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Part 5: Keeping Your Child Happy and Safe  >  Family Issues




For 20 years, I had the privilege to care for and provide medical relief to children in an orphanage. That also gave me the opportunity to share the joy of over 300 families whom I helped to adopt children from this orphanage and through adoption agencies like the Indian Association for Promotion of Adoption (IAPA) and the Family Service Centre.

Here I lay out information on the subject of adoption based on my personal experience, on Nilima Mehta’s book (Ours By Choice, published by the author, 1992), and information provided by the IAPA.

To Adopt Or Not To Adopt?
A couple should never adopt a child unless both are keen to adopt. If you are considering adopting another child, besides your biological one, take your first child into confidence.

Private Adoption Or Adoption Through An Agency?
Always adopt through an adoption agency because these agencies employ men and women experienced in finding a child best suited to the prospective parents. They also ensure that the child you adopt is legally free for adoption.

Waiting Period
After the social worker has helped you with the completion of the documentation and the formalities, the time of waiting begins. The agency will locate a child suitable to and compatible with you; this may take anything between 3 to 6 months or even longer.

Do not be tempted to register with several agencies in the hope of getting a ‘better’ choice or a faster placement. The agencies have their own networking system whereby they co-ordinate with each other to locate a child suitable for you.

Is This Your Child? 
If you have already pictured your child in your mind, share this image with the social worker; she will identify a baby who best matches your expectations and needs.

You will be provided with the birth history and social background of the child (but not the natural mother’s identity, which is kept confidential as per the law), whenever it is available. The child’s health profile will also be made available. Show the child to a paediatrician of your choice to confirm normal physical and mental development and to rule out any congenital disorder, if you like. The paediatrician will keep in mind that a child kept in an institution, though normal, may be below average when compared with one who gets constant individual attention from her biological parents. But I have seen that once the child starts getting individual attention from a loving adoptive family, she achieves her physical and mental milestones at an unbelievably rapid pace.

Legal Procedures And Costs Involved
When you have decided to adopt a particular child, a lawyer recommended by the agency or known to you will help you file all the relevant papers in court. After this, you can take the child home in pre-adoptive foster care.

You may be required to attend court when the case comes up for hearing. Then the lawyer will hand over the documents related to the adoption — the court decree, the Deed of Adoption (if relevant) and the child’s birth affidavit — to you.

The costs involved are not exorbitant. The lawyer will charge his fees and the agency charges a reasonable fee for its services.

Are There Any Risks Involved In Adopting A Child?
Adoptive parents should be ready to take the same risks as natural parents do. In fact, adoptive parents have certain advantages — the choice of when to adopt, and the chance to check on the child’s physical and mental normality. In comparison, biological parents take risks concerning their child’s possible handicap(s).

How Will Heredity And Environment Shape The Future Of The Child?
Physical characteristics like the skin, hair and eye colour, height, etc. are determined by heredity, but it is the stimulating environment that the child grows up in that moulds and maximises her potential.

What About Illnesses?
Before adoption, certain tests are carried out to rule out the possible common illnesses that the child might have. The children are often underweight when brought home; some may have scabies, others lice, but these are problems that can be easily tackled.

When And How Does One Tell The Child About Her Adoption?
The process should first start with sharing your decision to adopt with your immediate relatives and close friends. As far as the child is concerned, adoptive parents often successfully use stories of people like Sant Kabir (who was adopted) to initiate the revelation of her adoption to the child. 

It is important that the child learns about her adoption from her adoptive parents rather than from an outsider. The information may be given to her around the age of 3 years; and certainly before she begins school.

Some agencies suggest the following response: “For a long time, we wanted a baby just like you. We were lonely and our house seemed empty. Then, a person who knew where there were some babies who wanted mummies and daddies, helped us find you. You were so lovable and beautiful, just as you are now. You were the very baby we wanted, so we brought you to your new home, to be our very own forever.”

Telling a child about adoption is a gradual process. The most natural thing would be to give the child a big hug and kiss when you are happy and say: “We are so glad that we adopted you.” This way the child begins to associate the word ‘adoption’ with love and a sense of belonging.

