Part 1

Part 2

When it comes to physical and emotional health, you will have many questions about your child. Some questions can be answered. For others there may not be information available. Birth parents should fill out a family medical history, but not all parents do, and the information is only as reliable as the person filling it out.

The only way you will know for sure is if you ask.

Dental Hygiene and Care

• Brushes own teeth? With or without reminders?

• How often?

• Any special brand of toothpaste or toothbrush?

• Has child been to dentist? When was last check-up? Afraid of dentist?

• Any dental problems?

Health

• Date of last examination and name of doctor?

• Has child ever been hospitalized to your knowledge? Age and reason?

• Reaction to doctors and nurses (ex: fearful, enjoys going, anxious, cooperate during physical examination, fights exam or needles?)

• Any know illnesses in past? Recently?


• Any allergies to food or medicine?
• Susceptible to colds, earaches, etc.? Runs high fever with colds, flu, etc.?

• When ill, is there anything special the child likes (ex: certain foods, attention, snuggling, being left alone?)

• Frequent ear infections? Breathing problems? Noise sensitivities?

• Does child hear well?

• Does child wear glasses? (If so, how long? Wears them all day or part of time? Objects to them? How often is there breakage?)

• Give details of any special medical problems and treatment or care required.

• How is the child's physical and emotional health?

• Physical health – shots up-to-date?

• Allergies? Seasonal or year round?

• On any medications? What for?

Mental Health/Emotional Health

• How has the child adjusted to this home?

• How does the child handle routine expectations / chores?

• How is the child about expressions of affection, about touching?

• Does the child prefer men to women, women to men?

• How does the child take care of possessions?

• How well does the child get along with other children in the household?

• Does the child prefer same age, younger or older play mates?

• What is a typical day like for the family?

• What type of discipline works best?

• What doesn't work?

• What problems have occurred at home that you feel we should be aware of and how did you handle them?

• Has the child ever made allegations of abuse?

• What kinds of feelings does the child have about themselves?

• How does the child handle failure, stress, happiness, anger, pain, anxiety?

• Is the child aggressive towards caregivers or other children?

• What strengths does the child have?

• Does the child have a nickname?

• How well does the child communicate?

• Can the child talk about feelings or fears?

• Are there specific things the child is afraid of?

• How do they handle these fears?

• What is their experience with animals (dogs, cats, etc.)?

• How does the child’s emotional age compare to chronological age?


Developmental levels

• Are there any delays or impairments in the following developmental levels?

- Social/emotional

- Cognitive

- Gross motor, fine motor

- Adaptive

• Psychological diagnosis?

• Neurological diagnosis?

• Is the child in therapy? How often?

• What types of therapy have been used?

• Therapist's name and phone?

• What has the child been told regarding sex?

• Any sexual acting out? If so, how/when does it occur?

• Any history of sexual abuse?

Our final set of questions will deal with the child’s behavioral issues, school issues, and how your child feels about adoption.

Part 4

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