The growing number of children living with relatives other than parents requires pediatricians to respond to the unique needs of these patients and their families, says a new American Academy of Pediatrics (AAP) policy statement in the April 2017 Pediatrics.
The policy statement, "Needs of Kinship Care Families and Pediatric Practice" (published online March 27), cites growing evidence that children who can't live with their biological parents fare better when living with extended family rather than nonrelated foster parents.
Despite overall better outcomes, however, families providing kinship care face significant hardships. Because most children living with relatives are in informal arrangements made between the biological parents and the kin provider, for example, they may lack the authority to give legal consent for needed primary care, immunizations, and other non-emergency health services.
In addition, although research suggests children in kinship care may be at lower risk of behavioral health problems, their risk is still higher than for children living with biological parents. Kin caregivers also tend to be significantly older, experience more economic distress and have chronic health conditions or disabilities because of their age, which can be compounded by the increased, often unexpected demands of providing care.
"The vast majority of the remarkable families providing kinship care do so unbeknownst to the child welfare system, taking multiple children in despite their own health concerns and without extra income to put food on the table, "said David Rubin, MD, MSCE, FAAP, lead author of the AAP policy statement.
"With this statement, we want to raise awareness that some extra supports are needed to help ensure the well-being of both the child and their kin caregiver."
According to the AAP, pediatricians can easily identify guardianship arrangements during routine office updates of contact and consent information so they can better coordinate care and connect families with community resources available to families providing kinship care, including community legal services and navigator programs.
In the policy statement, the AAP recommends pediatricians adopt guidelines in the AAP's Fostering Health: Health Care for Children and Adolescents in Foster Care manual, such as more frequent follow-up visits and more in-depth evaluations of the child's developmental status, because children in kinship care have many of the same physical and mental health needs as other foster children.
Pediatricians also can provide greater guidance to kin caregivers around their own challenges to raising children, such as prospective planning for guardianship in the event their health declines, and education for older caregivers on current safety standards for sleep, motor vehicle travel and injury prevention.