As the child grows older and learns how babies are born, an inevitable question is: “Mummy, was I also in your tummy?” If you say ‘No’, the child might ask: “Then whose tummy was I in, and why didn’t she keep me?”

In most cases, the adoptive parents are not fully aware of the natural mother’s reasons for relinquishment of her child, so here you could say: ‘I don’t know the real reason why she could not keep you, but I’m sure she had problems and couldn’t look after you and wanted you to have a happy home.”

The child must be helped to understand that the woman whose tummy she was in gave her birth and that you are her ‘real’ mother now and for always — and that she is now part of your family. In this manner, she will develop a sense of belonging to you as your child.

A time comes in the life of some adopted children when they become restless and want to search for their roots and identity. They want to trace their biological parents. This is not possible in the Indian context, because adoption agencies have a sealed and confidential record system whereby there is no access to the relinquishment document and it remains a property of the court. 

As a paediatrician, I have seen several families ruined due to alcoholism — usually in the father. Neither the rich nor the poor are spared. The children of such families are the worst sufferers. That observation has made me discuss this subject in these pages. 

Should You  Drink At All?
There have been suggestions that moderate drinking is good for health. This is also reported in the Consumer Reports On Health, published by the Consumers Union in the United States of America. I suggest that you read the following carefully and then decide for yourself if moderate drinking is good for you.

Studies have shown that those who drink moderately — 1 drink a day for women and 2 for men — have 20% to 40% less risk of developing coronary disease than non-drinkers. (One drink equals 12 ounces of beer, 5 ounces of wine or 11/2 ounces of 80-proof liquor.) However, the reduction in this particular risk is comparable to what you might gain from a low fat diet.

Potential Risks Of Moderate Drinking

  • Breast cancer: New studies indicate that even moderate drinking may raise the risk of breast cancer significantly more than was previously believed.

  • Addiction: New drinkers who are impressed by the reduced risk of coronary disease due to moderate drinking may not be able to keep their drinking in control and may become victims of immoderate drinking as given below.

  • Accidents: The risk of dying from accidents or violence is up to 40% higher in moderate drinkers than in abstainers. 

  • Other diseases: Moderate drinking may increase the risk of cirrhosis of the liver and cancer of the mouth, throat, larynx, oesophagus and liver.

  • Danger during pregnancy and breastfeeding: Some studies suggest that having as little as one drink a day during pregnancy may increase the chance of miscarriage, slightly lower birth weight, cognitive and behavioural problems, or minor physical defects in the baby.

  • Extra risk in certain individuals: Do not even think about starting to drink if you have a family history of alcoholism or depression, a personal history of anxiety, depression, or dependency on a medication, or the slightest doubt about your own self-control.

The Age Factor
The earlier one starts drinking, the greater is the risk, both of starting to drink heavily and of eventually developing an alcohol-related disease.

Risks Of Immoderate Drinking
Immoderate drinking can harm rather than protect the heart by raising the blood pressure, weakening the heart muscles, and triggering abnormal cardiac rhythms. Excessive drinking increases the risk of breast cancer even more than moderate drinking does.

The biggest sufferers — besides the person who drinks in an immoderate manner — are the other family members. I have come across many instances of men battering their wives and children following immoderate drinking. It leads to shame, social isolation, economic loss, debts, antisocial activities and divorce. Children suffer from severe anxiety and fear. The whole family’s life gets disorganised.


Child Sexual Abuse Is Not Only A Western Phenomenon
Sexual abuse of children is being increasingly reported from India. More cases have come to light from the cities, but I do not think it is just an urban phenomenon, it seems that cases from the rural areas often go unreported.

Boys As Well As Girls Can Be Victims Of Sexual Abuse
Male as well as female children can be sexually abused. Of course, it is more common with female children. I mentioned the male child as well because I once saw a case of syphilis affecting the anal region of a boy due to sexual abuse by a neighbour. Some people also have a wrong notion that having sex with a virgin will cure venereal disease, and therefore prey on young children.

Guidelines For Parents
I would not like to scare parents to such an extent that they start overprotecting their children and in the bargain, make children mistrust all adults around them.

