Adoption laws and role of pediatrician

DNB PEDIATRICS THEORY QUESTION: Laws of Adoption in India; Discuss The Role of Pediatrician in Adoption of a Child (5+5)

Process by which child is seperated legally from his/ her biological parents.
Child becomes the lawful child of his/her adoptive parent
All the rights, privileges and responsibilities post adoption are  similar to that in case of a biological child.

A. Laws of Adoption in India (As on Nov 2017): 

1) Hindu Adoption Maintenance Act, 1956
2) Juvenile Justice(Care and Protection of Children Act), 2015(JJ Act)
      Model JJ Rules 2016
      Adoption Regulations 2017

1) Hindu Adoption Maintenance Act :

Only a Hindu, Buddhist, Jain, or Sikh husband above the age of 18 can adopt
under this act only with the consent of his living wife (Husband is the adopter and wife is merely consenter)

    A single female (unmarried, divorcee or widow) can also adopt
    A person having a male child can not adopt a male child
    A person having a girl child can not adopt a girl child
    Age difference between the adoptive father and the adoptive girl child to be a least 21 years
    The child has to be below 15 years of age
    Provision of payment or reward and any contravention shall be punishable

Adoption can be concluded through a registered Adoption deed subject to compliance with the  provisions of the Act

Courts permission to adopt under this act is required only in
the following cases:

  Where both the father and mother are dead
  Where both the father and mother have completely and finally renounced the world
  Where both the father and mother have abandoned the child
  Where both the father and mother have been declared to be of unsound mind by the court concerned
  Where the parentage of the child is not known
  Valid Adoption cannot be cancelled

2) Juvenile Justice Act-Adoption:

A secular Act (any body irrespective of religion can adopt a child under this act)
Nothing in this act shall apply to adoption under HAMA
All Inter-country adoptions shall be done as per provisions of this Act & Adoption
Regulations are framed by the Authority-Central Adoption Resource Authority 
(India is a Signatory to Hague Convention on Inter Country Adoption)
Children up to the age of 18 can be adopted under this Act
Orphan, Abandoned & Surrendered (OAS) children declared legally free for adoption By CWC can be placed in In-country and Intercountry Adoptions
Children of relatives, as defined in the JJ Act, can be adopted by a Incountry parent
Children of relatives, as defined the JJ Act, can be adopted by a Intercountry parent

Eligibility of Prospective Adoptive Parents

  A couple/single parent can adopt
  Single male not eligible to adopt a girl child
  PAPs age eligibility criteria is defined
  Minimum 2 years stable marital relationship is mandatory
  PAPs with 3 or more children shall not be eligible to adopt a normal OAS child
  Eligibility and suitability of the PAPs are ascertained through a Home Study 

Post adoption Follow up of the adoptive family both in case of In-country and Inter-country is undertaken for 2 years
Court Procedure (Including Adoption Order Annulment) is defined in the act
Attention: Guardians and Ward Act, 1890 is not an Adoption Law.

The Role of a Paediatrician:

 Pre- Adoption:  

Discourage illegal Adoptions and inform prospective Adoptive parents the law of the land and the procedure involved.
It is imperative to understand that one of the main objective of Adoption in India is to ensure children with disabilities/ not ‘normal’ children too have right to access to loving family care.

Pre-Adoption Visit:

Healthcare professionals should discuss with parents preadoption health records, and clarify the
It is a challenge when biological parentage is not known as there is potential complication of tracing genetic traits.

Comprehensive Medical Evaluation of the newly adopted child:

1) Complete Physical Examination: 

  Vital Signs
  Growth Points
  Complete Physical Examination, with Emphasis on Skin and genitilia
  Neurological Examination with Emphasis on Developmental and Neurological abnormalities

2) Diagnostic Testing:

  Infectious Diseases: HBV,HCV,HIV 1 & 2
                     Stool Pathogens
  Anaemia Screening
  Nutritional and Metabolic Screening
  Screen for Haemoglobinopathies
  Blood Lead concentration
  New Born Screening (Young)
  Rickets Screening

3) Immunization:

Evaluate Immunization Status and administer age appropriate vaccination, if no
records-Immunize as a un Vaccinated Child.
4) Other:

  Hearing Screening
  Vision: Examination, Refractory Error and Fundus
  Dental: Caries and Paediatric Dentistry referral
  Developmental Screening and assessment and Intervention if required.
  Speech, Language, occupational and Physical Therapy Referral when needed.
  Address unique behavioral issues and  psychological challenges that many children experience

Supporting Adoptive families and the child:

Parent should tell children if they're adopted, and Paediatricians should help them address challenges in rearing an adopted child.
Clinicians should teach adoptive parents to be open about the nature of the adoption with their child while still establishing that an adopted family is still a real family. (No Established Time- Children do not understand difference between biological/ adoptive family until 3),
Pediatrician is an important resource and advisor for parents dealing with psychological and emotional problems facing adopted children.

It is becoming increasingly important for Pediatricians to be aware of and knowledgeable about adoption, and that they play an important role in helping families and the child deal with the differences, the losses, and the many other issues surrounding the adoption.


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