Are you thinking about domestic infant adoption? This is an interview you must listen to! We talk with adoption medicine pediatrician, Dr. Todd Ochs, about common risk factors you should know about before adopting an infant.
In this episode, we cover:
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Are you thinking about domestic infant adoption? This is an interview you must listen to! We talk with adoption medicine pediatrician, Dr. Todd Ochs, about common risk factors you should know about before adopting an infant.
In this episode, we cover:
Please review RateThisPodcast.com/creatingafamily
Please leave us a rating or review RateThisPodcast.com/creatingafamily
Please pardon any errors, this is an automated transcript.
Dawn Davenport 0:00
Welcome everyone to Creating a Family talk about foster adoptive and kinship care. I'm Dawn Davenport. I am the host of this show, as well as director of a nonprofit, creating a family.org. Today, we're going to be talking about evaluating risk factors that are common to domestic infant adoption. So this is going to be a general overview of things you need to think about when you're considering adopting an infant. We will be talking with Dr. Todd Ochs. He is a board certified pediatrician in Chicago who specializes in medical issues common in adoption and foster care. His office is recognized as a center of excellence by the Illinois Department of Children and Family Services. And he is authorized in to see foster children for their comprehensive examinations after placement, and he is the pediatrician for an adolescent group home. He is the founding member of the American Academy of Pediatrics section on adoption and foster care. And he is an adoptive dad. So welcome Dr. Ochs, to Creating a Family.
Unknown Speaker 1:04
Thank you. All right, so
Dawn Davenport 1:06
we're just going to jump in to talk about some of the common risk factors that you see that we see in domestic infant adoption. The first one I want to start with is very common, and that is a lack of prenatal care. So why do expectant moms who are considering making an adoption plan often have limited prenatal care?
Speaker 1 1:31
Number one, they're usually poor. And in our country, supposedly, with the greatest health care system in the world, we have large numbers of people who don't have access. These are young women, who may be ostracized from their families may be independent from their families at a young age, our society does not support these young women, which is really sad. So they're poor. They don't have good access, you know, theoretically, they could have access, right? Because there's public health operations that exist in every city. But you have to be able to get there, you have to be able to eat right, you have to be able to and all this other stuff
Dawn Davenport 2:15
and afford prenatal vitamins and all the other stuff they're gonna tell you to do.
Speaker 1 2:19
Art of Having a healthy baby. And it's very, very difficult, I think.
Dawn Davenport 2:25
So what is covered in prenatal care? And how might the lack of prenatal care impact a baby, younger
Speaker 1 2:32
women are much more likely to have a healthy child, a healthy infant, just based on their age. But prenatal care includes lab testing. It includes serial examinations, and ultrasound. If there's any need for further evaluation, it's there. It's really not a slam dunk. It all requires periodic intervention. There's vitamins, there's diet, there are all the trace elements that are needed to develop the brain in a fetus. So the lack of prenatal care means that there are a lot of things that are not going to be addressed. It
Dawn Davenport 3:17
makes sense. All right, another common risk factor, and domestic infant adoption is prematurity. We see in the number of children who are placed for adoption, a greater incidence of prematurity. What causes premature birth?
Speaker 1 3:34
Well, premature birth is the reasons they need to get out of there are a mother who is malnourished, a mother who has something wrong, that hasn't been diagnosed, you know, we look at substance abuse as a kind of an absolute reason for prematurity. premature infants sometimes have errors of metabolism, or we call them anomalies. They have birth defects or other things, and they need to get out. The ones who come out way too early, are the ones where there's an effect from the biological mother, either doing drugs, stimulants or opiates. And the fetus just can't tolerate being in there anymore. If they're too premature, they don't survive. So
Dawn Davenport 4:26
could you give us some months? You know, so we certainly know that the risks associated with prematurity increase, the earlier the baby is born. So if you could use weeks premature, or maybe it's more weight of the baby, just to assess some of the risks. It's actually both. Okay, that makes sense. The weight
Speaker 1 4:46
of the babies, some are small for gestational age, those kids are usually pretty tough. The problem is with babies who are small for their gestational age, they can either be small universally, or They can have big heads and small bodies. brain growth induces head growth, which is crucial because if you have a really small head, you also have a really small brain. It does size alone matter. Well, men have bigger heads than women, and we're not smarter. So it doesn't mean everything. But for baby's brain development is really the key. In adoption, what you want is to be a child with a normal brain, and they'll deal with everything else. And oftentimes, in these children with prenatal malnutrition, prenatal substance abuse, all this other stuff, the brains are not always normal. Well, we don't know is, was his child supposed to be the one who develops the cure for cancer and have an IQ of 200? Or? No? Is this somebody who's going to be challenged their whole lives? Well,
Dawn Davenport 5:52
I think that we just can say that probably the more premature a child is, the greater the long term potential impacts on their physical health. And what you're saying is also on their brain development, even though we know that there are exceptions to that. There
Speaker 1 6:08
are always exceptions. But if a child's over 30 weeks, 3132 weeks, I'll usually do okay. And then also, what's just as important is the reason for the prematurity. Okay, you know, if the mother's blood pressure goes up, my oldest daughter was a 32 weaker, but my wife's blood pressure went up right before she delivered. So that was a child who was small for gestational age because of the high blood pressure, but her brain was fine.
