The Pediatrician and the Child in Foster Care

IMPORTANT POINTS

1. The primary reasons cited for placement in foster care (>80% of admissions of younger children) are child abuse and neglect.

2. Children in foster care are at high risk for human immunodeficiency virus (HIV) infection related to maternal lifestyle.

3. Biological parents retain guardianship while their children are in foster care unless parental rights are terminated.

4. Behavioral problems of children in foster care escalate with stress brought about, for example, by changes in visitation patterns, changes in foster care placement, and termination of parental rights.

5. Transracial adoption will become more common in foster care with the enactment of recent legislation that is intended to address the needs of the large number of minority children awaiting adoption. The new legislation prohibits the use of race as the sole criterion for adoptive placement, although it still may be one of several criteria considered.

6. Children in foster care have higher rates of chronic medical illness, mental health problems, behavioral disorders, developmental delays, and educational disabilities than other poor children.

7. The primary unmet health care need of children in foster care is mental health evaluation and treatment.

Introduction

About 500,000 children reside in foster care on any given day in the United States. They are primarily the children of the indigent, and their lives prior to placement were riddled by violence and neglect. Removed from or abandoned by their families, these children were placed into a system intended to nurture and repair them, while facilitating the rehabilitation of their families. In reality, foster care has become a system of last resort for the most vulnerable children and intransigent families.

Foster care is intended to be a temporary respite for a family in crisis, with the ultimate goal being reunification of the child and family. However, this system is in crisis, crushed by huge caseloads, families who have …