Adoption and fostering glossary

A guide to the adoption and fostering legal, medical and social work terminology used on Be My Parent.

Accommodated/Accommodated, S25 (Scotland) Act 1995
When a child is accommodated by the local authority, they provide the child with somewhere to live safely. The local authority has the consent of the child’s birth parents to care for the child and they retain full parental responsibility. This is a temporary arrangement until the child is able to return home, or alternative arrangements are made.

Adoption and Children Act 2002
The Adoption and Children Act 2002 (England and Wales) was the biggest overhaul of adoption law for 26 years. It was designed to improve and modernise the adoption process, including intercountry adoption, and ensure that the needs of the child are paramount. The Act was fully implemented in December 2005. Similar changes to adoption legislation are planned for Scotland and Northern Ireland.

Adoption financial support
Lump sums or ongoing payments may be made at any stage. All financial support payments are means-tested, so the financial circumstances of adopters have to be assessed. The payment is made by the placing authority.

Adoption order
An adoption order grants complete parental responsibility (in summary, who has the legal right to make decisions about the child and their future) to the child’s adoptive parents, and removes it from all others, including the child’s birth parents and the local authority.
An adoption order cannot be applied for until a child has lived with his or her adoptive parents, continuously, for at least ten weeks in England and Wales, and cannot be made by the court for 13 weeks in Northern Ireland and Scotland – though, in reality, most families have the order granted around nine to 12 months after the child moves in.
These time limits are for children placed for adoption by agencies, rather than, for example, long-term foster carers who later decide to apply to adopt the child they are fostering.

To become an adopter or foster carer, families need to be ‘approved’ by an adoption or fostering agency. The agency will assess the family, and then formally agree their suitability to adopt or foster, and recommend the type of child or children they would best be able to care for.
For a particular child, some agencies may favour families who have already been approved to adopt or permanently foster, so as to minimise delay in placing the child with permanent carers, which could be detrimental to the child.
A family does not have to be approved to subscribe to Be My Parent and make enquiries about the children we feature. If a family has not yet applied to an agency, they can ask the child’s agency if they would be willing to assess them, or arrange for another agency to do so.
However, this will only happen in exceptional circumstances, and already being approved, or close to approval, will speed up the matching process.

Asthma can affect anyone of any age. It is an extremely common condition, characterised by inflamed, swollen or sensitive airways. A child may wheeze or cough or find it hard to get breath, or their chest may feel tight. The frequency and severity of asthma varies from person to person but it often has a trigger, such as exercise, dust or a viral infection. Asthma is usually controlled quite successfully, either with inhalers and/or preventative medicines. Children may find they outgrow the condition, particularly if their symptoms are mild. The cause of asthma is uncertain, though it is believed to be a mix of genetic and allergic factors.

Astigmatism is a common eye condition that blurs the vision. The cornea, a transparent layer of tissue that falls over the front of the eye to protect it, should be regular and symmetrical. When imperfectly curved, light passing through the eyes is ‘smeared’. The extent of the blurring is usually present at birth and does not change over time.
Astigmatism may be so mild that a person does not need treatment, but, otherwise, they can treat it by wearing glasses or contact lenses. For severe cases, other options include refractive surgery, which reshapes the cornea, or laser treatment: both have permanent, successful results, although the risks should be fully discussed with a doctor.

Attachment difficulties / disorder
This is when an individual has difficulty building or maintaining healthy, close relationships because attachment between caregiver and child was unsatisfactory in the pivotal first two years of life. Children with attachment difficulties display a wide range of behaviours.
Avoidant attachment patterns mean an individual is overly self-reliant, often because as an infant their needs were denied or rejected.
Disorganised attachment patterns cause an individual to be controlling and distrustful because a caregiver was a source of anxiety as well as comfort.
Ambivalent attachment patterns mean a caregiver may have responded unreliably and unpredictably to an infant’s needs, prompting extremes of behaviour in later life.

Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is marked by disruptive behaviours seen in several places, not just school, and unexplained by any other condition. It is usually first noticed in early childhood. Children with ADHD may have difficulty focusing and concentrating, be hyperactive and impulsive, and experience mood swings. ADHD is thought to be common, affecting three to seven per cent of school children. Until recently, it was thought that children outgrew ADHD, but research now suggests that symptoms can continue into adulthood. ADHD can be managed in a range of ways. Some children may respond to behavioural therapies or dietary regulation, such as avoidance of caffeine or artificial colourings. Others may benefit from medication.
You can find more about ADHD from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Autistic spectrum disorder
Autistic spectrum disorder (ASD) affects how the brain functions, usually causing difficulties with social interaction and communication. Asperger’s syndrome is one of the disorders in the range of ASD. About two to three people in every 1000 have ASD, with males three times more likely to be affected. Symptoms usually appear at under, or around, two years old. They vary and range from mild to severe; some people have learning difficulties, while others excel academically, often in particular areas. The cause of ASD is unknown but there is ongoing research into hereditary and/or environmental factors. There is no cure, and someone with ASD will always have difficulties, although their symptoms may change. Treatment tends to focus on the areas of support and therapeutic input.
You can find more about autistic spectrum disorder from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Behavioural, emotional and social difficulties
These broad terms describe how an individual often cannot, or does not, respond appropriately to a situation, either emotionally, behaviourally and/or socially. That response will vary in severity and output for each individual. Common responses include, however, being confrontational, verbally aggressive, having poor concentration, withdrawing, and finding it difficult to communicate.

Bipolar disorder
Bipolar disorder is a mental health condition in which a person’s moods vary from one extreme to another. There are episodes of depression and episodes of mania (feeling ‘high’ and happy), often with stable periods in between. Treatment usually includes medication, such as lithium, to stabilise moods, and may also involve therapy. Bipolar disorder used to be known as ‘manic depression’. It can affect young people from around the age of puberty onwards but is very rare before then. It is thought that someone is slightly more likely to have bipolar disorder if someone else in their family is affected.

It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Bone marrow transplant
Bone marrow is a soft substance in the centre of our bones. Bone marrow contains stem cells, which create three important types of blood cell: red blood cells, which carry oxygen around the body; white blood cells, which help fight infection; and platelets, which help stop bleeding.
Bone marrow transplants are used in the treatment of some cancers; for example, leukaemia, which affects the person’s stem cells, and stops them being able to replace the important blood cells that the body needs to stay healthy.
Before the transplant, the abnormal stem cells are destroyed by chemotherapy or radiotherapy. A bone marrow transplant then replaces the abnormal stem cells with healthy stem cells, via a drip into the person’s blood. The healthy stem cells are either taken from a donor or a different part of the person’s body. The transplanted healthy stem cells then take over production of the new blood cells.
Bone marrow transplants are intensive procedures that can cause unpleasant side effects. There are also risks; for example, infection, the body rejecting the new stem cells, or the new stem cells attacking the body.

Can present younger than their years / emotionally behind their years
Although all children develop at different rates, there is a general pattern to their development, for example by the age of six or seven most children are rapidly developing their imaginative skills and can understand rules for behaviour. Children who have special needs, including attachment issues, may be behind in their social and emotional development. Depending on their age, this may present in a number of ways, such as: difficulty expressing feelings; reluctance to try new activities; low self-esteem and confidence; difficulty understanding the difference between right and wrong; and lack of empathy for others.

Care order
A child may be subject to a care order if the court considers it unsafe for them to live at home. The child is ‘looked after’ by the local authority, who shares parental responsibility with the child’s birth parents. The local authority is responsible for decisions about the child’s welfare including where they live and who they have contact with.

Cerebral palsy
About one in every 500 children has cerebral palsy. It is the name given to a range of conditions which affect movement and are caused by damage to the brain while a baby is in the womb, or during or shortly after birth. Cerebral palsy affects different people in different ways, can vary from very mild to severe, and can affect all or part of the body. Children with cerebral palsy may have difficulty moving their muscles, or not enough control over their movements. There is no cure for cerebral palsy, but treatment often includes regular physiotherapy sessions to assist movement. Other types of support may include medication, speech therapy or occupational therapy.
You can find more about cerebral palsy from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
You can find out more about cerebral palsy from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Challenging behaviour
Children with particular special needs may display what is known as challenging behaviour. For example, some children may have tantrums, show aggression, or be verbally abusive. Adopted and fostered children often have special needs related to their history and circumstances. A child who is disabled or has attachment issues or a learning difficulty may exhibit challenging behaviour. Training in dealing with challenging behaviour is available for prospective adopters and foster carers from their approving agency.

Child and Adolescent Mental Health Services (CAMHS)
Most local authorities offer a CAMHS service, which provides an inclusive approach to supporting the mental and psychological health of children and young people. The aim is for these children to be assessed and professionally treated and supported, along with their family, across a wide spectrum of services, such as health, education and social care. Such support is generally NHS-provided.
The approach CAMHS uses is organised around a four-tier framework, which ascends according to the extent of the child’s difficulties. For example, a child on tier one will not need to be referred to mental health specialists, but instead get support from people such as GPs, teachers or voluntary agencies. A child on tier four, however, may require admission into hospital or a specialist day unit. Some children may need support in more than one tier, or even all four, at the same time.
For more information about CAMHS, you can contact your local Primary Care Trust (PCT).

