The AAP recently issued a policy statement offering guidelines and strategies for pediatricians to address the unique needs of children living with nonparental family members.
Approximately 2.5 million children in the U.S. were living with a family member that was not their parent in 2013, according to the AAP, and although these children typically have better outcomes than those placed in nonfamilial foster care, researchers speculate that these children may face many of the same difficulties as those in traditional foster homes. Caregivers in these situations take custody when parents become absent for reasons such as incarceration, extended inpatient medical care or service in the military.
“The growing number of children in kinship care arrangements requires pediatricians to be better informed about the unique needs of these children and their families. Nonetheless, it remains uncertain how often pediatricians inquire about the caregiving arrangements of children during regular visits to their practices,” David Rubin, MD, FAAP, and colleagues wrote. “Given that the needs of children raised by kin versus biological parents may be different, clarifying caregiver and guardian relationships might prompt pediatricians to screen uniquely on the basis of their needs and help connect these families to appropriate community resources intended to benefit them.”
Some children are placed in kinship care through the child welfare system; however, many parents and family members voluntarily agree to this arrangement without legal paperwork. This practice can cause challenges related to custody in nonemergency health care. Differences in opinion between caregivers and biological parents can complicate and delay situations involving immunizations, developmental screenings, dental care, mental health referrals, diagnostic procedures, surgery, anesthesia and chemotherapy.
Children placed in kinship families, who are more likely to be black and removed from the home due to parental substance abuse and neglect, tend to face many obstacles related to their living situation. When compared with nonkin foster parents, kin caregivers are older in age, have less formal education, are more likely to care for large sibling groups, and have a greater number of chronic health conditions and disabilities. These caregivers are also more likely to be a part of a single-parent household.
Additionally, economic stress is commonly experienced by kin caregivers, and many rely on benefits from the Temporary Assistance to Needy Families program. This hardship can be seen through the lack of appropriate health coverage, where 21% of children in kinship families had no health insurance. A notable amount of these children (44%) were also living below the federal poverty level. Because of the stresses placed on kin caregivers, children in these family agreements tend to carry the stress of caring for their caregivers.
Although there are many possible conflicts and stressors for kinship families, the AAP notes positive attributes to familial connections. Children who are placed with extended family have fewer placement moves than those in traditional foster care and have contact with siblings and biological parents. They also are at a lower risk for behavioral and emotional issues.
The AAP has released several suggestions for pediatricians based on the increased needs of children placed in the care of extended family and their caregivers:
- The child’s medical home can identify guardianship arrangements during routine office updates of demographic, contact and consent information to allow for comprehensive care coordination.
- Pediatric practices can learn more about community legal services and navigator programs.
- Pediatric practices should learn about local statues that govern guardianship and consent for children in kinship care.
- Pediatricians should adopt pediatric health care guidance developed by the AAP for children in foster care as a standard of care for children in kinship care.
- Pediatricians should offer standardized developmental and behavioral health screening for children in kinship care and should refer children with these health needs for early intervention or treatment as needed.
- Pediatricians should provide families providing kinship care with guidance on how to access community resources that can provide information and referral for health insurance, legal support and other social services. – by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.