Dawn Davenport 6:38
So the reason for the prematurity also matters as well. Great deal. Let me take a moment here to tell you about our free courses that we offer for adoptive Foster and kinship parents. The courses are sponsored by the jockey being Family Foundation, we have 12 of them, they are terrific. And they're there for the taking. They're there for the using share the information with all your friends, the more people who take them, the better, you can find them at Bitly slash j, b, f support, that's bi T dot L, y slash j, b f support. Now, I want to move into the area of prenatal exposure. We don't have good data on how many children who were adopted domestic infants in the US have been exposed to alcohol or drugs, but we know that it is more common. So let's talk about prenatal exposure. I want to start with alcohol. What are some of the red flags that a mum might have abused alcohol during her pregnancy? When I'm asking is red flags that adoptive parents may pick up when they have met with the mom when they're looking at her file, things such as that?
Speaker 1 7:56
Well, if she has prenatal visits, and she's drunk, that's an absolute red flag, right? And foster kids, sometimes there'll be a kinship arrangement, and the aunt uncle will be able to give history. And that history is priceless. There was supposed to be a foster care study done several years ago on the incidence of prenatal alcohol exposure in foster kids, but they couldn't get any admissions from biological moms that they drunk. So the study went over. It's really the history that will give us the real solid base. There was a study done in 2003. And another country that showed that the facial features that an infant has that are consistent with prenatal alcohol exposure, or fetal alcohol syndrome correlate with how badly the brain is affected. So there are facial features. These are usually kids who are delivered prematurely. Their children who can have very small heads, which means they have very small brains and usually abnormal brains. Their behavior as an infant is very abnormal. They don't eat well, to failure to thrive, kids, they don't develop normally. So all the red flags would fit with somebody who has developmental challenges, maybe some congenital deformities of self guide, and often behavioral challenges as well. Oh, absolutely. Before I move on another red flag is if the mom drank excessively prior to pregnancy, that is a red flag that she drank at least at the initial part of this pregnancy. Again, getting this information is often difficult, almost impossible. Yeah, we've done a good job of making people ashamed. You know of we've stressed the dangers of drinking. And so we see that the hesitancy to admit it. But still, you know, somewhere around 10% of women drink during pregnancy in the United States. I wish it had the desired effect. But it is
Dawn Davenport 10:16
yeah, exactly that no one that does the degree of impact differ depending on when alcohol was consumed in the pregnancy?
Speaker 1 10:24
Absolutely. If you look at a developmental chart, the brain is in play the entire pregnancy. So what's affected 10 years ago, we had a conference at the DuPage. county courthouse and the runner up Ms. Teen Illinois was there. She had prenatal alcohol exposure. She had an IQ of 120. But she couldn't do math to save her life. So we don't know what's going to be affected. Unfortunately, it's very difficult.
