Family physicians are likely to encounter patients who are involved in the foster or kinship care system. Kinship care is the care of a child by a relative or close family friend that is mediated by the child welfare system. The foster care system in the United States serves approximately 675,000 children annually.¹ Of those placed in foster or kinship care, 59% will spend at least one year in care.¹ Most of these placements are a result of neglect, physical or sexual abuse, housing inadequacy, or parental incarceration or illicit drug use, all factors that can cause toxic stress in children.¹

The effects of toxic stress on the neuroendocrine-immune system may lead to childhood attention and attachment difficulties, poor emotional regulation, aggression, hyperactivity, and impulsivity. Toxic stress may increase the risk of adulthood cardiovascular disease, cancers, asthma, autoimmune disease, and depression.² As family physicians caring for all ages, we must consider how childhood trauma impacts health later in life by using trauma-informed care. Trauma-informed care is a whole-person approach to health care that acknowledges the impact of trauma on health and facilitates long-term engagement in care that is inherently patient-centered.³ Children in foster or kinship care are likely to experience fractured and inadequate health care. However, with proper attention, planning, and education, family physicians are well suited to lead a multidisciplinary team that cares for these children into adulthood.

Children who enter the child welfare system often have educational difficulties, developmental delays, mental health problems, and oral health issues. Up to 80% of children enter the system with at least one medical problem, and one-third have a chronic medical condition.² It is the role of a family physician to ensure continuity of care and help foster families navigate the health care system. It is also our responsibility to familiarize ourselves with the general structure and regulation of our local child welfare systems and to use trauma-informed care. We must support caregivers, who may already be under our care as patients, through the added stressors that often come with caring for foster children.

To ensure adequate comprehensive and coordinated care for foster children, the American Academy of Pediatrics recommends that these children be seen early and often, starting 24 to 72 hours from the initial placement and continuing monthly for the first three months.² It is good practice to allow extra time for these appointments. Visits should ideally occur monthly for the first six months of life, then every three months until 24 months of age, and then at least every six months thereafter.² Each of these visits should include an evaluation of mental and physical health, development, adjustment to foster care, and psychosocial stressors. Although many elements of a typical visit overlap with those performed at wellness visits,^4–6 additional guidance is provided in Table 1.²

Providing medical care for children in foster or kinship care requires extra time and special attention to the specific needs of this vulnerable population. Family physicians are in a unique position to provide continuity of care to the child and the caregiver. Table 2 provides resources for physicians and caregivers.