Starting the process of adoption is akin to eating at the iconic Varsity in downtown Atlanta. A prospective adoptive parent is greeted with a big question to answer: “What’ll ya have? What’ll ya have?” At the Varsity, the dining options are not extensive; a diner merely has to choose a burger or a hot dog, a side, and a drink. But adding permanently to your family through adoption will require decisions be made on numerous options as to the type of child desired. Making a decision on those options requires a bit more thought than choosing the fast food meal that tickles your fancy, or more accurately your stomach, at the moment. Let’s consider some of the options available to future moms and dads.

What age child do you desire to adopt? Commonly, people think of adoptions as involving infants, and many adoptions do. According to the U.S. Department of Health and Human Services, “Overall, 20 percent of children adopted from foster care were six years or older at the time of placement, 45 percent were under one year of age, and 35 percent were between the ages of one and five years old.”

Why are newborns such a large percentage of children being placed? First, most adoptive couples would prefer to adopt a newborn. The adoptive mother may not deliver the baby, but she can bring the baby home from the hospital. The adoptive couple is able to raise the child practically from birth. Second, there is a misconception that newborns come with little baggage. While it could be true they may not be as bonded to their birth parents; nevertheless, newborn babies also go through trauma.

A placement of an older child is typically made from foster care. Because of that context, the child comes with “baggage.” The fact that he had to be removed from a parent and placed in foster care signifies that he was subject to some type of abuse and neglect. The trauma of removal from a parent is compounded by situations experienced while in the foster care setting, i.e., moving from foster home to foster home, abuse in that setting, etc. But because older children tend to have more “issues,” they are often deemed less desirable, so many older children are available to be adopted from foster care. According to the most recent federal data, over 400,000 children are in foster care in the United States. And those kids are as much in need of a forever home as an infant.

The composition of the adoptive home may impact the selection of the age of the child to be adopted. If the adoptive couple already has a child or children in the home, they may not want to upset the existing birth order. Adding a sibling will be an adjustment, and it will be made more difficult if Junior is dethroned from his position as the oldest child.

Do you want a boy or a girl? For couples who do not have children, the selection of gender may not matter. A precious bundle of joy to love and nurture could be their only goal. But prospective adoptive couples who already have children may feel differently. If they have a son in the house, they may want to add a daughter or vice versa. If they have two children of one gender, they may want to try their hand at parenting the other gender.

Experienced adoption practitioners will attest that prospective adoptive couples most often request a girl if they have a gender preference. This assertion is confirmed by adoption statistics which evidence that U.S. parents ask for girls far more often than for boys. The percentages of requests by gender are 70% to 90% for girls and 10% to 30% for boys according to www.ingender.com. The 2000 U.S. Census figures showed that of all U.S. adopted children under age 18, 53% were girls and 47% were boys. Girls make up 64% of all children adopted outside the U.S. per Immigration and Naturalization Service (INS) records.

Why is there a preference for girls? Adam Pertman, author of Adoption Nation, has an answer. He notes, “The extent to which women are the driving factor in most adoptions is probably a factor.” He points out that women are the main attendees at adoption seminars he has attended and that they are typically the ones who handle completing the adoption paperwork during the process.

If the goal is to adopt a baby, then taking into account what gender is more desired is a prudent step. Stating a preference for only a girl to adopt puts a prospective adoptive parent in a large group of people seeking girls. Asking for a boy or stating that gender does not matter may result in a quicker match.

Adoptive couples also need to remember that if a baby is being placed as a newborn, a match is probably being made during the pregnancy. Thus, the baby has not been born, and the determination of gender has not yet been confirmed. The gender may be unknown because the birth mother has not undergone an ultrasound or because the gender could not be determined when an ultrasound was conducted. If either of those situations is the case, then couples with no gender requirement will be considered for the match.

Fortunately, when gender ultrasounds are conducted, they are pretty accurate. As parents.com pointed out, one study has determined that the accuracy rate of such ultrasounds is 98%. Ability to accurately determine gender can be affected by several factors—timing (more accurate the further along in the pregnancy); body size (greater body mass makes a clear image of the fetus more difficult); position (are the baby’s legs together?); and multiples (a baby may be hidden from view by another).

What race(s) are you willing to accept? When children are adopted, no one expects the child to physically resemble his adoptive parents. But when a child of another race is adopted, the evidence is clear that the child is not the parents’ biological child. Whether it is that parents don’t want the fact of adoption to be readily apparent or due to social or family considerations, prospective adoptive parents may not wish to adopt transracially. But statistics reveal that 40% of adopted children are of a different race than their adoptive parents. Being willing to adopt across racial lines will provide a prospective adoptive couple more opportunities for a placement.

Adoption takes place in the real world, so those seeking to adopt need to take cold, hard reality into account. A prospective adoptive parent may be willing to accept placement of a child of another race, but if his family will not accept that child, is a transracial adoption a good option to pursue? Sure, the adoptive parent will love the child, but what if grandma and grandpa won’t have anything to do with him? How will that impact the child?