Dawn Davenport 10:54
Yeah, it's a difficult diagnosis. Let me also add that you will not often, especially if you're adopting an infant, you're not going to have testing at birth postnatally. That's going to indicate whether the child has been exposed. And that's an accepting a lot of parents don't realize they think that they're going to know we're going to move in a minute to talking about illegal drugs as well as illegal drugs. And those can be picked up sometimes. But alcohol most often is not. Well,
Speaker 1 11:25
alcohol is cheap. It's legal. And most cases of prenatal exposure involve more than one drug. It's rare that a child is just exposed to one drug, if somebody does stimulants, no amphetamines, cocaine, they bring themselves down with alcohol. And so it's very difficult to just isolate one drug. I do want to say that adopted kids have a potential for several things. There's a reason that people drink or do illegal drugs. Usually, they're self treating some sort of psychological issue. So our adopted children have that risk. And inherited psychiatric disorders are not inconsequential. ADHD, schizophrenia, depression, anxiety, we don't inherit them exactly. But we inherit the potential for the allergies, you inherit the potential to be allergic, but not specific allergies. So we have that, then we have if people are drinking or doing drugs, usually they're not eating well. And they're essential elements for brain development. They're choline iron, that these moms are just not getting, they're not getting prenatal vitamins. So they're not getting folate, so the incidence of neural tube defects is much higher. I always tell parents, it's a challenge. We'll always have a puzzle with pieces missing.
Dawn Davenport 13:05
One of the things that I think is often overlooked, since we're still talking about alcohol is that because alcohol is illegal, we think that the impact on a developing fetus would be less we would make sense to think that the illegal substances would be worse, when in fact, alcohol provides the greatest Tourette agentic impact, meaning that it's the greatest impact on the fetus. It is both short term but specifically, long term resources to help parents exposed to alcohol creating a family has a facilitated interactive training for foster adoptive and kinship parents to help recognize children who may have been prenatally exposed to alcohol or drugs and then to train them on best practices for helping this child thrive. We also have a lot of resources on our website, creating a family.org hover over the word adaption click on adoption resources. And there's a whole section on prenatal substance exposure where we've got lots and lots of information on the long and short term impacts of fetal alcohol spectrum disorder, as well as parenting tips, lots of stuff. Did you know that creating a family has a training and support group curriculum it can be used as either a training or support group curriculum. It is for small groups. It is an interactive training and it is specifically for foster adoptive and kinship families. We have 25 curriculum. Each curriculum comes with a video a facilitator guide, a handout and an additional resource sheet if you need it. We'd also comes with their certificate of attendance, check it out at parent support groups.org. All right. There are so many drugs that a expectant mom could be using. So we're going to do kind of a whirlwind going through we can't get into a lot of detail. But what I'd like to do is pick your brain as to what the current research is showing about the long term and short term as well, but really focusing more on the mid to long term impacts of children who are exposed prenatally to the following substances. I'm going to start with opioids, because that's the one that's in the news the most, and by opioids, I'm including things like codeine, hydrocodone, Vicodin, things like that. morphine, oxycodone, Oxycontin, Percocet, hydromorphone, heroin, and also I want to include methadone and suboxone because those are often used in medical treatment for substance abuse disorder. And then also we cannot not to mention fentanyl because it's becoming an increasing problem. All right, so let's talk about opioids. Does the degree of impact long term for the child differ depending on when in the pregnancy, the opioid was used, and knowing full well that often it chews throughout the pregnancy? But let's say once the mom knew she was pregnant, she got into treatment or was in jail or whatever, so that her opioid use was decreased? So does it matter depending on when in the pregnancy? It
Speaker 1 16:16
can, because it's usually coupled also with prenatal malnutrition, so the brain doesn't develop normally. There was just an article about a syndrome associated with fentanyl. This raises another issue that the opioids can interfere with cholesterol metabolism, and interfere thusly with brain development. So all opioids are not good. They're also oftentimes adulterated with other substances.
Dawn Davenport 16:48
Yeah, fentanyl is a one we certainly hear a lot about now, right? Well, it's hundreds
Speaker 1 16:51
of times as potent as heroin. One thing that's very important is suboxone and methadone have a very, very long half life that long half life means that if mom's in treatment, and she's taking methadone Suboxone, that the infant will go through a long period of withdrawal. However, that long period of withdrawal has no effect on future brain development. But it's kind of Rocky, you know, we've had to give kids methadone and detox them, sometimes give them tincture of opium drops, and detoxify, but it's difficult to separate the severe malnutrition and brain development, and the use of the opioids. There are syndromes associated with opioid use during pregnancy. They're linked to cognitive delays, developmental delays, but this is a population of pregnant women who are poor, they may have intellectual challenges themselves. So it's really hard to know
Dawn Davenport 18:04
hard to know what's the exact cause of any, whether it's the malnutrition, whether it's a genetic factor, or whether it's the exposure to opioids. Let me ask you, I think a common misperception, we hear it all the time, adoptive parents make the assumption that if the baby was not born dependent on whatever substance the mom was taking, the baby did not have to go through a withdrawal after birth, or have had a diagnosis of neonatal abstinence syndrome. parents make the assumption that if those things were absent, then it means that the long term impacts are going to be less, when in fact, that's not necessarily the case at all. But we hear it all the time that well, he wasn't born dependent, therefore, I think he's fine.