Child Development Centre (CDC)
Child Development Centres (CDCs), part of the NHS, provide assessment, diagnosis, treatment and advice for children whose development may be delayed. Children will usually be referred by their GP or health visitor, but also perhaps by their paediatrician, social worker or Special Educational Needs Co-ordinator.
At the CDC, a treatment plan will be drawn up, in consultation with the child’s family. Progress will be fed back to the carers at regular intervals.

Childcare / parenting experience
Many agencies may be looking to place a child specifically, or ideally, with families with some experience of caring for, or being around, children. This may be for many reasons, such as because the child has particular needs that would require more assured, confident parenting.
Childcare experience can involve anything from babysitting, working in the childcare sector, to looking after nieces and nephews. Parenting experience refers to just that – experience of parenting an adoptive, foster or birth child.
This kind of experience is always helpful. If a prospective adoptive or foster family has not had much contact with children in adulthood, they may be advised to think about how they can increase this, such as volunteering at a local playgroup or school.
However, childcare or parenting experience is not essential, and many families with no experience of either will go on to adopt or foster, with the support and preparation of their agency.

Cleft lip and palate
A cleft lip and/or palate is among the most common birth defects in babies, with around one in 700 babies being born in the UK with a cleft: around 50 per cent of these babies are born with both a cleft lip and palate; 25 per cent with a cleft lip; and 25 per cent with a cleft palate.
A ‘cleft’ is a split or opening. It occurs when the top lip or roof of the mouth (palate) does not fuse completely in the womb. The severity of the condition really ranges. For example, a cleft lip can be anything from a small notch in the lip to total separation of one or both sides of the lip, extending into the nose.
Surgical repair of a cleft lip is normally done by the age of three months, and generally only leaves a small amount of scarring. Surgery for a cleft palate takes place between six and 15 months of age, and can be more difficult to repair, as the cleft palate can cause associated problems with feeding, speech and hearing. This is also why the condition should be treated early.

Clinical psychologist
A clinical psychologist will work with people who have a range of psychological or mental health problems, such as challenging behaviours, addictive behaviours, eating disorders, depression, learning disabilities, and so on. The aim is to improve the client’s psychological well-being.
Clinical psychologists tend to work with one particular client group; for example, children or people with learning difficulties. They use assessment methods such as psychometric tests, interviews and direct observation. The treatments they will provide include therapy, counselling and signposting support. They are often called on to act as expert witnesses in court.
Clinical psychologists work mostly in hospitals, health centres and as part of the Child and Adolescent Mental Health Services (CAMHS), usually in multidisciplinary teams, alongside colleagues such as doctors, teachers, social workers and occupational therapists.

Cognitive development
Cognitive development is a term used to cover the processes by which babies and children learn to think, reason, solve problems, and develop memory and language skills, during their early years. Learning cognitive skills is part of the complicated process of child development.

Cystic fibrosis
Cystic fibrosis is a life-threatening inherited condition affecting over 7,500 people in the UK. It causes the lungs and other internal organs to become clogged with thick, sticky mucus. This makes it hard to breathe and digest food, which can lead to infections and poor weight gain. Cystic fibrosis affects one in every 2,500 babies. Treatment includes medication, a special diet to help weight gain, and physiotherapy to clear the mucus, which parents and carers can be taught. Although there is currently no cure, treatment has improved in recent years and many children will live well into adulthood.
You can find more about cystic fibrosis from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Developmental delay
Children who fall behind the progress made by most other children their age are said to be developmentally delayed. A child with global developmental delay may be behind in all areas, while other children may only show delay in particular areas, such as motor or language skills. Where this delay is due to past experiences, it may be temporary. It can also last for longer. For some children, their delay may be linked to learning or physical impairments.

Developmental milestones / age appropriate
Developmental milestones are age-appropriate developmental goals, such as crawling, based on the ‘average’ age that a child will achieve them. Where there is failure to meet such targets within the expected timeframe, the child is said to be developmentally delayed. Where a child is meeting those milestones, their development is regarded as age appropriate.
Want to know whether your child is developing age-appropriately? Take a look at our simple chart of developmental milestones, which covers the first six years of a child’s life.

Developmental uncertainty
This can refer either to children who are developmentally delayed and it is uncertain whether this delay is permanent or for how long it will continue, or for children who for various reasons, perhaps because they are too young, have not had a precise developmental assessment.

Difficult early experiences
All of the children featured in Be My Parent have experienced loss and disruptions to a greater or lesser extent. For some children, this may have included severe neglect, abuse, or trauma. These experiences will usually only be hinted at in the profiles – unless there is particular relevance in giving more details – to avoid anything that could potentially embarrass or distress anyone involved, particularly the child, now or when they are older. When you make an enquiry, the child’s social worker will be able to provide more detailed information to yourself or your social worker.

Direct (or face-to-face) contact
This involves a meeting or a visit; it often takes place in a neutral area, such as a family centre, sometimes under the supervision of a social worker. Contact can also be made by telephone.

Disability Living Allowance (DLA)
This is a tax-free benefit for anybody under 65 years who needs help with personal care or mobility because of a physical or mental disability. The amount of money received varies depending on how much the disability affects them. To get DLA, either the receiver, or somebody acting on their behalf, has to actively apply for it. DLA is usually mentioned in a child’s profile only when it is already being paid for disabled child.

The Disability Discrimination Act (1995) defines a disabled person as someone with “a physical or mental impairment which has a substantial and long-term adverse effect on [their]…ability to carry out normal day to day activities.” It is Be My Parent’s policy to use ‘disabled’ over ‘someone with a disability’, where possible, because we believe this stresses that children with impairments are ‘disabled’ by society’s discriminatory arrangements.

This is the term given to an unplanned ending to an adoptive or permanent foster placement.

Down’s syndrome
Down’s syndrome is the most common chromosomal disorder, affecting one person in every 1000, and it is one of the most common causes of learning difficulties. The severity with which a person will be affected varies, but there will usually be some health problems, developmental delay and distinctive facial features. Down’s syndrome occurs across all ethnic groups and in both genders. With suitable treatment and support, average life expectancy is about 60 years.
You can find more about Down’s syndrome from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Drug withdrawal symptoms / treatment for drug withdrawal
Most drugs that are taken during pregnancy will pass through the placenta (afterbirth) and enter a baby’s blood supply. A newborn whose mother used drugs during pregnancy may therefore need to remain in hospital for a short while – usually five to ten days – to be monitored for drug withdrawal symptoms, which can occur hours or days after birth.
The nature and severity of the symptoms really do depend on a whole host of factors, such as the type of substance used and the frequency, as well as the child’s level of dependency. However, symptoms often include difficulties with feeding, irritability, tremors, diarrhoea and vomiting. The baby may also have been born prematurely as a result of the drug use, and have corresponding low birth weight and growth.
If a baby experiences drug withdrawal symptoms, the hospital will administer suitable treatment, which involves ‘weaning’ the baby off the drug: for example, giving them small amounts of a safe form of the drug until they no longer need it.
Once discharged from hospital, there may still be lingering symptoms. The baby may also seem generally fraught and require a lot of patience and tender care. However, symptoms do improve with time.
In the long term, there may remain some uncertainty about the baby’s future development. As a result, babies who have experienced drug withdrawal symptoms should be monitored by health and social care professionals as they grow.
For more information, see the Be My Parent feature, Prenatal exposure to drugs and alcohol.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Dyslexia is a condition that mainly affects reading, writing and spelling.
Although considered a learning difficulty, people at every level of intellectual development can have dyslexia. It is believed to be hereditary and to be caused by irregularities in the area of the brain that deals with language.
The symptoms of dyslexia will be a little different for every person, and usually become apparent early on. Toddlers may have speech and language delay and perhaps show difficulty with keeping rhythm or dressing themselves. However, dyslexia is usually diagnosed later in childhood, once the child is at school, through screening tests and a dyslexia assessment.
Once dyslexia is confirmed, the child will usually require some specialist teaching, irrespective of whether they are in mainstream or special school. Their carers can also help them by encouraging their reading and writing in a patient, positive way, and acknowledging their strengths in other areas, such as verbal, social or lateral skills.
You can find more about dyslexia from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Dysmorphic features
A dysmorphic feature is any bodily feature considered by medical professionals to be abnormally formed. To be deemed ‘dysmorphic’, the irregularity of the feature will usually be fairly pronounced, even if it may not always be noticeable or observed.
A dysmorphic feature can be a stand-alone birth defect, but it sometimes suggests an underlying disorder or syndrome. An example of this is the identifiable facial features of a child with Down’s syndrome, such as a flat facial profile and almond-shaped eyes.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Dyspraxia is a condition mainly marked by difficulties with movement, though also associated with difficulties with language, perception and thought. Somebody with dyspraxia may have poor balance, co-ordination and handwriting, trouble remembering and following instructions, and under-developed social skills.
Up to ten per cent of the population show symptoms of dyspraxia, with around two per cent being severely affected. Men are four times more likely to be affected than women. Little is known about what causes dyspraxia. The possibility of it running in families has been put forward, though not confirmed. Other theories propose irregularities in, or impairment of, neurone and cell development. However, research continues.
Dyspraxia is managed with therapeutic input from a wide range of professionals, most commonly speech and occupational therapists.
You can find more about dyspraxia from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Early Years Action / Early Years Action Plus
If a child is not progressing as they should be at nursery or pre-school, they may need extra support to help them succeed to the best of their ability. This is called Early Years Action. School Action is the equivalent programme for children of school age.
An Early Years Action plan will carefully address a child’s special educational needs, and probably include an Individual Education Plan (IEP). The child’s progress will be regularly monitored and fed back to their carers. A child who makes little or no progress may graduate to Early Years Action Plus, which includes support from outside specialists.

