 destabilising the existing adoptive family. See chapter 7. 86 Placing a child with birth relatives 4.13. Local authorities are required by section 22C of the Children Act 1989 (the 1989 Act) to consider a placement with relatives if the child being looked after cannot return to their birth parents. Where this solution is the right one for the child, the placement is likely to be secured under a fostering arrangement or by a residence or special guardianship order, but the appropriateness of adoption by a relative should not be automatically ruled out. 4.14. There may be some circumstances where the security provided by the irrevocability of an adoption order, and its lifelong effect, would be best for the child and outweigh the potential drawbacks of the ‘skewing’ of relationships. For example, a grandparent adopting their grandchild would be legally the child’s parent, which would mean the child’s birth parent would, in law, be their sibling. There is no presumption that a special guardianship order will be preferable to an adoption order if the placement is with a relative. It will be necessary to consider the particular facts of each individual case. See for example Re S (Adoption order or special guardianship order) [2007] EWCA Civ 54, Re AJ (adoption order or special guardianship order) [2007] EWCA Civ 55 and Re M-J (Adoption order or special guardianship order) [2007] EWCA Civ 56. In some circumstances where the relatives who would most suitably care for the child live outside the British Islands, it may be that such a placement can best be achieved by adoption. Health 4.15. Agencies have a duty to satisfy themselves that prospective adopters have a reasonable expectation of continuing to enjoy good health. The medical adviser should explain and interpret health 