The pediatrician may be one of the only sources of advocacy, support, stability, and advice for the child in foster care. In that role, he or she must understand the needs and experiences of a foster child compared with other patients in the practice so that the unmet needs of this vulnerable population can be addressed.
Children in foster care are at increased risk for physical, mental, and developmental problems.1 Children in foster care lack the orientation that most other children get early in life from their families who orient young children to expectations and requirements within their social unit through activities, rules, and discipline. Similarly, hospital systems institutionalize what can be expected and what constitutes appropriate employee behavior and work performance.
Children in foster care are often deprived of these basic orientations.2 The pediatrician can help this vulnerable population by developing interdisciplinary collaboration and coordination skills as well as an understanding of the many health issues faced by foster children.
Challenges for the pediatrician
Caring for children who have suffered neglect, abuse, or trauma is challenging, time consuming, and difficult. Care coordination for this population is essential but difficult because of a number of factors. The population is often transient, and it is not always clear to the pediatrician with whom they need to coordinate care—parents, child welfare professionals, or the courts.3
Further, case workers and foster parents may not be aware of all the child’s health conditions and needs, and they may also lack the skills to access and negotiate the healthcare system for their child/client.3
The foster care/child welfare system is a unique bureaucracy with structure, regulations, and systems with which the pediatrician, more than likely, is not familiar. The pediatrician also may be faced with a number of other challenges including:3,4
Incomplete health records documenting prior care, history, development, and current medical problems.
Case workers/foster parents with poor knowledge of current medical and social issues.
Identifying the appropriate person from whom to obtain consent for procedures and routine healthcare.
Inability to refer for evaluation and treatment of needed services from subspecialist, dental, or mental health services.
A vulnerable population
More than a half million children are in foster care every day in the United States, and the foster care environment can sometimes lead to further instability and trauma in this already vulnerable population. Estimates of chronic health problems among foster children range from 30% to 80%. The American Academy of Pediatrics (AAP) designates foster children as having a special healthcare need because of the significant prevalence of health disparities. For example, it is estimated that between 35% and 50% of children in foster care have a special healthcare need compared with less than 20% in the general population.1