Eczema is an inflammatory condition of the skin, which can occur anywhere on the body. It is marked by itchy, dry and red skin, and ranges from mild irritation to severe scaling. The most common types in children are atopic eczema, which affects around twenty per cent of children and is often associated with asthma and hay fever, and infantile seborrhoeic eczema (or ‘cradle cap’), which affects babies under one year old, and usually spreads from the scalp or nappy area. Unless the inflammation is very severe, treatment usually consists of emollients (moisturisers) and medicated creams. Many children will find that the condition lessens with age, or disappears altogether, especially if an allergic cause is found and avoided.

Educational psychologist
An educational psychologist provides support to children having difficulties within an educational setting. These difficulties often centre around learning, but may also involve behavioural issues or disorders. It is usually educational psychologists who make recommendations in relation to special educational needs. They also develop policy and advise teachers, governors, social workers and others on issues such as bullying.
Educational psychologists must be qualified teachers with significant experience, as well as academic training in psychology. Most are employed by their local authority, but some are independent. Every school should, in theory, have a named educational psychologist.
A child is referred to an educational psychologist by their school. If somebody else feels that this referral may be necessary, they will need to approach the school to discuss their concerns.
Educational psychologists work with each child differently. This may include observing them in the classroom and playground, having discussion with carers, teachers or the child one-on-one, and carrying out psychological or educational tests.

Epilepsy is common, and can develop at any age. It is characterised by recurrent seizures, which occur when there is abnormal electrical activity in the brain. ‘Generalised’ seizures involve both sides of the brain and consciousness is lost; ‘partial’ seizures involve a specific part of the brain and consciousness is not lost, or impaired only slightly. About two thirds of childhood seizures are partial seizures. Epilepsy may result from a disability, an accident or illness involving brain trauma, a genetic predisposition, or it may have no known cause. It is managed or treated with anti-convulsant medication. About a third of children ‘grow out’ of their epilepsy by the time they reach adulthood. Many will still need medication on a long-term basis.
You can find more about epilepsy from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Emergency foster care
Emergency foster care is fostering at very short notice, such as in the middle of the night if a child’s birth parent is taken into hospital. It is usually a temporary placement until another is found.

Enhanced fostering allowance
All foster carers receive an allowance for caring for their foster child or children to reimburse them for the costs of maintaining a child. Some receive an enhanced allowance on top of this, usually because they have extra skills, experience and training that make them able to care for children with special needs. This can include children with serious health conditions or disabilities, children with challenging behaviour, or children who have frequent contact with their birth family, eg several times a week.

Failure to thrive (FTT)
Failure to thrive is fairly common and is sometimes called faltering growth. It refers to children who are not growing or gaining weight at the expected rate for their age and sex. It is usually noticed in the first few years of life.
A failure to thrive is diagnosed by looking at factors including the child’s height, head circumference, weight, and weight gain against a chart of what should be expected. If a baby was premature or has birth parents who are smaller than normal, this is taken into account.
There are a number of possible causes of failing to thrive, such as problems with feeding and/or nutrition, illness or a specific health condition. It can also be linked to problems during pregnancy, including illness and a birth mother’s use of drugs or alcohol, and problems at home, specifically lack of care (or neglect) both practically and emotionally. For this reason, many adopted and permanently fostered children may be identified as failing to thrive when they first come into the care system.
There may be an increased chance that a child who failed to thrive goes on to experience some level of developmental delay.

Febrile convulsion/seizure
Two to 5 per cent of babies and young children will have a seizure during a fever. The seizure is ‘febrile’ as it is directly caused by the fever, usually triggered by an infection or inflammation.
This type of convulsion does not usually indicate epilepsy, which produces seizures without fever or illness. Studies also show that, with no other factors, such as family history, only 1 to 2 per cent of children who have febrile convulsions will go on to develop epilepsy.
A child who has had a febrile convulsion should always see a doctor for a check-up and to report the seizure. The convulsions seldom cause lasting effects like learning difficulties or brain damage, but this is slightly more likely if the duration of the seizure was abnormally long, or there were several seizures in a row. In these circumstances, an ambulance should be called immediately.

Foetal alcohol spectrum disorder (FASD)
Foetal alcohol spectrum disorders (FASD) is used to describe a wide range of disorders affecting children whose birth mother misused alcohol during pregnancy. They are also known as foetal alcohol syndrome (FAS) or foetal alcohol effects (FAE). It is not clear what level of alcohol use – including volume, frequency and duration – can trigger structural damage to the brain in unborn babies.
Characteristics of foetal alcohol syndrome (FAS) often include abnormalities of growth, a weakened immune system, and certain facial characteristics. Children with some, but not all, of these characteristics are said to have foetal alcohol effects (FAE). Most babies with FASD will seem irritable, have trouble eating and sleeping, and be sensitive to sensory stimulation. They may also have some level of developmental delay and learning difficulties at a later stage. FASD cannot be cured, but with consistency, support and loving care, children can be helped to understand and live with their condition.
You can find more about foetal alcohol spectrum disorder from Contact a Family (you can look up five terms a month before you will be required to pay for this service). You can also read the Be My Parent feature Prenatal exposure to drugs and alcohol.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.
The charity Parents for Children has developed a Foetally Affected Children’s Team (FACT) Centre of Excellence in recognition of the need to support children affected by their birth mother’s substance misuse.

Fostering allowance
This is always paid to foster carers, but the exact amount of money varies for each local authority and fostering agency. In England, the national minimum allowance for foster carers came into effect in April 2007.

Freeing order
Under a freeing order, all parental responsibility is transferred from the birth parents to the local authority and the child is ‘freed’ for adoption. Freeing orders were often granted when the birth parents are considered to be unreasonably withholding their consent to their child being adopted. They were replaced by placement orders (England and Wales) in December 2005, and by permanence orders with authority for adoption (Scotland) as part of the Adoption and Children (Scotland) Act 2007. However, there are still some children under freeing orders who are waiting for a new family.

A gastrostomy is a tube inserted into the stomach through a hole in the abdomen. It is either a permanent or temporary way of feeding children, who cannot eat or are not getting enough nutrients, with a special liquid. For example, a child may have a health condition or disability that causes digestive problems or makes it difficult for them to chew or swallow. A gastrostomy may be needed for a long or short length of time. Unless there are other health conditions or disabilities, most children with a gastrostomy are able to lead a normal, active life, and can take baths and showers and go swimming. A nurse will advise on how the gastrostomy works and how to look after it, and many families find it surprisingly easy to manage with practice. Usually children with a gastrostomy will need regular monitoring at either their GP surgery or hospital.
There are different types of gastrostomy devices. A standard gastrostomy is about 30cm long. Sometimes it is necessary to use a percutaneous endoscopic gastrostomy (PEG) tube, which reaches the stomach through the mouth, and is often used when there is doubt that a child will tolerate their feeds. Once they are able to do so, the PEG tube may be replaced with a smaller gastrostomy tube, around 5cm long, known as a ‘button’. The main brand of these is a MIC-KEY button. Only a small part of the button shows outside the stomach, and is covered by a valve. Some children may have a malecot tube, a flexible rubber catheter, inserted through the abdomen. There is no right or wrong device, and the decision depends on factors such as the child’s age and condition. Families can also change the type of gastrostomy at any point, if it no longer suits them or the child.

Glue ear
Glue ear, also known as otitis media, is a very common childhood condition that can cause temporary hearing impairment. Children under five are mainly affected, with around 90 per cent having glue ear at least once. If the hearing loss continues for a prolonged period of time, it can delay the speech and language development of the child.
Glue ear is caused when fluid builds up in the middle ear and causes inflammation, often after colds or flu. This can lead to dulled hearing and, sometimes, ear pain.
Glue ear usually gets better by itself with no need for treatment. However, if hearing loss lasts longer than three months, it is usually treated with a minor operation to drain the fluid from the middle ear and insert grommets (tiny plastic tubes) to stop the build up of further fluid. Some may also need their adenoids (small lumps at the back of the throat that are part of the immune system) removed.

