FOSTER CARE: Health Concerns of Children in Foster Care
Children in foster care comprise some of our most medically at-risk and vulnerable children. As the result of various circumstances, including poor prenatal care, maternal substance use, and erratic past medical care, these children may have significant unrecognized or under-treated illnesses, immunization delays, failure to thrive, and dental caries. Mental health concerns secondary to removal from the family unit are also common. Developmental delay that is secondary to one of the above risk factors or the result of parental deprivation occurs in about half of all children who are less than age three when they enter foster care.
Children require a thorough physical assessment within one week of entering foster care. If there is an urgent medical emergency, these children should be evaluated in the Emergency Department. Appointments for medical care should be made in order to evaluate any acute physical or psychiatric disease and to document any obvious injuries (e.g. bruises, marks, fractures) or signs of sexual abuse. They should also have age-appropriate and pertinent lab work and a routine PPD if they are older than 12 months.
These children need to be reassessed within one month and as soon as the previous medical records, including immunizations, have been received. This should include vision, hearing, and developmental and/or psychological evaluations in addition to a complete physical examination. Foster children frequently need referrals to dentists and specialists such as ophthalmologists, mental health professionals, speech therapists, and occupational and physical therapists. For a list of common medical problems of children entering foster care, see the table below.
More frequent medical visits, usually every three to six months, may be necessary to evaluate the child's on-going health needs and to assess the foster parents’ and caseworker’s needs and responsibilities. Ongoing developmental assessments may also be necessary. Routine, periodic, health care visits should take place as recommended by American Academy of Pediatrics. For more information, see Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
Possible Medical Problems of Children Entering Foster Care
Anxiety
Asthma
Attachment disorders
Compulsive water drinking (polydipsia)
Depression
Developmental delay
Emotional or behavioral problems
Encopresis
Enuresis
Excess appetite (hyperphagia)
Failure to thrive
Genetic and birth defect syndromes
HIV infection
Inadequate immunization
Long bone and rib fractures
Poor dental hygiene or multiple caries
Poorly controlled chronic illness
Prenatal exposure to cocaine, alcohol, narcotics
Sexually transmitted diseases
Shaken baby syndrome
Sleep disorders
Appropriate Medical Evaluation Checklists
The initial screening within one week of entering foster care should include:
Review of pertinent birth history and family history (if available)
Physical exam
Assessment for signs of abuse and neglect
Evaluation for active illnesses, injuries, disabilities, or mental health issues
Determination of current medications
Assessment for allergies
Assessment of need for medical equipment (nebulizer, eye glasses, hearing aid)
Assessment of tuberculosis risk and placement of PPD
Screening for lead poisoning, anemia, or other exposure
A comprehensive medical assessment within one month of entering foster care should include:
Reassessment of above issues
Review of available medical records
Assessment of vision and hearing
Assessment of HIV risk that includes risk of HIV exposure, capacity to consent to an HIV test, and HIV testing history (This is required by law for all children in foster care.)
Evaluation of substance abuse and disabilities (This needs to be done within 45 days of placement.)
Assessment of development (This may be done later than one month if the child is showing dramatic improvement in foster care.)
Management of chronic illness and disabilities
Referrals for dental assessments and mental health assessments (Preferably done within one month of entering foster care.)
Development of a problem list and treatment plan
Documentation to local Department of Social Services
