As the idea of institutional care gained acceptance, formal rules appeared about how to place children into families: boys could become apprenticed to an artisan and girls might be married off under the institution's authority.[19] Institutions informally adopted out children as well, a mechanism treated as a way to obtain cheap labor, demonstrated by the fact that when the adopted died, their bodies were returned by the family to the institution for burial.[20]
The next stage of adoption's evolution fell to the emerging nation of the United States. Rapid immigration and the American Civil War resulted in unprecedented overcrowding of orphanages and foundling homes in the mid-nineteenth century. Charles Loring Brace, a Protestant minister became appalled by the legions of homeless waifs roaming the streets of New York City. Brace considered the abandoned youth, particularly Catholics, to be the most dangerous element challenging the city's order.[26][27]

In the 1970s, as adoption search and support organizations developed, there were challenges to the language in common use at the time. As books like Adoption Triangle by Sorosky, Pannor and Baran were published, and support groups formed like CUB (Concerned United Birthparents), a major shift from "natural parent" to "birthparent"[182][183] occurred. Along with the change in times and social attitudes came additional examination of the language used in adoption.
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