Grommets are used to treat glue ear (fluid build-up that causes hearing problems) in children. They are small, plastic drainage tubes inserted into the eardrum during a short operation. First the fluid in the ear is drained out, and then the grommets are inserted. Grommets usually fall out naturally after six to nine months. If the child still has glue ear after this time, they may need to have another set of grommets fitted.

Hay fever
Hay fever is a very common condition, caused by an allergy to pollen, and is usually genetic.
The symptoms include a runny nose, itchy throat, watery eyes and sneezing, which occur at a particular time of year, depending on the type of pollen the child is allergic to (e.g. Spring, trees; May to July, grass and flowers; winter, weeds or mould spores).
A child with hay fever cannot avoid pollen altogether, but their carer can try to lessen their exposure to it. Some examples include: keeping the child indoors when the ‘pollen count’ (number of pollen grains in the air) is high; keeping windows closed; drying clothes inside; and bathing the child after they have been outdoors.
If a child is really suffering with hay fever, there is also a wide range of effective antihistamine and steroid tablets, sprays and drops, all available over the counter. Many are now non-sedating, and should be safe for children in low doses, but this does depend on the child’s age, and should be checked with a doctor or pharmacist.
The good news is that people become less sensitive to pollen as they get older: many find their allergy ‘peaks’ in their twenties.
You can find more about hay fever from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Hearing impairment
People who have a hearing impairment lack hearing, either wholly or partially, and this is either present from birth or a result of disease, disorder or injury, later in life. The term covers all levels and types of deafness, including temporary deafness, such as glue ear.
Having impaired hearing is common. Around 20,000 babies and children, up to 15 years of age, have moderate to severe levels of hearing impairment, and approximately 12,000 of these children (and around 840 babies) are born with hearing loss every year.
Treatment depends on the type and severity of hearing impairment. Some children will be fitted with a hearing aid, a device that amplifies sound. Children with hearing impairments will also receive wide and varied support.
You can find more from The National Deaf Children’s Society.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Heart murmur
In a healthy heart, blood pumps smoothly through the chambers and the valves open and close, making a series of recognisable sounds, audible to a doctor through a stethoscope. A heart murmur is an unusual heart sound, heard though the stethoscope, and sometimes described as a ‘whooshing’ noise. Heart murmurs are very common in babies and children.
Most heart murmurs are ‘innocent’ (harmless) and often result from the fast rate that children’s hearts naturally beat, or an increase in the speed at which the heart pumps – when excited or feverish, for example. Innocent murmurs do not need treatment and these children can lead an active, normal life.
A heart murmur that is not ‘innocent’ can be a sign of a heart condition, and may be accompanied by symptoms such as a blue tinge to the child’s skin, shortness of breath and dizziness. The child’s paediatric cardiologist will do a variety of tests to determine the cause of the murmur, which could include abnormal development of the heart tissues or a hole in the heart. Treatment depends on the cause and may involve cardiac surgery. A child with a severe heart defect usually has a good chance of leading a normal life.
You can find out more from the British Heart Foundation or the Children’s Heart Federation.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Hepatitis B
Hepatitis B is a virus that is transmitted through contact with infected blood or bodily fluids. Infected mothers can transmit the virus to their baby during pregnancy, childbirth or breastfeeding.
Symptoms of the virus usually develop within one to six months. It is estimated that one-third of infections produce no symptoms, another third have mild symptoms similar to those of flu, and a final third experience severe illness, which can include abdominal pain, diarrhoea and jaundice.
Many people will clear the hepatitis B virus and become immune, but those who retain the infection for longer than six months are said to have developed a chronic reaction. This is more common in babies and children.
If a baby is diagnosed as having the hepatitis B virus they will be immunised and given a course of immunoglobulin injections. Their progress will also need continual monitoring and regular check-ups. However, the majority of people with hepatitis B will not need medical treatment.
You can find out more about hepatitis B from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Hepatitis C
Hepatitis C is a virus that is transmitted primarily through contact with infected blood. Infected mothers can transmit the virus to their baby during pregnancy and possibly childbirth.
Hepatitis C predominately affects the liver. Around 20 per cent of people fight the infection and clear it naturally from their bodies within two to six months. For the rest, some will remain well and never develop liver damage or have any long-term effects. Others may develop mild to moderate liver damage (with or without symptoms). Around 20 per cent will progress to cirrhosis (scarring of the liver) over many years. Symptoms can include chronic fatigue, aches and pains, and nausea.
There is currently no vaccine to prevent hepatitis C, but treatment can clear the infection in around 50 per cent of people who have contracted it.
You can find out more about hepatitis C from NHS Direct (free service), or the Hepatitis C Trust.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Hole in the heart / septal defect
A ‘hole in the heart’ refers to a defect in the wall between the heart’s chambers. This occurs in the womb and is therefore present from birth. Sometimes a hole in the heart is genetic, but there is usually no obvious cause.
The three main ‘types’ are: an atrial septal defect (ASD); ventricular septal defect (VSD); and atrioventricular septal defect (AVSD).
An ASD means that there is a hole between the atria (the two upper filling chambers). An AVSD is less common, and refers to a hole in the middle of the heart, between the atria and ventricles. AVSD mostly affects people with Down’s syndrome. Both types can cause more blood to flow to the lungs, with the potential to damage them. A VSD is the most common type, where there is a hole between the ventricles (the two lower pumping chambers). This can enlarge the heart and make it work harder than it should.
A hole in the heart is usually found in the first few months of life, during a routine check-up, but sometimes it is not noticed until much later, perhaps even adulthood. This may be through chance or because possible symptoms have been spotted, such as appearing inappropriately tired, or out of breath after exercise, or simply because the child is ‘failing to thrive’. Other indicators may be a heart murmur or frequent chest infections.
Often, a hole in the heart will produce no symptoms at all. This is especially true of an ASD or VSD. If so, and/or the hole is very small, it is best left alone, as a hole can never get any bigger. For many children, the hole will actually get smaller or even close by itself.
If the hole needs closing, this can be done through an operation or, if appropriate, a less invasive procedure, called a catheter intervention, where a tube is passed through a vein into the heart.
All children with a hole in their hearts will be at increased risk of infective endocarditis, an infection of the inner surface of the heart. They will therefore need antibiotics before operations or certain dental treatments. However, this risk disappears once the hole has been closed.
You can find out more about a hole in the heart from the British Heart Foundation.
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Hydrocephalus is a condition that occurs when there is too much fluid in the brain, because it does not drain away as it should. This fluid is called cerebrospinal fluid.
To treat hydrocephalus, many people benefit from having a thin tube, or ‘shunt’, inserted into the brain. This drains the fluid to another part of the body, as normally happens with people who do not have hydrocephalus. As the shunt is usually permanent, it is important to have regular medical appointments to monitor progress and prevent infection.
The cause of hydrocephalus is not known, but it is thought to be due to damage to the brain or the blood supply to the brain, an infection, or another condition such as spina bifida. It may be present at birth (congenital) or may develop later. Babies with hydrocephalus may have an enlarged head and symptoms such as vomiting, poor feeding and irritability. Children with hydrocephalus may have developmental delay and behavioural and learning difficulties.
You can find more about hydrocephalus from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
You can find out more about hydrocephalus from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Inappropriate behaviours
This applies to a wide range of behaviours that are seen to present difficulties, and may be socially unacceptable. Such behaviour is often intimidatory or invasive, such as outbursts of aggression, both verbal and physical, or sexualised behaviour. It may mean a person is simply behaving unsuitably in certain social situations; for example, it is appropriate that a child is friendly among friends and family, but such behaviour becomes inappropriate when a child is indiscriminately friendly to strangers.

Independent fostering agency
Local authorities and voluntary organisations, such as Action for Children (formerly NCH) and Barnardos, have provided foster care for decades. In the last ten to 15 years, a new trend developed, with independent people setting up their own agencies. These have been inspected and regulated since April 2002.
Have a look at fostering agencies near you!
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Indirect (letterbox) contact
This may include progress reports, letters, videos or photographs of the child, usually sent or exchanged through a third party, such as a social worker or an agency.

Individual Education Plan (IEP)
Some children may need, or may receive as part of their school’s policy, an Individual Education Plan (IEP). This legal document sets out the strategies used to meet the identified needs of an individual child who may have learning difficulties or disabilities, or perhaps be excelling academically. Plans are set, with expected outcomes, and everything is written down so that the child is constantly monitored. The IEP may include the Special Educational Need (SEN) Code of Practice.

Interim care order
An interim (or temporary) care order may be granted while waiting for a final care order court hearing. This will give the local authority and others involved more time to gather information about the child’s welfare to help the court make its decision. The order lasts for eight weeks, but the local authority can apply to the court for an extension.

Lack of care
‘Lack of care’ is a phrase used for a wide spectrum of oversight, from carelessness and negligence to chronic neglect and abuse.