Speaker 1 18:51
Well, when I was a resident Cook County Hospital, we would have babies whose moms did heroin, and the heroin babies would have a bad day or two, and they'd be fine. Because they would detox quickly. But were their brains fine. The truth is that taking a child with whatever challenges and putting them into a loving, supportive, intellectually stimulating household, they're going to do better. But it's a lot to ask an adoptive parent to take on.
Dawn Davenport 19:23
That's the unknown, of course, yeah, that is the heart. There are certainly some opioids that are legal and being used legally. One of the things that we know is that methadone and suboxone Yes, they have a long half life and yes, they are opiates, and yes, they do impact the baby, but the research indicates that because they're steady dosed. The mom is being seen, her pregnancy is known, so she's more likely to be getting support and for eating and I don't know that any studies have indicated prenatal care, but that these babies tend to do relatively well. And if a mom took oxycodone because she broke her leg during pregnancy that's being dosed at a specific dosage. She's being monitored. Yes, the baby has been exposed. But it's the unmonitored use of somebody who's struggling with substance abuse disorder that is more problematic, or that's what we are seeing. I think that's absolutely true. And are speed dating through the other drugs that we need to talk about? What is the research showing about exposure to methamphetamines? What is the long term impact for children who were exposed prenatally to meth?
Speaker 1 20:34
Well, I take methamphetamine and cocaine are very similar because they're both stimulants. Okay? The problem is that a stimulant contracts, the blood vessels. And as we're creating tissue, there are these mesenchymal little networks of vessels to create the tissue, and they can get snipped by a potent vasoconstrictor is or cocaine or methamphetamine. So these kids are small, their brains can be very small, and also can be abnormal. They're irritable, they may not fit well, it's very difficult, and the mothers are usually in horrible shape. And we're talking again, about severe prenatal malnutrition. So the trace elements that are necessary to create the fetal brain and fetal organs are not there.
Dawn Davenport 21:28
There has been some long term studies on what was at the time called crack babies, we would never call them that now. But children who were exposed to the less expensive form of cocaine, and now we've been studying those kids, gosh, they're into their 30s. And we have not seen some of the or at least the studies that I've looked at, they seem to have done relatively well. And the nightmare scenario that was certainly being portrayed in the media back then did not happen.
Speaker 1 21:58
That's true. There are also issues of resiliency, each infant is different. Each child is different in how they bounce back. Sure, the risks of pinching off these developing tissues is it's in vitro. Does it really happen in life? If adults are doing well having been exposed? That doesn't mean the mom should go ahead and do?
Dawn Davenport 22:23
No, no, this is not. We're not encouraged. But we're talking to adoptive parents. So if there is a record, we're not giving permission for anyone, no child does good when exposed to any alcohol or drug. But from an adoptive parents standpoint, who is looking at a match with a mom who used methamphetamines cocaine crack? What is the research show as far as the long term prognosis for those kids? I mean, that's the question we're asking.
Speaker 1 22:52
I think you're correct in that there's less effect than with alcohol, probably less effect than with drugs like fentanyl and opiates in general. However, the prenatal malnutrition is oftentimes more acute because the amphetamines and cocaine suppress appetite. So these moms don't eat. Alright,
Dawn Davenport 23:16
so we're gonna move on because we're doing kind of a speed round here. The next one is a very important one, because we see an increase in this and that is the use of marijuana during pregnancy. Not only is it becoming legal in many more states, because it's legal. I think the assumption is that there aren't impacts. Fortunately, there is a fair amount of research in this area right now that's being done. Can you just summarize briefly, what do we see for the long term impacts of Children Exposed, whereas mom's used edibles or smoked marijuana during pregnancy? The
Speaker 1 23:51
articles I've read show that there are cognitive delays and kids who are exposed prenatally to tetrahydrocannabinol. The other issue, of course, is why any of these parents do any of these drugs, the CBD, the issue is dosing. One of the true dangerous things is all these animals because the dosages of tetrahydrocannabinol, or whatever else, are not usually standardized. One of the things that happens when people consume THC is the more so it's probably not high quality food, though. Yeah, probably not. But there are articles that show that there are cognitive issues with these kids in the future, which is learning problems and such. So is that a huge red flag probably depends on quantity and frequency.
