In honor of May being National Foster Care Month, Strengthening Families, Changing Lives is running a special series designed to give a voice to the many different perspectives of foster care and adoption. This series will feature guest posts by people with widely varying experiences.
Unique Health Needs of Children in Foster Care
by Lisa Zetley, MD
“I just don’t quite know how to help this child. I don’t have much information about her health. She comes back from visits with her mother and complains of stomachaches. Do you think there is something about the snack that she gets during the visit? Or do the visits go badly? She is such a sweet child, I really wish I could figure out why she has these stomachaches.”
I heard this story from a foster mother last week, when she brought her foster child in for her first check-up since coming into care. As a pediatrician at the Downtown Health Center who cares for many children in foster care, this is a scenario I encounter on a regular basis. Foster parents often receive little health information about the children they care for, and have worries about behaviors or symptoms they observe. I have great respect for foster parents who commit to caring for these vulnerable children, and am honored to partner with them to piece together a child’s health history, and ensure that medical needs are met during their time in foster care.
It has been well established that youth in foster care have a higher rate of health problems than children not in foster care. Fifty percent of children and adolescents have one concern or diagnosis that requires regular follow-up with a primary care doctor and twenty-five percent have three or more health problems! These problems include conditions such as asthma, chronic headaches, anemia, and seizures, but do not take into account developmental delay or mental health concerns. Fifty percent of young children in foster care have delayed development and at least sixty percent of youth in foster care have a moderate or severe mental health concern at some point during their time in foster care! These statistics support the recommendations made by the American Academy of Pediatrics and the Child Welfare League of America that children in foster care need more frequent health care monitoring.
When a child is placed in foster care, an initial health screen visit is recommended within three days in order to assess for signs and symptoms of abuse or neglect, evaluate for presence of contagious conditions or acute illness, assess for signs of severe mental health problems, refer for urgent follow-up of serious health conditions, and ensure that the child or teen has the necessary medical equipment and medications previously prescribed of which caregivers are aware. In Milwaukee, we are fortunate to have these examinations completed at the Child Protection Center. This clinic has physicians and nurse practitioners with expertise in identifying abuse and neglect, and they do an incredible job in their assessments of youth who are in crisis as they begin their time in foster care.
Following this initial screening exam, it is important for children in foster care to attend their first comprehensive visit with the physician who will be “their doctor” during their time in out-of-home care. This visit should be completed within 30 days of entering care, and should involve a complete check-up, a review any medical information obtained by the foster family, an immunization update, and an assessment for other common conditions (behavior or mental health concerns, tooth decay, developmental delay, difficulty with school, etc). Ideally this doctor would be the same one the child visited for primary care prior to placement into foster care, as the previous provider would know the child and his or her health issues. Often this is not possible. This 30 day comprehensive visit can provide valuable information about the child and may ease the child’s transition into the foster home.
Children in foster care also need to be seen more often for check-ups than children not in foster care. They should be seen two to three months following the comprehensive exam to see how the adjustment is going, or if new health concerns have been identified. Check-ups should be performed on a more frequent basis due to the higher risk of health conditions. The frequency depends on the child’s age. In my experience, as the foster child becomes more comfortable and secure in the foster home, they often thrive and grow. However, they also let their defenses down, and begin to process the trauma of their past. Visits to the doctor can help youth and their caregivers evaluate the symptoms that can occur due to this time (chronic headaches, bedwetting, sleep problems, behavioral outbursts) and can recommend referrals as necessary. A consistent health care provider can also be available to work with the biological parent, if and when that is appropriate.
Foster parents are often relied upon to bring the child to medical appointments and discuss the findings of the exam (the child’s needs and the doctor’s thoughts) with the rest of the ‘team.’ This can be very challenging, especially if the child has complex health needs and multiple medical providers. I encourage you to ask the doctor to write a brief summary or letter about their concerns that can be shared with the child welfare worker. This summary can outline the follow-up needed for the child, as well as provide the child welfare worker with contact information for the doctor if further questions arise. We have all played the game telephone; the more people who the verbal message gets passed to, the more potential for miscommunication. A written document can help to avoid these problems!
Having cared for children in foster care for the past 18 years, I recognize that there are many challenges that foster parents face when trying to ensure the kids in their care get the health services they need. Lack of prior health history, need for parental consent to obtain certain health services, shortage of pediatric providers accepting new Medicaid patients, and changes in placement or worker while in foster care are just a few of the barriers that make providing adequate health care more challenging. I have found that close communication and collaboration between myself, as the health care provider, the foster family, and the child welfare worker is the best way to overcome these obstacles and do what’s best for the child.
As for my patient with stomachaches, we were able to determine that she was experiencing anxiety about driving with an unfamiliar visitation worker to her visits with mom. The foster mom found that allowing the child to travel with her favorite stuffed animal and book helped her feel secure and also distracted her during the drive. Giving the child a sense of control by allowing her to choose the stuffed animal and book also helped. Not all problems can be solved this easily, but children in out-of-home care benefit greatly from increased attention to their health needs. Foster parents are wonderful advocates who can partner with doctors and child welfare workers to assure that children thrive during the time in their home.
Dr. Lisa Zetley is a pediatrician at the Downtown Health Center, which is a clinic affiliated with Children’s Medical Group. She is an Assistant Professor of Pediatrics at the Medical College of Wisconsin and enjoys teaching residents and medical students about pediatrics as a part of her practice. Dr. Zetley finds great joy in providing primary care to children and adolescents. She is also passionate in her advocacy about children in foster care. She serves as the co-chair of the Foster Care Committee for the Wisconsin Chapter of the American Academy of Pediatrics.