Lazy eye (amblyopia)]
Lazy eye, or amblyopia, is an early childhood condition that affects around one in 25 children. It is a problem with the development of vision by the child’s brain, and usually occurs in one eye, but can occur in both.
If the visual image from one eye is very different to the other (for example, as a result of a squint, cataract, astigmatism, etc), the brain starts to ignore this image and instead uses the image from the good eye. The eye that is ignored is called a ‘lazy eye’.
Vision develops from birth until around eight years. It is therefore very important that treatment for lazy eye takes place in this age bracket. If left untreated, the vision will be permanently damaged.
The usual treatment is to wear a patch over the good eye for several hours a day for a number of months. The patch obscures vision in the good eye, encouraging the weaker eye to work harder. Other treatment includes eye drops, vision therapy and wearing special glasses or contact lenses.

Learning difficulties / disabilities
People with a significant impairment in their ability to learn are described as having learning difficulties/disabilities. ‘Difficulties’ and ‘disabilities’ are often interchangeable terms but ‘disabilities’ sometimes implies a lifelong condition, and/or a symptom of a diagnosed disorder. Learning difficulties/disabilities are often described as ‘mild’, ‘moderate’ or ’severe’.

Life story work
As much information as possible about the child and their history and identity is pulled together as a resource for the child as they grow up outside the birth family. This is usually part of the preparation for an adoptive or permanent foster placement.

Life threatening / life-limiting condition
A condition is life threatening when there is treatment that may cure it, but also the risk that the treatment could fail, such as with cancer. Children in long-term remission or following successful curative treatment are not included in this category.
A condition is life limiting when there is no reasonable hope of a cure. This may involve progressive deterioration, e.g. muscular dystrophy, or the inevitability of premature death, e.g. cystic fibrosis. Although a life-limiting condition cannot be cured, there may be plenty of treatment and support that can ease its severity and hopefully prolong the person’s life expectancy.

‘Looked after’
A looked after child is ‘in the care of’ or ‘accommodated by’ their local authority, often within a foster family, because their birth parents are temporarily unable to care for them. Most children return to their birth families within a short time but other alternative options, such as adoption or permanent fostering, may be considered to be in their best interests.
Please see our look at legal and financial matters in adoption and fostering.

Mainstream school / education
Mainstream schools promote an inclusive education, open to everyone and catering for pupils of all needs and abilities. Pupils with special educational needs will usually receive specialist help and support within the mainstream classroom.

Makaton is a trademarked communication system based on a combination of speech, sign language and graphic symbols. It is used internationally, in slightly adapted forms.
Makaton is primarily used by children and adults who, for various reasons, such as being on the autistic spectrum or having learning disabilities, have difficulties with speech or reading. Those using Makaton will speak using visual signs, or read by looking at pictorial signs. The eventual aim is for the signs to no longer be a necessary prop.
Makaton is a system that the child will have to learn and build upon, with input from their carer. In the UK, there is a national network of qualified Makaton tutors who provide training workshops for carers. Others may prefer to purchase distance training packs. If Makaton has been recommended for a child by a professional, such as a speech therapist, they may share their own training resources with the carer.

A balanced diet includes a combination of food groups, such as carbohydrates, proteins, fats, dairy products, vitamins and minerals. Anyone can become malnourished if, over a prolonged period of time, they lack all or some of these food groups.
Children under five are particularly vulnerable, especially if premature or they had a low birth weight. Certain medical conditions could also affect a child’s ability to feed by mouth or absorb nutrients. Looked after children may be at particular risk due to early neglect, which is likely to have included a poor diet.
There are different types of malnutrition, depending on the nutrients that are lacking, and these produce slightly different side effects. However, most malnourished children will appear more lethargic, anxious or irritable than ‘normal’. They will also take longer to recover from illness or infection. If malnutrition is severe and untreated, it can eventually lead to death.
A person of any weight can be malnourished if they do not eat enough of the ‘right’ foods, but most children with the condition will be underweight and small. They may fail to grow to their full genetic potential, both developmentally and physically (failure to thrive). This is especially true of children who experience malnutrition in the first two years of life, when the effects are often long-lasting.
By the time you adopt or permanently foster a child, any malnutrition should have been medically treated. However, if you suspect a child in your care is malnourished, it is important to work with healthcare professionals to supplement nutritional intake; for example, by introducing special formula milk or fortified food, by mouth or into the blood or stomach (with a nasogastric tube).
As well as continuing to encourage your child to maintain a healthy diet, and showing them how, you may also need to support them in approaching food more positively, especially if they show signs of hoarding, overeating or being very picky.

This means that support is based on the financial circumstances of the carer(s), and that more financial support will be provided for those with lower incomes or fewer savings.

Mental ill-health
One in four people in the UK experience mental ill-health at some point in their lives. Different people are affected in different ways and often there is no clear or specific cause.
There are many different types of mental health issues including schizophrenia, depression, and eating disorders. Some types have a genetic element, which means they tend to run in families, while for others, there is no clear cause.
Various types of treatment are available for mental health problems. Some people benefit from regular medication, a course of counselling, or other types of therapy.

Children have microcephaly when the circumference of their head is smaller than is age appropriate, either because the brain has not developed properly, or it has stopped growing. It is more usual for the brain to be normally formed, despite its smaller size.
Microcephaly is often evident at birth, and its cause can either be genetic or non-genetic. Where it is genetic, it is often a symptom of conditions such as Down’s syndrome. Non-genetic reasons include maternal misuse of drugs or alcohol during pregnancy.
Children with microcephaly have various neurological impairments, from mild learning difficulties to cerebral palsy, but not all will have developmental delay. It really does depend on the child and any accompanying conditions they may have.
A child with microcephaly will always have a smaller head than is age appropriate. Their development will be monitored throughout childhood, and additional support, therapeutic or medicated, will be offered, as needed.
You can find more about microcephaly from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as it may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, which will be included in the child’s profile when available.

Mother and baby care
Sometimes a birth mother under the age of 18 will move into a carer’s home with their baby, so that the carer can provide support and teach them how to care for their child. This is called a ‘mother and baby’ placement.

Motor skills
Learning motor skills is part of the complicated process of child development. Motor skills are what you use when you move the muscles in your body. Gross motor skills use large parts of the body to produce movements such as crawling, walking, and throwing. Fine motor skills are more refined, and use smaller parts of the body to produce movements such as grasping a toy, holding a pencil, or sticking out your tongue. Children with motor skills difficulties may benefit from support such as physiotherapy.

Nasogastric tube
A nasogastric (NG) tube enters through the nostrils, down the back of the throat, and into the stomach, to enable a child to be fed instead of, or as well as, feeding via the mouth. It is normally a temporary way of feeding children who cannot eat or who are not getting enough nutrients with a special liquid. For example, a child may have a health condition or disability that causes digestive problems or makes it difficult for them to chew or swallow, or they may have a blockage at the back of their throat or oesophagus (food tube).
There are two main types of specially designed nasogastric tubes: a short-term tube, made of PVC plastic, that needs to be changed every five to seven days, and a long-term tube, made from very soft plastic, which can be used for four to six weeks. The tube stays in place until it needs replacing, is no longer required, or an alternative method of feeding, such as a gastrostomy, is used instead.
Inserting the tube is a safe, though not very pleasant, procedure, and can be completed very quickly. Adhesive tape is used to secure the end of the tube to the child’s nose. Some carers may be given the option to learn how to do this themselves (with training), though for other children, the procedure will always be done by a nurse. Usually, children with a nasogastric tube will need regular monitoring at either their GP surgery or hospital.
A nasogastric tube can also be used to remove the contents of the stomach, including air, if needed.

Neonatal unit
A neonatal unit is a unit of a hospital specialising in the care of neonates. A neonate is a newborn baby in the first 28 days of life. Babies who are either premature or full-term with neonatal problems can be looked after here.
Within a neonatal unit there can be separate specialised units:
• Special care baby unit/ special baby unit:
A special care baby unit is a unit specialising in the care and monitoring of ill or premature babies. The unit can help with feeding and keeping the baby warm. If a baby is born with drug withdrawal symptoms, they can be monitored and treated there.
• Neonatal intensive care unit:
A neonatal intensive care unit, often shortened to NICU, provides higher intensity care for sicker babies, and has a higher nurse to baby ratio. Very premature babies are often cared for here, or babies who need help with breathing, or who need an operation.

Neurofibromatosis is a genetic disorder causing tumours, usually benign (posing no danger to a person’s health), on nerve tissue. Although genetic, neurofibromatosis can occur spontaneously in a family, and from there on be inherited. It is already present in a person at birth, though typically diagnosed later in childhood.
Some people with neurofibromatosis are almost entirely unaffected by it, while others are disabled by the disorder. The disorder has two types – NF1 and NF2 – and symptoms between the two can vary slightly. For example, people with NF2 generally develop tumours on the nerves in both ears, causing hearing loss, possible deafness, and problems with balance.
Indications that a person has neurofibromatosis include ‘café au lait’ spots, nodules, lumps, and unusual freckling on the skin. More occasional features are short stature and large head size.
Other complications, although uncommon, can occur. These include abnormalities of the skeleton, cancerous growths and seizures.
There is currently no cure for neurofibromatosis. The disorder is instead treated by surgically removing tumours. Additional therapeutic support, such as physiotherapy, occupational therapy and speech therapy, can also be helpful, depending on the individual’s symptoms.
You can find more about neurofibromatosis from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as it may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, which will be included in the child’s profile when available.