Sometimes, it is just the curiosity of a boy or hormonal changes in a teenager that may have led to such an episode. Possibly, there was no intention to sexually abuse the other person. But all boys and girls must be made to understand that it is not right.

The moment children enter school, they should be told that certain parts of their body are ‘private’ and that others have no business to touch or play with them. 

The issue of the possibility of sexual abuse should be discussed in a casual way in the presence of the child. An incident that has appeared in a local newspaper, magazine or a journal could be used to bring up the issue. 

Let the parents create an atmosphere in which a child feels free to report to them if anything like this happens. The parents should then listen sympathetically and follow up the case. The child should not be made to feel guilty or unduly fearful whereby she stops reporting to the parents in the future.

Sometimes, the person who abuses the child will brainwash her in such a way that the child will not be able to tell her parents. Very often, it is a family friend or a relative who is the culprit; though it can also be a complete stranger. 

I encourage the custom in certain families where a grownup brother or sister, and grown-up children and parents are not allowed to sleep in the same room. Also, as far as possible, children should not be left alone with servants. Movies, books and magazines that tend to titillate should be avoided.

Sexual abuse should be suspected if one finds a sudden change in the child’s behaviour. The child may become withdrawn or may show aggressive behaviour. She may start bed-wetting or start masturbating excessively. She may seem afraid of meeting new people and feel insecure in the absence of her parents.

Seek the help of your doctor or a family counsellor if you have any suspicion that your child is being sexually abused. A book and reference guide on the subject is Bitter Chocolate: Child Sexual Abuse In India. Written by Pinki Virani, Bitter Chocolate records the testimonies of the police, doctors, child psychologists, mental health professionals, social workers, lawyers and traumatised victims themselves. 

Helping Children In Need
If you sense that a child— any child— is being abused, whether sexually or otherwise, call your local Childline at the number 1098, throughout India. Childline began in 1996 as a 24-hour phone service for children in need, and it is today run through a network of non-governmental organisations in 14 cities.

Children usually develop an idea of the concept of death between the ages of 5 and 9 years. The death of a member of the family (a relative or a pet) or a friend; the television, movies or stories; religious influences and reactions of adults at home when a close one dies, all contribute to influence the child’s concept of death.

Do not evade questions about death. Help your child to know that death is an inevitable part of life’s journey. That we get upset when we lose something, or that we weep when a person dear to us dies need not be considered a sign of weakness. Similarly, anxiety about the future, feelings of guilt that we probably did not give our best to the one who has left us, or anger at the doctors who attended the patient are common reactions. 

A child may show undue anxiety and fear, with restlessness, loss of appetite and difficulty in going to sleep. Some children may believe that they caused the death — by their bad behaviour in general and lack of respect. The child may also show no sign of grief if she was not attached to the bereaved; don’t let this upset you. The important point is to accept the child’s reaction as natural and respect it.

Should a child be taken to a funeral or to the burial grounds? Personally, I am for it if a child of school going age is keen on it. Keep someone in charge of the child; she should be brought back home if what she sees unduly upsets her. Children are less likely to be disturbed if they are prepared in advance about what they are likely to see at the time of burial or cremation. 

A child may ask about what happens after death or where one goes. Follow your instinct when you answer, but never tell the child that bad people go to narak or hell. In some families, children are told that the person who has died has gone to be with God; tell your child this if you are comfortable with it. Soon, more questions may follow; ask a counsellor for help if you feel inadequate to answer them. 

Terminally III Children
It is important that the parents be allowed to stay with a terminally ill child. Contact the Make-A-Wish Foundation if your child has a particular desire she would like fulfilled; ask your doctor or hospital counsellor about this. Answer her questions honestly. And let her know that you will always love her — even when she is no longer with you. 

Parents who are either considering a divorce or have already divorced sometimes consult me about the possible adverse effects of the separation on their children. These children can become withdrawn. Their school performance may suffer. Some of them may feel guilty — they may wrongly believe that they were responsible for the rift between their parents. They can develop a strong bitterness against one or both the parents. Physical problems related to emotional disturbances may emerge. Fear may overwhelm the children. They may be afraid of losing the parent to whom they are more attached. They may even worry that the parent in whose custody they are now may marry again and that the new person in their lives — the stepparent — may not give them the love and security that they seek.

