American Academy of Pediatrics: How Pediatricians Can Support Families of Children Who Are Adopted, Fostered or in Kinship Care

Simple acts can help instill a sense of security and resilience in children and teens involved in the child welfare system

Hundreds of thousands of children and adolescents enter the U.S. child welfare system each year, whether through foster care, adoption or placement with relatives. Their needs are complex and unique, and they are more likely to have physical, developmental and mental health concerns – which are especially critical during the COVID-19 pandemic.

The American Academy of Pediatrics details the needs of children and families in an updated clinical report, “Pediatrician Guidance in Supporting Families of Children Who are Adopted, Fostered, or in Kinship Care,” to be published in the December 2020 Pediatrics (published online Nov. 23).

“Pediatricians can help families navigate difficult social circumstances, medical care and transitions to adulthood,” said Veronnie F. Jones, MD, MSPH, FAAP, an author of the report, written by the AAP Council on Foster Care, Adoption, and Kinship Care. “Questions come up, such as – what to do if a child is placed in the care of a grandparent and is showing signs of depression? We provide resources for physicians to identify children’s health needs early, help with treatment, and anticipate future challenges.”

The U.S. child welfare system served nearly 690,000 children in 2018, according to research. The primary reasons for entering foster care include neglect (62%), parental substance use (36%), poor coping skills of the caregiver (14%), physical abuse (13%) and inadequate housing (10%). A growing number of children – estimated between 5- 10% of the total foster care population -- are specifically placed because of complex medical needs.

Caregivers often seek guidance on how to discuss reasons for initial foster care placement or adoption, the AAP notes. Pediatricians can counsel caregivers about the need to understand the child’s specific questions in the context of the child’s current development stage. They can encourage honest, nonjudgmental communication using positive language, and learn how to have conversations about racial and cultural issues, and grief or loss.

Many children and adolescents experience social and emotional issues during periods of transition.

“We build trust with children when we communicate openly and early,” said Elaine E. Schulte, MD, MPH, FAAP, an author of the report. “We counsel families to use the terms ‘biological family’ or ‘birth family’ as part of their regular conversations with children, rather than wait until they’re older to discuss the foster care or adoption process.”

The AAP recommends:

• Children and teens involved in the child welfare system often have multiple health care needs that will require an interdisciplinary team.
• Pediatricians can advocate for legislation that supports continuity of school placement and academic success.
• Children in foster care or adoption are at a far great risk than the general population for neurodevelopmental disorders. Pediatricians can provide surveillance and screening for disorders, such as fetal alcohol syndrome or common mental health issues.
• Pediatricians can advocate for young adults who are transitioning out of care or the juvenile justice system. They are at higher risk for poor physical and mental health outcomes, low socioeconomic status, and lower educational attainment.
• Pediatricians can address the effects of adverse childhood experiences, early childhood adversity, and trauma on early brain development and life course trajectory for both physical and mental health, as recommended by AAP policy.

The needs of children in the child welfare system are even greater during the COVID-19 pandemic.  The clinical report and interim guidance recently released by the AAP are helpful resources: Guidance for Children and Families Involved with the Child Welfare System During the COVID-19 Pandemic:.

“Simple interactions can have dramatic influences on children and teen resilience,” Dr. Jones said. “That is one of the most gratifying experiences in caring for adoptive children and children in kinship and foster care.”

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The American Academy of Pediatrics is an organization of 67,000 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.