Nurture group
A nurture group is a small supportive class, usually within a mainstream primary school, that provides a safe, secure and predictable environment. It aims to respond to the different developmental needs of each pupil, as well as provide support with academic work.
Children who attend nurture groups are often from stressful or disrupted backgrounds, and need to catch up socially and emotionally before they can progress in formal education. The groups usually have an emphasis on communication and language development through interaction, social learning, co-operation and play. The children are also encouraged to trust in adults by fostering a good relationship with the teacher who runs the group.
Children remain a member of their mainstream class while attending nurture group sessions every week for around two to four terms. They eventually return full-time to their regular class.

Occupational therapy
Occupational therapy assesses and treats people with physical, psychological or learning disabilities that affect their quality of life. The aim of the therapy is to help them achieve more independence.
Occupational therapists work with people of all ages, and also offer support to the carers of children with special needs. A child’s main ‘occupation’ is to learn and play, and occupational therapy may be recommended for children who have difficulties with their cognitive, physical and motor skills, such as those with developmental delays, spina bifida or cerebral palsy.
Occupational therapists work in various community settings, but will usually visit patients at home. Assessment can then include suggesting how they might adapt to their surroundings, e.g. by installing wheelchair ramps in the home, as well as helping them learn new ways of doing things.

A doctor who specialises in the care and treatment of children. Children needing a permanent placement will have medical information available about them for perspective carers.

Paediatric unit
This is a hospital unit or ward providing continuing care to infants, children and adolescents.

Although agencies make decisions about whether a family should be approved as an adopter or permanent foster carer, they are guided in this by recommendations made by a group of people who come together to form an adoption or fostering panel. Panels are made up of people with diverse and relevant experience of adoption or fostering – personal and professional. Panels provide considered recommendations about:
whether a child should be adopted or fostered
whether applicant(s) are suitable to adopt or foster
and whether a child should be adopted or fostered by particular applicants.
The panel’s recommendations must be taken into account by the agency when making its decision.

Parental responsibilities order
A local authority can apply to the court for a parental responsibilities order. This means they will have complete parental responsibility for the child in question. The child’s birth parents have greatly diminished parental responsibility but retain the right to oppose their child being adopted or freed for adoption. Parental responsibilities orders were replaced by permanence orders as part of the Adoption and Children (Scotland) Act 2007. However, there are still some children under parental responsibilities orders who are waiting for a new family.

Permanence order
Since the implementation of the Adoption and Children (Scotland) Act 2007 in September 2009, a legal order that can be applied for by the local authority to secure the child’s future is called a permanence order. This is a flexible order that can take two main forms. In every order, there is one mandatory provision – a right and a responsibility that the local authority must assume. These are: the right to decide where the child lives and the responsibility to provide guidance. Beyond that, where permanent fostering is the plan, the remainder of the rights and responsibilities for the child may be shared between the local authority, the foster carers and, if appropriate, the birth parents. In these cases, the permanence order is regarded as a ‘destination order’ to underpin a secure arrangement for the child throughout their childhood. This does not prevent the local authority going back to court to seek authority for adoption if that proves feasible and right for the child.
Where adoption is the clear goal, the local authority may additionally ask the court for the authority to place the child for adoption. In granting this, the court would normally remove all responsibilities and rights from the birth parents, and these would be held by the local authority until the completion of the adoption. You may therefore see Scottish children where the legal status is either ‘permanence order’ or ‘permanence order with authority for adoption’.

Permanent fostering
The aim of permanent fostering is to sustain a child within a family, and enable them to feel secure, until they reach adulthood. Permanent fostering is more suitable than adoption in some cases, such as for an older child who needs to maintain regular direct contact with birth family, or a disabled child who needs continuing social work input and support. Although the foster placement is a permanent one, legal responsibility remains with children services.

Personal / Self-care
Personal/self-care refers to both upkeep of appearance and generally being able to ‘look after’ oneself. This can refer to self-presentation or something more specific, such as a child’s potty training. For confidentiality reasons, Be My Parent uses only general terms, particularly for older children. Where there may be difficulties, such as when a child is wetting the bed, we may mention that he or she needs help with aspects of his or her personal/self-care skills.

Personal Education Plan (PEP)
Every child and looked after young person must receive a Personal Educational Plan (PEP). This document should establish clear objectives, milestones and targets, both academic and behavioural, with the aim of encouraging dialogue between social workers, schools and carers. Other existing plans should fit into, and be integrated with, the PEP. These may include an Individual Education Plan (IEP).

Physiotherapy treats difficulties with physical movement. Treatment concentrates on certain areas of the body such as the muscles, joints, bones, and lungs, and the different techniques include manipulation, heat, massage, exercise, stretching and hydrotherapy (which happens in water).
Many people may benefit from physiotherapy, including people with long-term health conditions, e.g. arthritis, and people with injuries, such as those that are sports-related. Children with cerebral palsy, asthma, Down’s syndrome, cystic fibrosis, spina bifida, and any condition that affects movement, posture, growth and development, may also benefit.
A course of physiotherapy usually takes place over a number of sessions, depending on what is being treated. Often, a physiotherapist will teach their patient some exercises to practice at home between sessions, either alone or with the help of a carer.

Picture Exchange Communication System (PECS)
PECS is an effective training tool to help children and adults with communication difficulties. It was first developed in the United States, and is trademarked by Pyramid Educational Products.
PECS relies on picture exchange to communicate wants, needs and feelings. For example, a child must present a picture of a drink in order to receive an actual drink. This leads to forming simple sentences with pictures. The programme consists of six progressive phases, and may take weeks, months or even years to complete.
People need to be trained to teach PECS, at a cost, through Pyramid Educational Products, who produce a training manual and a range of resources. Others may wish to devise their own method of picture exchange, and there are many internet websites devoted to this subject.
Another communication system, sometimes used for children with autism, learning disorders and other speech and language difficulties, is Makaton.

Piedro boots
Piedro boots are special shoes for children who need extra ankle or arch support to maintain good standing and walking positions. They are often prescribed by physiotherapists.
Piedro boots are easier to put on than normal shoes, as they open closer to the toes. They have removable insoles and come in several widths and sizes.

Placement order
A placement order gives a local authority permission to place a child for adoption with or without the birth parents agreement. Placement orders are often granted when the court decides that adoption is in a child’s best interests but the birth parents are unreasonably withholding their consent. Parental responsibility for the child is shared with the local authority; the birth parents and the adoptive parents until the child is legally adopted. Placement orders replaced freeing orders in December 2005.
For a more in-depth look at the adoption and fostering process, why not take a look at our Information for Families section?

Play therapy
This is a form of therapy that uses play situations to help children act out and express their feelings and experiences, with the aim of diagnosing and treating difficulties in various areas, such as learning or social development.
To find out more about how play therapists work with children, read our feature article.

Police checks
Anyone who is assessed by an adoption or fostering agency has a police check (carried out by the Criminal Records Bureau for England and Wales). It is essentially a check of your police record, so your agency is told of anything on your record that would preclude you from adopting or fostering, such as offences against children.
The Be My Parent website has an area of children’s profiles that is accessible only to subscribers who have had a satisfactory police check, as verified by Be My Parent. This is in addition to the main area of children’s profiles (accessible to all subscribers).

Portage provides regular home-visiting, pre-school education for children with additional needs, and their families. Such children may be disabled and/or have developmental delay and special educational needs. The Portage network in the UK is monitored by the National Portage Association.

Post-adoption support
The Adoption and Children Act 2002 for England and Wales has produced legislation which requires local authorities to provide post-adoption support, either themselves or by arrangement with specialist services.

Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is diagnosed when people show a range of psychological symptoms, considered to be extreme or particularly long-lasting, after a distressing and/or threatening event. Children in the care system who have PTSD, for example, may have witnessed or experienced abuse, whether sexual, emotional or physical.
Somebody with PTSD will usually feel that they constantly ‘re-live’ the trauma, with symptoms including flashbacks and nightmares, intrusive thoughts, and episodes of panic. They may appear emotionally detached, and avoid anything that reminds them of the event. Children will often re-live the trauma in their play. Symptoms can vary in severity, and can emerge at any point – even years after the actual event.
Symptoms of PTSD can be lessened and usually resolved. Generally, medication is not recommended, unless in conjunction with other support. Most specialists advise that somebody with PTSD be encouraged to talk to others about their feelings. If appropriate, they may especially benefit from talking to professionals or people who have gone through similar traumas. Getting support from their adoptive or permanent foster family will also be a vital part of a child’s recovery process.

