Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care

Abstract

The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children' s medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs. THE FACES OF CHILD WELFARE IN THE UNITED STATES The child welfare system strives to protect the safety of children while supporting families whose children are placed in foster care. In this document, the term "child" includes infants, children, adolescents, and young adults. The child welfare system also serves as a bridge to the primary goal of permanency through reunification or adoption. On September 30, 2018, the Adoption and Foster Care Analysis and Reporting System reported that 437 283 children and adolescents were in foster care. 1 Of these children, 262 956 entered foster care during the fiscal year of 2018, with 250 103 exiting foster care. The number of children served in the foster care system during 2018 was 687 345. There were 125 422 children waiting to be adopted, with 71 254 having parental rights terminated and 63 123 subsequently being adopted from care. 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%). Other reasons that account for less than 10% in each category include child behavior problems, parental incarceration, parental alcoholism, abandonment, sexual abuse, child disability, relinquishment, parental death, and child alcohol and other substance use. 1 A growing number of children, estimated to be 5% to 10%

How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review

“…Globally, CiC have significant health care needs compared to children not in care. 50 However, to date, the health of CiC, both locally (in Australia) and internationally (USA, UK and New Zealand), has been discussed predominantly in terms of their primary health needs and outcomes. 19,41,[46][47] International guidance consistently reports that CiC's primary health needs should be identified and met, through health assessments, health care plans, routine health checks, and the provision of appropriate medical care when relevant, encompassing medical, dental, optical, auditory, and mental health.…”

“…44,[53][54]59 Five of the six clinical guidelines (three from the UK and two from the USA) provided comprehensive and specific in-depth guidance to promote physical activity among CiC. 23,25,40,[50][51] Consistent with the nutrition-related standards, the UK provided the most detailed guidelines for physical activity in their departmental and clinical documents. It was stated consistently in mandatory departmental documents that all CiC, like their peers outside the system, should have opportunities for physical activity and be encouraged and supported to participate in play, leisure, sporting, exercise or recreational activities of their interest.…”

Understanding Adoption as a Reproductive Justice Issue

“…However, curiosity and exploration of these losses are normal experiences for adoptees and can be an important part of an adopted person developing a coherent narrative of themself. Clinicians and adoptive parents can support adoptees’ development of a narratively coherent identity by cultivating open communication about adoption between parent and child, including issues related to curiosity about birth parents and ethnic-racial and cultural identity (Farr & Grotevant, 2019; Jones et al, 2020). Adopted individuals’ identity development should be supported throughout their lifespan as adoptive identity may become more salient at various developmental milestones, such as pursuing marriage and parenthood, becoming caregivers for ageing parents, experiencing health problems, or losing parents (Grotevant & Von Korff, 2011).…”

Focus on rural adolescent cannabis use and abuse: ignored epidemiologic trends, unique risks, long-term concerns, and hope

“…Parental SUD (2018) was a factor in 36% of cases that led to removing children from the home, while parental alcoholism factored in 5%. Of the 62% referrals of children referred for neglect, many were considered related to undocumented parental substance use 21 . Likewise, rural parents tend to be less emotionally supportive, more intrusive, and harsher than urban parents and the bar for academic excellence is low 6 …”

“…Of the 62% referrals of children referred for neglect, many were considered related to undocumented parental substance use. 21 Likewise, rural parents tend to be less emotionally supportive, more intrusive, and harsher than urban parents and the bar for academic excellence is low. 6,22 Moreover, the teen birth rate in rural areas is nearly one-third higher than in the rest of the United States.…”