Adoptive parents often in the dark about care for ‘safe haven’ kids

With abortion now restricted or even penalized in nearly half of U.S. states, there’s likely to be an increase in the number of mothers using safe haven laws to anonymously relinquish their newborn babies.

Parents who choose this option bring their newborn baby to a safe location, typically an emergency room or fire station, and state their intention to “surrender” their baby to personnel at the location. They are asked to provide voluntary information about the infant’s prenatal history and family medical history and can then leave, without facing any penalty. Any identifying information they provide is redacted so their anonymity is protected.

Such laws, first enacted in Texas in 1999 to prevent infant abandonment and infanticide, have since been adopted by all 50 states, the District of Columbia, and Puerto Rico. Although no systematic data are collected, by one estimate more than 4,000 babies have been left at safe haven sites.

Yet little attention has been paid to how best to care for these infants once they have been placed in prospective adoptive homes.

As the founder of the Safe Surrender Clinic at Children’s Hospital Los Angeles (CHLA), I’ve witnessed many families adopting infants who were relinquished through California’s Safely Surrendered Baby Law. Like any new parents, they are overjoyed with the infant in their care. But they also understand that the parenting challenges that lie ahead for them are complicated. They wonder how to navigate the unknown medical history of their child and worry about how prenatal exposure to drugs or alcohol, high levels of maternal stress, or inadequate prenatal care might affect their child’s future.

They often seek clues to unknown aspects of their child’s core identity, even such basic elements as their child’s racial or ethnic backgrounds. Our Safe Surrender Clinic helps these families navigate uncertain futures, and it will become essential for medical providers and lawmakers across the country to assess similar needs in their communities to meet the expected demand and prepare accordingly.

Consider a boy I’ll call Joseph, who was relinquished at a hospital following his birth and placed in a foster home with prospective adoptive parents. When I first met him at six weeks old, he was healthy, meeting his early milestones, and was developing a strong early bond with his foster parents. Despite this great start to his life, we knew from the information his birth mother revealed that he’d experienced some significant prenatal risk factors, including a lack of prenatal care and his mother’s homelessness and mental health struggles. While Joseph’s foster parents were excited at the prospect of adopting him, they remained concerned about the long-term impact of the prenatal neglect he had experienced.

Our interdisciplinary team works to track the development of safe haven infants in Los Angeles County, evaluate their medical concerns, and provide guidance on how to promote their early bonding and attachment in order to mitigate the risks and unknowns they may have experienced. Most importantly, we take the time to explore with families the unknown questions they have about their baby and help determine which of those can be answered, which ones can’t, and how best to can address their underlying concerns, now and in the future.

We’re still learning about the unique needs of safe surrender infants — very little research has been done on them in part because there has been a relatively small number of them. California sees an average of only 80 infants relinquished under its law each year.

Preliminary research shows a few interesting findings. First, California’s safe haven law is working as intended to decrease infant abandonment and death. In the first year after the law was passed in 2001, 20 babies were abandoned in the state, 13 of whom were dead when they were discovered. Fast forward to the most recent years for which statewide data exist (2016 to 2019) and there’s a very different story. Over those four years, only four babies were abandoned and all were found alive.

This is a remarkable policy success, but it is not at all clear that this trend will hold should there be a significant uptick in the number of mothers who are not able or willing to care for their new babies.

The other compelling finding is that safe haven babies are at increased risk for medical issues relative to the general population. In research we conducted, more than half of the safely surrendered babies in Los Angeles County were diagnosed with medical issues in their first year of their life.

In addition, the majority of safe haven infants were relinquished in communities with low median incomes, indicating that this is where their mothers lived. This suggests that the use of safe haven laws is often a sad consequence of economic disparities and lack of community resources.

While this research is drawn only from the Los Angeles area, it highlights concerns that will suddenly become much more relevant in other communities across the country.

When we saw Joseph again at 18 months old, he was healthy, energetic, and active, with all the willpower and drive of a confident toddler. Yet his parents shared that his journey had been difficult. As a baby, he had started falling behind in developmental milestones. At one year old, he showed motor delays, speech delays, and social delays. Fortunately, the family had been connected with early intervention services and Joseph had been getting weekly developmental support and infant mental health services.

This hard work paid off in the form of a healthy and happy toddler. But without the specialized guidance his parents received and the resources that they were able to access, his story might have been very different.

Established with funding from Medi-Cal, California’s Medicaid health care program, in 2013, the CHLA Safe Surrender Clinic is the only one of its kind dedicated to the unique needs of infants relinquished through safe haven laws. And even with that level of specificity, the clinic is unable to evaluate every safe haven infant in the state or even in Los Angeles County. It is essential that clinics like ours be established in other communities, particularly in states where abortion has been outlawed and in underserved communities that might expect to see a disproportionate use of safe haven laws.

I do not in any way mean to suggest that all safe haven infants need specialized care. Many do fine with typical well-baby pediatric care. Yet with their increased risk factors as a population, there is a clear need for more surveillance and early intervention services.

The Safe Surrender Clinic team is comprised of two psychologists, an occupational therapist, and a pediatrician. The clinic’s model could be replicated by most hospitals or medical centers, but states need to urgently fund and upgrade early childhood systems of care to support the needs of a new wave of relinquished babies — as well as babies in the foster care or private adoption systems. Safe haven laws are just the beginning of a child’s journey and states risk failing them if they do not fund and strengthen the medical, developmental, and mental health systems of care for these children and their families.

Micah Orliss is a psychologist in the Department of Pediatrics at Children’s Hospital Los Angeles, director of the hospital’s Safe Surrender Clinic, and a clinical assistant professor at the Keck School of Medicine of USC. He also serves as a Children’s Mental Health Champion for the Association of University Centers on Disabilities and the Centers for Disease Control and Prevention.