Preferred area for placement
In this part of the profile, agencies indicate the areas of the UK they would consider for prospective families for the child or children they are looking to place. These are indicated by their initials. See map below for key.
Map of the UK with key for region codes (large type)
On the whole, it may be preferable to look first for children in your own area, as this could be more convenient for arranging meetings and having access to support, or if direct contact is to be envisaged. However, if you feel you are the right family then it may be worth discussing your situation with the social worker.

Premature birth / prematurity
A pregnancy reaches full term between 38 to 42 weeks. A child born before this time span is considered premature.
For some babies, their prematurity will be life threatening, and they may not survive. Because they have had less time to develop in the womb, those that do may have medical and developmental difficulties. The risk of both depends on birth weight and how early they are born.
Most difficulties will be mild or moderate, such as shortsightedness, but some may be more severe, like hydrocephalus. Studies have shown that half of babies born at 25 weeks will have learning difficulties, problems with sight and hearing, and increased risk of conditions like asthma and anaemia. All premature babies will have some developmental uncertainty until they are older and their progress can be monitored.
Most will not require hospital treatment, but very premature babies may need special care, usually in an incubator, to support their body temperature and control their feeding. Some will need a ventilator to help them breathe.
Although the facts can sound scary, medical advancement in this area is staggering, and most premature babies will survive and grow up to be normal, healthy, active adults.

Pupil Referral Unit
A Pupil Referral Unit (PRU) is a centre, maintained by local education authorities, that provides part-or full-time education for children of compulsory school age, unable to attend either mainstream or special school because of illness, exclusion, or for other reasons. Where possible, PRUs gather pupils together by age and the reason for the referral. They must offer a balanced curriculum and supply qualified teachers or instructors. The aim for most children in a PRU is to eventually return to school. Some children, who are having difficulties and may be at risk of exclusion, may also receive support from a PRU while still at school.

Reflect or actively develop
Supporting and promoting a positive sense of self identity is important for all children and particularly so for children who are unable to live within their birth families and are placed for adoption. Ethnic, cultural and religious identity is an important part of self identity, and therefore social workers will consider this aspect of a child’s needs in an adoptive placement very carefully. This needs to be development of a child’s identity that is meaningful and secure, and creates belonging and connectedness. The diverse heritage of some children will need to be thoughtfully considered and translated into a need that an adoptive placement should have the potential to fulfil.
The significance of a person’s culture is likely to grow and develop and have a significance at adolescence and adulthood that may not be apparent as a young child. This is why it is so carefully considered in the long-term planning for all looked after children, along with the whole range of needs an individual child has.
Therefore in placing a child for adoption, it is important for children to be brought up in a family who either is of the same – i.e. ‘reflect’ – ethnic and cultural descent as their birth family, or will help children develop a sense of their birth family’s heritage – i.e. ‘actively develop/promote’ this.
All adopters will need to consider the qualities, experiences and attributes they have in order to be able to do this for any child they are being considered for.
As the Department for Education (England) Adoption Guidance, published in February 2011 as a follow up to the Adoption and Children Act 2002 (England and Wales), indicates: “Maintaining continuity of the heritage of their birth family is important to most children; it is a means of retaining knowledge of their identity and feeling that, although they have left their birth family, they have not abandoned important cultural, religious or linguistic values of their community. This will be of particular significance as they reach adulthood.”
‘Actively developing’ children’s ethnic, cultural – and possibly religious – identity will involve families finding in their support network and the area where they live, or further afield, people, places or other ways of providing an ongoing link and contact with the culture, ethnicity, language or religion of the child’s birth family, so that they can develop this side of their identity. It will also involve having an understanding of discrimination and racism that a child might face as they grow up.
Again, Guidance from the Department for Education mentioned above makes clear that: “All families should help children placed with them to understand and appreciate their background and culture. Where the child and prospective adopter do not share the same background, the prospective adopter will need flexible and creative support to be given by their agency. This should be in the form of education and training, not just simplistic advice, provided in a vacuum, on learning their children’s cultural traditions or about the food/cooking from their birth heritage. The support plan should consider how the child’s understanding of their background and origin might be enhanced. This can include providing opportunities for children to meet others from similar backgrounds, and to practise their religion – both in a formal place of worship and in the home.” It could also be through an agreed contact plan and ongoing relationship with birth family if assessed and considered appropriate.
The child’s new adoptive or permanent foster family can create a world surrounding their child, formed of toys, books, pictures, television, schools, neighbourhood, peers, supporting adults, and language, that will promote a positive sense of the child’s ethnic origins and cultural heritage, in a way that is age appropriate. They can celebrate relevant festivals (including religious ones), perhaps take the child to visit their birth parents’ home country. They could also read newspapers and research or keep track of current events to keep them informed of issues relevant to their child’s origins, thus demonstrating the significance given to this aspect of the child’s culture and being informed in case they ever want to know. They can also equip themselves with practical expertise on diet, skin and hair care. Ethnic, cultural, religious and language identity are developed through a ‘lived experience’.
We would advise that any adopter is open and reflective with their assessing agency in considering their individual strengths and related experiences in this area. Adopters should seek to understand, explore and give meaning to any child’s history, heritage, experience and development.

Reflux occurs when the content of the stomach rises up into the oesophagus (food tube). The most common symptom is heartburn, although other features may include chest pain, hoarseness, difficulty swallowing and asthma. As stomach content often includes acid, reflux can occasionally damage the lining of the oesophagus or, if it backs up into there too, the larynx (voice box). Rarely, it can lead to cancer.
Reflux may be harder to diagnose in infants and small children. Things to look out for include poor weight gain, frequent spitting and vomiting, excessive crying, recurrent pneumonia, coughing and discomfort feeding. Many children tend to outgrow the condition. However, reflux can also re-occur in later life.
The symptoms of reflux can be alleviated in a variety of ways. There are medications on the market to reduce stomach acid, many of which are available without prescription. Changes in diet can also ease reflux, such as avoiding spicy or fried foods. Not lying down after eating is recommended, as this can make reflux worse. In severe cases, surgery may be an option.

Relinquished for adoption
A child is relinquished for adoption when a birth mother makes the decision that she would like her child to be adopted. This decision is most often made when a baby is born, though it can also be made when a child is older. The birth mother, and the birth father if involved, will be counselled to ensure that adoption is really what is wanted. It is now relatively rare for a looked after child to have been relinquished in this way.

Residence order
A residence order decides who a child lives with. It can be granted to any person that cares for a child and it means that they share parental responsibility with the child’s birth parents. A residence order can be granted to a parent, other relative, friend or foster carer (if the child has lived with them for a year or more).

Residential care
In most cases, when a local authority ‘looks after’ a child or young person they place them with a foster family, but sometimes residential care is preferred. This is normally a centre where the young person lives with other young people; their care is provided by members of staff. Usually young people stay in residential care temporarily until it is safe for them to return home, or until a new permanent family is found. Often, they have regular contact with their birth family during this time. Some people refer to residential care as children’s homes.

Schizophrenia is a major mental health disorder, characterised by a severe disturbance in thought, mood and sense of reality. Although symptoms vary, common indicators include hallucinations and delusional thoughts. Schizophrenia affects about one in every hundred people, and is usually treated with medication and/or psychological therapies. Symptoms might be continuous or reoccurring, or be part of a one-off episode.
Statistically schizophrenia tends to ‘run in families’, with the risk becoming higher if the biological relationship is closer. However, the reasons for this are uncertain, and current evidence points towards a possible combination of genetic and environmental factors.
People genetically predisposed may wish to avoid potential triggers, such as intense stress or particular drugs. Additionally, offering a secure and loving home to a looked after child, with a genetic risk of schizophrenia, may be one of the best preventative treatments of all.

Section 19 and 20 of the Adoption and Children Act 2002 (England & Wales)
Under Section 19 of the Act, a child’s birth parent/s or guardian can consent to the placement of their child for adoption. They must give consent by signing a special form witnessed by a CAFCASS (Children and Family Court Advisory and Support Service) officer or a Welsh Family Proceedings Officer. The CAFCASS officer will ensure that the parent/s are able to fully understand their decision.
Under Section 20 of the Act, a child’s birth parent/s or guardian may also at the same time, or at a later date, give ‘advance consent’ to the making of a future adoption order. The parent or guardian can say at this point or later that they do not want to be notified of the final adoption hearing.
The child’s parents can also withdraw this consent under the Act, before an adoption order is granted. The withdrawal of consent by the child’s parents is ineffective if it is given after an application for an adoption order is made.

School Action / School Action Plus
The Special Educational Need (SEN) Code of Practice is a plan of three stages, which ascends in degree of response to children with special educational needs. The first two stages are School Action and School Action Plus. School Action involves extra support within the school. A child who makes little or no progress may then graduate to School Action Plus, which includes support from outside specialists.

