Pediatricians who provide care for children in foster care have a unique opportunity and a special responsibility to assess the totality of the child's experience and to be a sympathetic and objective advocate for the child.1 Many children in foster care have suffered repeated abuse and prolonged neglect and often have a myriad of unmet medical and mental health needs.2 However, paramount in the lives of these children is their need for continuity and a sense of permanence. Legal responsibility for establishing where these children will live and which adults will have custody of them rests jointly with the child welfare system and the judiciary. Pediatricians and other professionals with expertise in child development should participate actively as advisors to social workers and judges about the child's needs and best interests, especially in the context of placement and permanency planning.
Maintaining the integrity of distressed families by providing adequate support services is generally in the best interest of the child. Keeping families together, however, may not be best for all children. Alternatives based upon an assessment of the developmental needs of the children and the capabilities of the family to meet those needs must be given consideration. As a society we value the rights of the birth family, sometimes hold them to be inviolable, and presume that families are competent. This belief and a lack of resources for assessment, planning, and services have resulted in inaccurate assessment of the child's relationships with his/her family by social service agencies and courts.
- Received February 8, 1993.
- Accepted February 8, 1993.
- Copyright © 1993 by the American Academy of Pediatrics