Dawn Davenport 24:41
And one could argue I suppose that if it's legal marijuana, then at least you know the dosage at least you know what you're getting. I want to move on to we don't see this as much, but hallucinogens including ecstasy. What's the research show right now as far as well? long term impacts, we see it less common, but we still see it.
Speaker 1 25:02
Well, now LSD and some drugs like it are being looked at, as treatments in psychiatry. When I worked at a free clinic in New Orleans, we talked people down from bed trips, and I'm really reticent to see drugs like the surge ik acid dimethyl Lammott being used therapeutically, the underlying psychiatric issues can come into play. with use of hallucinogens, hallucinogens at least theoretically open handfuls of synapses at the same time, and can unroofed a psychosis. So these kids are at much higher risk. But it may be that they're higher risk because they're moms and that risk. Okay,
Dawn Davenport 25:52
well, that makes sense. Okay, we don't as I said, I don't think too many people are taking it therapeutically when they are pregnant, but non therapeutically, we see on occasion. All right, let me just remind everyone that creating a family does have a facilitated training that we offer for foster adoptive and kinship parents to help them recognize kids who may have been prenatally exposed to alcohol or drugs, because as we say, it's not always a parent at all. And then best practices for helping these kids thrive. We also have a lot of resources on our website, creating a family.org. Let me interrupt to thank our listeners that are returning this week, we truly appreciate you. And also want to welcome new listeners, your recommendation of this podcast to your friends is one of the best ways for us to spread our message about creating a family and what we do and to spread good research based trauma informed information. So please help us spread the word by letting others in your circle know that it exists. All right, we're talking about common risk factors and domestic infant adoption. And we're talking with Dr. Todd oaks, who is a pediatrician who specializes in this. So we've talked about some of the physical risk factors, lack of prenatal care prematurity, we've talked about some of the prenatal substance exposure factors, alcohol as well as various drugs. Now I want to talk about mental health issues. Often when looking at a potential match, the adoption professionals will ask about family history, and sometimes we will see in the family history, as well as the health issue of the birth parents certain mental health issues. So what I'd like to do is go through a couple of common mental health disorders and ask how much of a genetic connection there is, with these mental illnesses or these mental health issues, mental health disorders? So how heritable or how genetically connected they are? Let me talk about the first one, anxiety disorders you know, that would include anxiety, panic disorders, obsessive compulsive phobias, things like that. What does the research show as to the heritability of anxiety disorders, anxiety
Speaker 1 28:13
disorders are very much inherited, and they can be even more so in a biological family, because the interactions relate to the anxiety and panic. Also, anxiety and depression are kissin cousins, they often travel on the same road. Well,
Dawn Davenport 28:30
let me introduce in depression, which would include bipolar and other mood disorders, how heritable or depressive disorders
Speaker 1 28:37
Oh, very, very much. If a pregnant mom in the past has suffered from postnatal depression, a depressive disorder and anxiety disorder, I would assume that the infant is really, very highly at risk for developing the same thing. So going
Dawn Davenport 28:59
in with your eyes open, because all things are treatable as well. But it helps if parents are on the lookout for symptoms to get help. Sometimes
Speaker 1 29:06
they're more treatable than others. But in general, anxiety and depression are very treatable issues. Okay. And there are many medications used to help therapy, therapy and medications together are one plus one equals three, they're much more effective together than they are individually.
Dawn Davenport 29:30
Interesting. It's a good way to say it, one plus one equals three. What about personality disorders, antisocial, borderline personality, narcissism, things like that? Is there a heritability or genetic component to those?
Speaker 1 29:44
I absolutely think so. But there's also an incredible social ontogeny to them, I believe to OCD, obsessive compulsive disorder is treated with the same drugs as anxiety and depression. You know, but infants. Infants don't have OCD. No. But parents are making decisions for the life. Right, right. At least the rest of our lives. Yeah, exactly.