Settling-in grant
This is paid to cover, or ease, the initial costs of caring for a child when they are placed with a family. It is a one-off payment and is not the same as a regular adoption allowance.
For a more in-depth look at the adoption and fostering process, why not take a look at our Information for Families section?
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Short break (or respite) care
Short break (or respite) care is when children live with their own family or foster carers, but having short stays with another foster family, to give their main carers a break. Disabled children with special needs or children with behavioural difficulties may benefit from this type of foster care. This is also known as Family Link or Shared Care.

Short-term fostering
Short-term fostering can cover any non-permanent period, from a day to several months. It is a short-term arrangement until the child can return home to their birth family, or an adoptive or permanent foster placement is found.

Sign language
Sign language is a way of visually communicating with others, used mainly by people with hearing difficulties, and involves gestures, facial expressions and body language.
Sign language is not a universal language, and different types are used in every country. Even in the UK, not everyone communicates with the same form, though the most popular by far is British Sign Language, which is used by around 50,000 people. It has its own grammatical structure and syntax, and can vary regionally.
If you are thinking about adopting or permanently fostering a child who uses sign language, and do not know how to use it, there are plenty of books and educational courses to help get you started.

Sign language
Signalong is a sign-based system of communication, produced by The Signalong Group. It is designed to help children and adults with communication difficulties. The system uses, where possible, unaltered British Sign Language signs. These signs are explained in descriptions and diagrams, and depend on a range of factors, such as hand shapes and positioning.
Signalong is not intended to replace speech. Only the most important words – the ‘key words’ – are signed. Grammatical language is used alongside Signalong, as is other forms of communication, such as body language, facial expression and tone of voice. It is believed that all this will help ‘carry’ the message.

Special educational needs
The Education Act 1996 says a child has special educational needs if they have a “learning difficulty which calls for special educational provision”. Schools have a duty to identify and meet special educational needs, with help from local/health authorities. There is a Special Education Needs Co-ordinator (SENCO) in all state schools, ensuring such children receive the right support.

Special guardianship
Special guardianship provides permanence for children for whom adoption or fostering is not the best option. The special guardian is the child’s permanent carer and can exercise parental responsibility to the exclusion of others on most issues. Although the child’s birth parents are still legally responsible for them, their rights are very limited. Support services for special guardians are similar to those for adopters. Special guardianship is a new option introduced under the Adoption and Children Act (2002) England and Wales.

Special needs
This is a term that points to the ‘particular’ needs of the child. Such needs can range from the medical to the emotional, the behavioural to the developmental. A child may have ‘special needs’ because they are part of a large sibling group, or because they are an older child and present the ‘special needs’ that one might expect from an older child who has been looked after for a long time.

Special school / education
Special schools are schools with a special curriculum, and which usually cater for children with special educational needs. Special schools are often run by their local authority, but there are also non-maintained special schools, usually run by charities, and independent special schools.

Speech and language difficulties
People with difficulty communicating to the best of their ability are said to have speech and language difficulties. This may be associated with physical disabilities, such as cleft palate, or other physical difficulties, such as those involving feeding, chewing and swallowing.
Speech and language difficulties may also stem from neurological disorders, learning disabilities, hearing loss and other identifiable sources. However, there may be difficulty with using and understanding language with no obvious physical trigger, and which may or may not be rooted in emotional grounds.

Speech and language therapy / service
People with difficulty communicating to the best of their ability may be referred to a speech and language therapist. A speech and language therapist sometimes works in isolation with the individual, but more often will work alongside caregivers and appropriate professionals, such as those from school if the patient is a child. People are often referred to speech and language therapists by their GP. The therapy will usually take place in either a hospital or health centre, community centre or a school. Sometimes the speech and language therapist will visit the patient at home.

Splints are used to support, protect or hold a part of the body still to restrict movement. In children, for example, a splint may be needed to correct a growth problem, mend a bone, or protect an area from further injury.
Splints are moulded to a specific part of the body, e.g. hand, leg, wrist, toe, finger, or elbow, and are usually made of plastic.
Children may need to wear a splint for a set length of time, such as a few months or longer. They may need to wear their splint all the time, for part of the day, or only at night.
It is important to keep the splint (and the skin around and underneath it) clean and keep an eye out for problems such as pain, discomfort or a rash.

Standard Assessment Tests (SATs)
SATs are examination tests, given in the areas of English, maths and science, to children at the end of school years two, six and nine. These school years roughly correspond with the ages of six/seven, ten/eleven, and thirteen/fourteen. SATs are used to show a child’s academic progress compared with other children born in the same month.

Statement of special educational needs (SEN)
The SEN Code of Practice is a plan of three stages, which ascends in degree of response to children with special educational needs. The final stage is statemented provision, which is granted by the local authority when it assesses a child’s needs cannot reasonably be met by their school. Local authorities are legally bound to arrange the provision specified in the statement of special educational needs, and a school named as best meeting the child’s needs has a duty to admit them. The statement is annually reviewed.

Supervision requirement, S70 Children (Scotland) Act 1995
Where the local authority steps in and needs to consider alternative plans for permanence for a child, many of the children featured from Scotland will be on a supervision requirement from the Children’s Hearing under section 70 of the Children (Scotland) Act 1995. This is the key first step when a compulsory legal order is required to ensure the safety and well being of a child. The birth parents still retain their parental responsibilities and rights but important aspects of these are suspended – in particular the Hearing decides where the child will live and can make conditions about contact. The need for the supervision requirement must be reviewed annually. The Hearing would be kept informed about the need for a plan for permanence for a child and, where the local authority are starting a legal process to secure that plan, they must be formally asked for their advice. In order to avoid delay for a child, the Hearing can agree to a move on a fostering basis to a family who might ultimately hope to adopt the child. This includes placement within Scotland or in other parts of the UK.

Support networks
Your support networks are your friends, family, and anyone in your wider community, such as religious associates. Agencies will usually want to know more about your support networks, as this helps them understand who will be there for you, and with whom your child will interact. This may be even more relevant if you are a single carer, or if you are planning to adopt or permanently foster a large sibling group.

Sure Start
Sure Start is a government programme to give every child the best start in life. Sure Start centres were initially set up in disadvantaged areas, but the current target is for every community to have one.
A Sure Start centre aims to offer support and information for families with children aged five and under. Every child’s programme will vary, according to the area, the child’s needs and the circumstances of the family. However, the programme may include early years’ teaching, advice, health screenings, support with getting back to work, free childcare for nursery children, and so on.

Talipes / club foot
Talipes is the medical term for a foot that is malformed or mispositioned at birth. One in a thousand children have talipes, and 50 per cent have it in both feet. Talipes can be hereditary, caused by underlying disorders, or by conditions in the womb.
There are four different types of talipes, depending on how the foot is twisted. The most common is Congenital Talipes Equinovarus (CTEV) – also known as club foot – with the heel and foot rolled inwards, and the toes pointing upwards.
Some children with talipes need corrective treatment to ease mobility difficulties, and this should be started as young as possible. Talipes is often treated with physiotherapy and gentle manipulation of the area by strapping, plaster casting, splinting or wearing special boots (such as Piedro boots) for an agreed amount of time – sometimes years. Some children will need an operation to straighten the foot if other treatments do not work, especially if the deformity is severe.
A child with talipes may experience further difficulties as they grow. For this reason, they require regular check-ups until they reach adulthood.
You can find more about talipes from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

The first teeth usually appear between four and seven months, but may emerge before or after this. Some babies are even born with one or two already formed! The teething process usually continues until around three years of age. It usually causes some discomfort and irritability, as the gums become tender and swollen. The child may drool, wake up more in the night, have difficulty feeding, and need extra soothing.

Therapeutic support
Therapeutic support is a general term used for many types of support that a child may receive, or would benefit from receiving in the future. Therapeutic support enables children to explore their feelings and understand their experiences in a more in-depth way, with a specialist person or organisation.
Some children receiving therapeutic support may have had difficult early experiences, for example being neglected, abused, or witnessing domestic violence. Others may have behavioural difficulties or developmental delay. Many adopted and fostered children have attachment difficulties, and therapeutic support for the child and their new family may help the child to settle and form attachments.
In Be My Parent, the term often refers to counselling, psychotherapy, play therapy, or behavioural therapy, including services provided by the Child and Adolescent Mental Health Services (CAMHS).

Visual impairment
People who are blind or partially sighted are said to have a visual impairment. A person with severe sight loss may be described as blind even if they have some degree of vision. Some children with a visual impairment may have another health condition or disability such as diabetes or cerebral palsy. Visual impairment may also be caused by an injury to the head.
You can find more about visual impairment from Contact a Family (you can look up five terms a month before you will be required to pay for this service).
You can also find more about visual impairment from NHS Direct (free service).
It is really important that you find out how this medical condition specifically impacts on this particular child, as this may vary widely. We are recommending that agencies ask their medical adviser to provide information on this, and this will be included in the child’s profile when available.

Voluntary adoption agency (VAA)
A VAA is a registered and inspected adoption agency run by non-statutory organisations, e.g. by charities like Barnardos and NCH. They range in size and often specialise in the type of adoption they offer. They may seek adopters for black children or sibling groups.