Some children quietly pray that the parents may come together again. When they notice that this is not happening, they start having behavioural problems. The insecurity of the early years may have a permanent effect on these children’s personalities and it may influence their own parenting skills later in life.

On the other hand, divorce may bring the children closer to other members of an extended family like uncles, aunts or grandparents.

For these reasons, carefully consider your decision to divorce. It is difficult to forget the hurts caused by one’s partner, but it is possible — though not always easy — to forgive.

Do Prepare For Divorce If That Seems To Be The Right Option
Here I must quote a few beautiful lines from a song in the Hindi film ‘Gumrah’.

Taluq Bojh Ban Jai To Uska Chodna Acha,
Voh Afsana Jise Anjam Tak Lana Na Ho Mumkin,
Use Ek Khubsurat Mod Dekar, Chodna Acha.

(When the relationship becomes a burden, it may be wise to quit. Let the story which cannot be brought to its logical end be given a beautiful twist and left alone).

Certainly a distinction must be made between a real burden and day-to-day problems. Sometimes, problems and difficulties in life help us grow. But if the relationship leads to the stunting of our growth, it may be time to end it.

Daily fights between parents can also adversely affect the growth of the children and can inflict wounds that may be difficult, or even impossible to heal. In such a situation, it may be right to prepare for a divorce. 

Once the decision to file for divorce has been made, it is important to sit with your partner to discuss how you can part as friends rather than enemies and how you can minimise the effects your divorce can have on the lives of your children. 

Take the help of a common trustworthy friend or your child’s paediatrician if the situation is not amicable.

I am in favour of children having a pet, provided you can organise the care that it requires. Therefore, discuss the subject with the family and even your doctor before you bring a pet home. Your doctor should be consulted because the hair of some animals can lead to attacks of asthma in those having a family history of asthma or other allergic disorders. The size of your living accommodation should also be considered before you take a final decision about the type of pet you should own.

A pet can help a child to learn to give and to receive love. Looking after a pet will also teach your child to assume responsibility for the care of another. A pet can also be a good companion for an only child or a child having chronic medical problems.

A pet can help a child to learn to give and to receive love
A pet can help a child to learn to give and to receive love

There is no doubt that those belonging to step-families are likely to have problems in adjusting with each other. But then adjustment is needed in all human relationships. I have seen both happily adjusted step-families and unhappy birth families and vice versa.

Some preparation is essential before a parent marries again. Children, especially older ones, must be taken into confidence. The single parent can explain to the children that, in spite of all possible efforts, it has not been possible for a lone parent to give them the best care. The parent can also honestly express his or her own need to have a companion.

The prospective parent can be introduced to the children before marriage. It is important to explain to them that their daddy or mummy was different from the would-be step-parent, who is also a good person. 

When the step-family starts living under the same roof, the new person in the family should be ready to face opposition or even accusations.

Discipline should be left to the children’s birth parent. If the step-parent treats the children with respect and understanding, the children start appreciating that. This should be enough to break the ice and the children may start coming closer to the step-parent.

The step-parent may also find out about the hobbies that the children have. He or she should encourage them to pursue the same. If the child likes to swim, they can all go together. The family may go out on a picnic to have fun together.

If the new couple have children of their own, the parents need to handle the situation even more sensitively. If one of the parents is divorced, the children should be allowed to visit the other parent.

As days pass, patience, understanding and a sense of humour can help step-families become united.

If parents also take time to care for the less fortunate people in the community, children may join them in such healthy activities, making the process of integration easier and smoother.

If you have twins and you want a small family, you might as well decide not to have any more children, your chances of having twins again are higher compared to other mothers who did not have them.

If you have twins, your chances of having twins again are high
If you have twins, your chances of having twins again are high

Prepare In Advance
Your doctor will be able to tell you when you are pregnant if you are heading for twins. You and your family should mentally and physically get ready to receive them. You will need extra help, especially if you already have another child. Read about breastfeeding twins. With a little support, most mothers have no problem breastfeeding their twins. 

