Pediatric Assessments of Young Children in Child Welfare by Placement Type

Background and purpose: The majority of research about physical health problems of children in child welfare has focused specifically on children in foster care, and found that these children have high rates of medical and developmental problems and have poorer health status than Medicaid-eligible children. Few studies have investigated children in family maintenance programs. Also, studies from the 1990s noted underweight was the primary weight problem in the foster care population. No studies have examined weight problems in this population since the U.S. obesity epidemic has been recognized. This study's objectives were: 1.Describe health-related problems (weight, medical, and developmental) across placement types; 2. Examine the association of placement (unrelated foster, kin, and in-home) and demographic/child welfare variables with health-related problems.

Methods: This study utilized a retrospective medical chart review of all children less than 6 years old (n=449) seen at an outpatient child welfare pediatric clinic in an urban area. Data on caregiver and child demographics, child welfare characteristics, diagnoses, and developmental screening findings were abstracted from the chart. Regression modeling was used to estimate odds of having a weight, medical, or provisional developmental delay problem by placement and demographic/child welfare characteristics.

Results: Almost 13% of children in the sample were overweight (≥ 95%) and more than a quarter were at risk of being overweight/overweight (≥85%) while only 7% were underweight (≤ 5%). Most children (78%) had a physical health diagnosis and 25 % were provisionally identified with developmental delay. No differences between weight diagnoses, type of medical diagnoses, and developmental delay by placement type were found, although children with three or more physical diagnoses were more likely to be with kin (p<.05). Children two years old or older were more likely to be at being at risk of overweight/overweight than children under two years old (p<.05) and Hispanic children were more likely to be at risk of overweight/overweight than non-Hispanic children (p<.01). Length of stay in child welfare was positively related with a medical diagnosis or provisional developmental delay (p<.01).

Conclusions and Implications: Results argue for careful assessment of weight, medical, and developmental problems in children active to child welfare, whether residing in their home of origin, with kin, or with unrelated foster parents. The comprehensive examination and enhanced health maintenance schedule endorsed by the Child Welfare League of America for children in foster care should be extended to children in family maintenance as child welfare involvement rather than placement is related to health-related problems. Because of the high number of medical problems for children with kin caregivers, there should be an increased emphasis on comprehensive medical and child welfare case management services to detect and treat medical problems of children placed with kin. Additionally, children in the study 2 years old or older had a higher incidence of overweight problems than the national average and children of Hispanic origin were particularly at risk for overweight problems. The increasing problem of obesity among young children in child welfare warrants further investigation and intervention.