Will you accept a baby whose birth mother smoked during the pregnancy? Despite medical evidence as to the deleterious effects of smoking in general and smoking during pregnancy in particular, the fact is that some birth mothers still smoke while pregnant. Studies have shown that smoking during pregnancy is higher in teens and in women with less than twelve years of education. It is not uncommon for women in these two categories to end up as birth mothers.

While it is possible that a birth mother who smokes might quit during the pregnancy, smoking cessation is not likely. Up to 30% of women continue to smoke during pregnancy with rates as high as 50% in high-risk populations such as the young, poor, and urban populations per a study by Laura Stroud, PhD. Kicking the habit is hard to start with; when a birth mother is facing an unplanned pregnancy (an extremely common reason for an adoptive placement) and the stress of deciding to make an adoptive placement as well, the likelihood she will be able to quit smoking is low. Therefore, adoptive parents will have to decide whether they would put themselves in a position to take placement of a tobacco-exposed baby.

What are the possible risks from prenatal tobacco exposure? The American Lung Association advises that smoking while pregnant is associated with miscarriages, stillbirths, premature babies, and low birth weight due to poor fetal growth. Nevertheless, as reported in an article by Julian Davies, M.D., children who have suffered tobacco-associated growth impairment generally “catch-up” with height and weight during their first few years of life. In the long-term, these babies have an increased risk of nicotine addiction in adulthood based on a forty-year study in which the results were published in the Biological Psychiatry journal.

Effects of the birth mother’s smoking may be seen in the baby shortly after birth. Babies born to smoking mothers may experience nicotine withdrawal symptoms and may have much higher levels of stress than babies born to nonsmokers. In neonatal abstinence syndrome, the babies lack of continued delivery of nicotine results in symptoms such as jitteriness and excitability, being difficult to console, and being rigid or stiff when held. Withdrawal symptoms generally appear within one to seven days following birth and usually go away by the age of six months.

Would you consider a baby who was alcohol-exposed in utero? Is the fact that a baby available for a match has been exposed to alcohol prebirth a game changer? If so, does it matter when the exposure occurred or how much exposure there was? Would the answer be different if the birth mother consumed one glass of champagne at her cousin’s wedding reception when she was eight months pregnant as opposed to her downing a fifth of vodka every week during the entire pregnancy?

Prospective adoptive parents need to go into a possible match with their eyes wide open. Just because the birth mother says she has not consumed alcohol during the pregnancy does not mean that she has not. Alcohol use is typically self-reported to both the adoption entity and the OB. Further, since a great many placements involve unplanned pregnancies, a birth mother may have unknowingly consumed alcohol while she was pregnant.

To answer to whether an alcohol-exposed infant will be considered, a couple needs to have a grasp of what the consequences of alcohol use are. According to the CDC, there is no safe time to drink alcohol during a pregnancy; moreover, there is no safe drinking level in pregnancy. In fact, an academic article on the NIH website describes alcohol use in pregnancy as “a major public health problem.” Why is that consumption a problem? Because when a pregnant woman consumes alcohol, the alcohol passes freely through the placenta to her unborn child.

Estimates are that around 15% of pregnant women consume alcohol during their pregnancy. Risk factors for alcohol use in pregnancy include poverty, homelessness, and preconception substance use. Those who suffer from a psychiatric illness or who have a personal history of physical or sexual abuse carry an even greater risk for alcohol use during pregnancy. All of these factors are commonly seen in the population of birth mothers, making the likelihood their consuming alcohol during pregnancy high. Chances are, then, that prospective adoptive parents will face the issue of determining what, if any, amount of alcohol exposure is acceptable to them.

The worst case scenario from alcohol use is fetal alcohol syndrome (“FAS”), a term coined by Dr. Kenneth Lyon Jones in 1973. FAS is the most severe disorder resulting from alcohol use during pregnancy. It may cause abnormalities in brain development and growth problems. While treatments can manage the condition, there is no known cure for FAS.

Prenatal alcohol exposure is a leading cause of birth defects and neurodevelopmental abnormalities in the U.S. Such exposure can result in a range of developmental, behavioral, and cognitive issues. These problems can appear any time during childhood and may last a lifetime.

When faced with choosing preferences for a child to adopt, prospective adoptive parents will have to make a number of decisions. Given the long-term importance of adding to their family, these choices need to be thoroughly considered and made from an informed perspective. Racing to fill out a checklist and indiscriminately marking what will or won’t be considered is not the way to go. Prospective adoptive parents must walk a fine line between being so picky that their restrictive choices realistically preclude them from adopting to being so accepting that they are leaving themselves open to a child with issues they are not prepared to handle. Eager future parents should take more time to consider what they are prepared to handle in their family than they would what they would like on their plate at a fast food eatery.

Are you ready to pursue adoption? Visit Adoption.org or call 1-800-ADOPT-98 to connect with compassionate, nonjudgmental adoption specialists who can help you get started on the journey of a lifetime.