Adopted children may also suffer from a loss of access to important medical or genetic birth family histories. Although adoption agencies take pains to gather medical and family history information, it is often not possible to have full information for the entire birth family. In a closed or semi-open adoption, there may be no way for an adopted child to ask questions or clarify vague or missing information that may only become relevant long after the adoption occurred. Even a simple doctor's appointment wherein an adopted child is quizzed about their family medical history can become a trigger for painful or awkward feelings, reminding the adopted child (or adult) that he or she is somehow different from others and doesn't have the same information available to share with the doctor.
Adopted children may struggle with self-esteem and identity development issues more so than their non-adopted peers. Identity issues are of particular concern for teenagers who are aware that they are adopted and even more so, for those adopted in a closed or semi-open circumstance. Such children often wonder why they were given up for adoption. They may also wonder about what their birth family looks like, acts like, does for a living, etc. They may struggle with the knowledge that they may have a whole other family "out there" including half-siblings or extended family members that they may never meet. These issues may still arise in open adoption circumstances, but in that case, adopted children may have the opportunity to form some manner of relationship with their birthmother so as to gain direct access to relevant information.
Guilt feelings may accompany such identity issues and concerns. Adopted children may feel as though they are betraying their adoptive family and/or that they will hurt their adoptive family by expressing their desire to learn about their birth family. In a best case scenario, adopted children do not have to wonder how their adoptive family members feel about their interest in their birthparents because adoptive parents will have addressed these concerns directly in previous conversation. Even in such a best-case scenario, the emotions may still be somewhat painful or difficult.
It is not obvious that an adoption has occurred when adopted children physically resemble their adoptive parents since people are unlikely to spontaneously ask about adoption issues. When parents and children are visibly different (as with interracial adoptions, people outside the family may ask questions or (in an unsolicited manner) "share" their viewpoints on adoption and the appropriateness of adopting a child from another race or culture. This type of attention can quickly become annoying and even hurtful if adoptive parents do not take steps to shut it down. Ignoring such questions, or calmly and assertively stating that the topic is not something that is open for discussion are often good ways to quiet nosy strangers. A more nuanced approach is appropriate when touchy questions have been asked by people the family knows to be well meaning and sincere. In such a case, adoptive children need to look at the questioner's motives for asking, which may stem from a genuine lack of knowledge rather than a desire to harm or take delight in others' discomfort. Sensitive adoptive children may also fall victim to teasing and bullying at school, where other children taunt them in an attempt to make them feel ashamed for being adopted.
Not every adopted child will express an interest in his or her birth family history. Some children become aware that most adoptions occur when birthmothers judge themselves financially and/or emotionally unable to raise a given child, and come to feel that there isn't anything to gain by wondering about or seeking out their birth family. Such children prefer to just leave the adoption as a "done deal" and move on with who they are now, letting the past stay in the past. There is nothing wrong with adopted children who fail to show concern about their birth parents, and likewise, nothing wrong with adopted children who do show such interest. Both reactions are normal, if sometimes painful.