The growing number of children
living with relatives other than parents requires pediatricians to respond to
the unique needs of these patients and their families, says a new American
Academy of Pediatrics policy statement in the April 2017 Pediatrics.
The policy statement, “Needs of Kinship Care Families and Pediatric Practice
” (published online March 27),
cites growing evidence that children who can’t live with their biological parents
fare better when living with extended family rather than nonrelated foster
Despite overall better outcomes,
however, families providing kinship care face significant hardships. Because
most children living with relatives are in informal arrangements made between
the biological parents and the kin provider, for example, they may lack the
authority to give legal consent for needed primary care, immunizations and
other non-emergency health services.
In addition, although research
suggests children in kinship care may be at lower risk of behavioral health
problems, their risk is still higher than for children living with biological
parents. Kin caregivers also tend to be significantly older, experience
more economic distress and have chronic health conditions or disabilities
because of their age, which can be compounded by the increased, often
unexpected demands of providing care.
“The vast majority of the
remarkable families providing kinship care do so unbeknownst to the child
welfare system, taking multiple children in despite their own health concerns
and without extra income to put food on the table, “said David Rubin, MD, MSCE,
FAAP, lead author of the AAP policy statement.
“With this statement, we want to
raise awareness that some extra supports are needed to help ensure the
well-being of both the child and their kin caregiver.
According to the AAP, pediatricians
can easily identify guardianship arrangements during routine office updates of
contact and consent information so they can better coordinate care and connect
families with community resources available to families providing kinship care,
including community legal services and navigator programs. In the policy
statement, the AAP recommends pediatricians adopt guidelines in the AAP’s Fostering
Health: Health Care for Children and Adolescents in Foster Care manual,
such as more frequent follow-up visits and more in-depth evaluations of the
child’s developmental status, because children in kinship care have many of the
same physical and mental health needs as other foster children.
Pediatricians also can provide
greater guidance to kin caregivers around their own challenges to raising
children, such as prospective planning for guardianship in the event their
health declines, and education for older caregivers on current safety standards
for sleep, motor vehicle travel and injury prevention.
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org
and follow us on Twitter @AmerAcadPeds.