Advances in Pediatrics

Care of the Foster Child: A Primer for the Pediatrician

      Foster care was designed to provide temporary, nurturing environments to children while their caregivers (usually birth parents) receive services to help them facilitate eventual reunification. The number of children in foster care in the United States has been steadily increasing in the past 2 decades with more than 500,000 children in care on any given day [
      The Adoption and Foster Care Reporting and Analysis System (AFCARS) Reports #10–17.
      • Szilagyi M.
      The pediatrician and the child in foster care.
      • US House of Representatives, Subcommittee on Children, Youth and Families
      No place to call home: discarded children in America.
      ]. However, according to the US Department of Health and Human Services, Adoption and Foster Care Analysis and Reporting System (AFCARS), there has been a gradual decline in numbers since fiscal year (FY) 2007. In AFCARS Report #17, an estimated 424,000 children were in foster care in the United States on September 30, 2009. Since 2007, the number of foster children exiting the system has been greater than those entering. Overall, the number of children in foster care has declined to its lowest level since 2002, and the number of adoptions has increased to its highest level [
      The Adoption and Foster Care Reporting and Analysis System (AFCARS) Reports #10–17.
      • The Adoption and Foster Care Reporting and Analysis System (AFCARS) Report
      Trends in foster care and adoption FY 2002-FY 2009.
      ]. The recent trend has been to (1) attempt to keep children with their birth families while providing family preservation services, (2) push for more timely reunification of families, and (3) commence concurrent planning early with the aim of expediting termination of parental rights and permanency preparation in cases where reunification is not possible [
      American Academy of Pediatrics. Committee on early childhood, adoption, and dependent care: health care of young children in foster care.
      The Adoption Assistance Child Welfare Act. Pub L No. 96–272 (1980).
      ]. Despite this progress, there still are a large number of children in foster care who require quality health care assessments, treatment, and close monitoring.
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