Elsewhere in this book, I have said, “Treat every child as a royal soul”. This is especially important in the case of twins, and more so if they are identical. They may develop such an affinity with each other that they may not mix with other children. While you should be pleased that they like each other, let them develop their own individualities. Discuss their schooling with the teacher. Let them be placed in separate divisions in school.

All women work — whether at unremunerated household work or paid employment outside the home. Mothers play multiple roles in childbearing, child-rearing and house-keeping be appreciated.

Working Outside The Home
A woman who works outside the home deserves special mention. While she is happy to be a homemaker and wants to continue to play that role, she may also need to work for economic reasons or to satisfy her personal aspirations. It is the responsibility of her family as well as that of the employer to support her so that she can function efficiently and happily. For this to happen, more awareness needs to be created about such matters with the participation of men and women.

Working — And Pregnant — Women
A large study involving nearly 16,000 women in 17 European countries has shown that well-educated women who work in psychologically demanding professions are 40% more likely to give birth prematurely.

The study warns pregnant women not to strain and push themselves to the limit. They should also find time to relax.

Are Men Ready To Pitch In?
Earlier, the average Indian husband wanted his wife to stay at home. Reluctantly, he may have agreed to let her go out to work. But when they both came home equally tired, he still expected his wife to give him a hot meal cooked by her or under her supervision. He did not help her in the household chores. He also expected that his wife would meet all the needs of their children.

Fortunately, this scenario is changing. A Mumbai eveninger carried an article by Firdaus Ali about fathers who wanted to participate in the process and experience of bringing up a child. The gentlemen interviewed did not shy away from playing substitute mother, while their wives worked. All the fathers were “enjoying teaching, discussing, playing and perhaps reliving their own childhoods... New thoughts, ideas, innovations are some of the gifts growing children impart to their fathers,” wrote Ali.

Reveals Dr. Rajesh Parekh, who shares the joys of watching his three children grow while his wife Dr. Firuza Parekh is busy at the Jaslok Hospital Infertility Clinic: “We have adjusted our timings in such a way that we spend more time with the kids.” Children too, benefit from watching their parents share the responsibility of their care. Dr. Parekh explains: “They develop respect for both sexes. And since there is no hierarchy within their family, they would make far more democratic adults in the future.”

Ten Helpful Points For A Mother Who Is Considering The Option Of Working Outside The Home:

  1. If financial constraint is not the limiting factor, stay with your child most of the time in the first 3 years of life. Even older children miss Mom if she is not around. They need her, not only to listen to their woes but also to share their joys.

  2. Take a part-time job.

  3. Work from home.

  4. See that you have a proper person to look after your child in your absence. It could be your husband, your mother or mother-in-law, some other relative or a paid caretaker.

  5. Discuss with your husband if he may be able to adjust his work timings in order to help out with the child.

  6. Make sure that some person is at home when the child returns from school. Some employers may allow you to start work early and leave early so that you can be at home to receive your child. If it is not possible on a particular day, leave a note for the child with the other attendant(s) as to why you could not be present. Talk to her on the phone. It is not a good idea to allow a child to come home to an empty home; she is likely to feel insecure and get into bad company.

  7. Do things together as a family whenever possible. See that you have at least one meal together. Spend more time talking to each other or playing simple games together. It may even mean watching a TV programme that the whole family enjoys.

  8. Save some money for holidays. These need not be expensive. Plan in advance so that you can have real fun together.

  9. Do not try to be a perfect parent whose home is spotlessly clean, who does social work and who has a prestigious job. Know your limits. See that you have 7 to 8 hours of sleep; that you have time with a common friend with whom you can share everything on your mind and with whom you can laugh (and also cry if required). Make sure also that you and your spouse spend quality time together.

  10. Share your feelings with your spouse and children. Find out how everyone can share the responsibility of carrying out household chores.


7 March, 2016

Part 5
Keeping Your Child Happy and Safe
Healthy Habits
Family Issues
Prevention Of Accidents
Keeping Children Entertained
Spending the Holidays Together
Guide to Child Care
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand

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