Dawn Davenport 30:09
I tell people, they won't be in the footie pajamas stage forever, trust me,
Speaker 1 30:13
in my mind, they're all very, very frequently social interactions that contribute to the personality disorders. So it's
Dawn Davenport 30:23
not it may be there's a predisposition, but that there's also the environment where the child is raised. And hopefully the environment that the child is going to be raised in in your home will not be unleashed unmedicated with any of these issues, what about psychotic disorders that would include like schizophrenia in there? Is there a genetic connection there?
Speaker 1 30:44
There absolutely is. It's not a one to one. Well, for any
Dawn Davenport 30:47
of these things, there's not a one for one, if you're a parent has this, you're guaranteed to have it? Yeah,
Speaker 1 30:53
I wish the recurrent, there are no guarantees. I bet you do wish there was depression and anxiety, I think it's more common, that offspring will suffer. Schizophrenia is definitely genetically transmitted, but it's not as common. It also doesn't appear till the second or third decade of life. So this kids in the late teens, 20s, and then they're diagnosed with schizophrenia, for an adoptive parent. That's tough,
Dawn Davenport 31:25
right. But again, going in, if you know that there's schizophrenia and the history, then you are more likely to recognize the symptoms of it when your child is 1819 2025, whatever. Alright. And the last is ADHD, attention deficit hyperactivity disorder. I don't really consider it much of a mental health issue. But on the other hand, it's classified as that. So how heritable is ADHD,
Speaker 1 31:53
I feel it's very much inherited. Attention deficit, hyperactivity disorder can be so disruptive to children, even early in life. And certainly in elementary school, that high school, it is treatable. And there are accommodations that have to be made, both by the parents and by the schools to help this child make his or her way, sometimes the hyperactivity in these kids is really could be anxiety could be there on the autistic spectrum, you know, it's unclear. So all that's hyperactive is not ADHD. No,
Dawn Davenport 32:34
in fact, prenatal substance exposure is very often misdiagnosed as ADHD. And of course, you can have ADHD and have been prenatally exposed, so they can go together as well. And I also would say, two of my kids have ADHD, I would say that it also comes with some depending on how severe it is, there are also some really good things about it. There are some strengths that come along with it. But there are challenges, particularly in the parenting and learning how to help the child be able to get to the point where it can be an asset, or at least aspects of it can be an asset, any other mental health issues, that parents who are considering adopting a private domestic adoption in the US should consider Well,
Speaker 1 33:21
the autistic spectrum is omnipresent in schools. And really, in our practice, in the population of young mothers who make an adoption plan. It's something that we may not know, we don't really know, the inherited parts of what relates to the autistic spectrum. We just don't know what Yeah, and there are so many different causes and presentations of people on the autistic spectrum, that it would be difficult to say, your baby's definitely going to be autistic, but it's just that to happen.
Dawn Davenport 33:59
If the mom is autistic, or somewhere on the spectrum. What is the likelihood that the child who is not being raised by that mom will be somewhere on the spectrum?
Speaker 1 34:11
You know, I wish we really knew it, I would say it's not enough to breed a red flag at all. In fact, I would make the assumption that this child has every chance to just be a quirky kid, as opposed to an autistic
Dawn Davenport 34:32
kid, right. And now, I mean, there's some argument that says now, we diagnose quirkiness, whereas in the past, we didn't. And so I think that's a very valid point.
Speaker 1 34:43
Well, I think most of us who were geeks in high school would have been diagnosed with Asperger Syndrome back in the day.
Dawn Davenport 34:50
Yeah, exactly. So that's something to say the last risk factor that I want to add and I will address it since it's the legal risk factors but it is very A common risk factor with domestic infant adoption. And so the primary legal risk factor is an unknown, or unidentified birth father, we just need to mention it because it is something you need to think about what you need to do and how it impacts you is going to be controlled by the laws of the state, where the parent lives and where you live. And you need to work with your adoption agency or an adoption attorney to understand what the risk is in your specific case. And what must be done to reduce your risk. We absolutely have to know that it is a risk and you need to go in with your eyes wide open there are in every state specific procedures that can be done, but you need to know about them, and you need to do them. Well, thank you so much, Dr. Todd Oakes, for being with us today to help us evaluate the risk factors common to domestic infant adoption. We truly appreciate it. So welcome. Thank you. Thank you. Thank you to our partners children's connection, who has been one of our longest supporters of this podcast, as well as creating a family in general children's connection is an adoption agency providing services for domestic infant adoption placing babies throughout the US. They also do home studies and post adoption support for families in Texas.
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