse than white people across the majority of examined measures of health, health care and social determinants of health. Understanding this broader context can help adoptive parents make sense of why their child may feel mistrustful, cautious or treated differently within healthcare settings.
A Swedish-based study found that transnational adopted individuals reported these as the primary barriers they faced in medical and mental health care settings:
- “Color blindness,” the claim of treating individuals equally without acknowledging how their race affects their life experiences
- Limited knowledge and interest in adopted identity by clinicians
- A false dichotomous view of adoptees as either deeply traumatized or entirely well-adjusted, among many others
While Sweden is less ethnically diverse than the U.S., it is plausible that some of these results are similar to the experiences of U.S. transnational and transracial adopted children growing up in a society with racism deeply ingrained in its structures and institutions.
The adopted people in the study also expressed a desire for more support and resources, including access to clinicians who share their background, care that recognizes how their needs may change throughout life and more education and community for both adopted people and their families.
As a parent, supporting your child can mean asking questions like, “How does it feel to be ______?” and seeking out trusted clinicians and community members who share or understand their identities. It also means approaching your child’s identity with a mindset of lifelong learning, recognizing that their experiences and challenges may change over time.
When it comes to finding culturally and adoption-competent providers, the adoption agency you work with may directly have resources, such as post-adoption counselors and psychologists, or be able to refer you to other resources in your community. Additionally, the NCFA has a list of adoption medicine clinics & practitioners organized by state.
How Can Parents Prepare Children to Navigate Conversations About Family Health History With Others?
Adopted people and their families often face difficult, intrusive questions about adoption and biological family history. While these questions may not be asked with bad intentions, they can still be uncomfortable. Your child and family have a right to privacy. Learning to set firm but respectful boundaries is an important lifelong skill. It is also important to talk with siblings and extended family members who know sensitive information about your child so they understand what is private and what, if anything, can be shared.
As a parent, you play an important role in protecting your child’s privacy, as well as empowering them to share only what they are comfortable sharing if they are ready to do so. Below we’ve summarized some important points to consider:
- Normalize the experience and foster empathy: Help your child understand that many adopted individuals face the same kinds of challenges and that they are not alone. Tell them that others may ask intrusive questions out of curiosity, not realizing how harmful or uncomfortable they may be. Regardless of the intent, remind your child that their feelings matter and that it is okay and necessary to communicate their boundaries.
- Practice with your child: Preparing your child for questions about their adoption or family health history can involve role-playing common scenarios as a family. This gives your child a comfortable space to ask questions, learn types of responses and practice them, and decide what they feel comfortable sharing before facing these conversations in school, healthcare settings or social situations. You can create scripts and phrases for your child to have prepared for potential uncomfortable situations, such as “I’m not ready to talk about that,” or “Why do you ask that?”
- Remember that your child’s story is theirs to tell: Adoption is an experience that deeply affects the whole family, but your child should have ownership over their story and their background. You may feel tempted to tell others about your child’s background, especially those close to you. But your child should have the opportunity to share only if they are ready and comfortable. You can say things like “That’s my child’s story to tell.”
The Cradle’s W.I.S.E. Up!® program is designed to empower adopted and foster children to decide if, when and how to share their stories. They use engaging activities and supportive dialogue to create a safe space where youth build self-awareness, resilience and communication skills to navigate questions about their families and experiences and prepare them for intrusive questions and insensitive remarks.
Adopted Identity Across a Lifetime
Adoption is not just an experience, but an identity that individuals carry with them throughout their lives. It doesn’t just impact them, but also future generations of their family. Teaching children from an early age how to cope with the difficult emotions that come with the uncertainty and grief from adoption is an important life skill that they will continue to use for the rest of their lives. Being a supportive family can look like establishing the home as a safe place for open and honest dialogue about adoption, having cultural humility for your child’s identity and giving your child the agency to tell or not tell their story.
If you need support, The Cradle is here to help. Our adoption-competent therapists can provide the support you and your family may need to navigate adoption’s challenges so you can better celebrate its many rewards. Fill out our online inquiry form or call us at 847-475-5800 to speak with one of our counselors.
Equipping Adopted Persons with the Tools to Access and Understand Their Family Medical History is an article series written by Joelle Warden, an adopted individual and current Stanford undergraduate (class of 2026) pursuing a B.A. in Human Biology concentrating in Neuropsychology & Medical Humanities. In this series, she will share her research and personal insights into the process and important considerations of building a biological family health history.
