While there are things that you can do to try and avoid being in the position to have to turn down a referral, there are still situations that are unexpected.

- Background issues. While all children who are available for adoption will have a significant loss in their history, and many will have very sad stories, some background issues could warrant deciding that a child is not right for your family. Birth family histories of mental illness, a birth mother that consumed alcohol or drugs, or known sexual abuse are all background issues with significant impact on a child and could lead to a family turning down a referral.

-Health issues. While it is very common for children available for adoption to have minor medical issues, sometimes parents are offered a referral with a special need that is not something they are prepared for, or a child with a severe degree of a special need that the family was open to. Sometimes a child is healthy, but has "health risks" that a family is unable to accept, such as signs of Fetal Alcohol Syndrome, severe developmental delay, etc.

Malnutrition is another issue that is not always considered a "special need", but can have long term effects on a child's health and well-being. Some parents who are referred a child with severe malnutrition do not feel comfortable accepting that referral.

- Age issues. It is also possible for parents to be referred a child that is a little bit younger or a little bit older than what they had requested. In this situation, the age of the child may not be a good fit for the family because of other children in the home. While having virtual twins or having kids very close in age or with a large gap in age works well for many families, each family has to decide what age child will work best in their family.

- Gender issues. While many people would argue that since parents who have biological children do not get to choose the gender of their child then adoptive parents should not get to choose the gender of their children either, most adoption programs allow just that. While I think out of all of these issues, gender would be the least reason for a family to turn down a referral, I have heard of families turning down a referral for a boy or a girl when they a already have several children in the home of one gender and really want a child of the opposite gender.

Accepting a referral or turning down a referral are both very significant decisions, and not ones that should be made lightly. Adoptive parents should never accept a referral out of guilt or obligation, and yet they should also know that it is normal to feel a variety of emotions when accepting a referral. Being upfront with your social worker and your agency about what age, gender and special needs you feel comfortable with and finding the right adoption program are the best ways to avoid being in a position to turn down a referral.