A growing body of
evidence suggests that
children who cannot
live with their biological
parents fare better overall when living
with extended family than with non-
related foster parents. Acknowledging
the benefits of kinship care arrange-
ments, federal laws and public policies
increasingly favor placing children with
family members rather than in nonrel-
ative foster care.
Despite overall better outcomes, families providing kinship care endure many
hardships, and the children experience
many of the same adversities as children
in traditional foster care.
A new AAP policy statement from
the Council on Foster Care, Adoption
and Kinship Care outlines the unique
strengths and vulnerabilities of these
children and families, and offers strat-
egies for pediatricians to help them
to thrive. The policy, Needs of Kinship
Care Families and Pediatric Practice, is
available at https://doi.org/10.1542/
peds.2017-0099 and is published in the
April issue of Pediatrics.
As many as 3% of U.S. children live
in kinship care arrangements.
Because placement with a kinship
caregiver often is sudden and unplanned,
caregivers frequently are unprepared to
meet the needs of the children and are
unaware of available supports. Further-
more, caregivers may not have legal au-
thority to advocate or make decisions for
a child, complicating health care and ed-
ucational decisions. Caregivers frequent-
ly have their own financial and health
burdens, and often are asked to care for
sibling groups, multiplying the stresses.
Pediatricians can help by recognizing
these families in the office setting and
addressing their needs.
Among the recommendations in the
policy are the following:
• Children may need more frequent
visits to address mental health, de-
velopmental and educational needs,
similar to children in traditional
nonrelative foster care. These needs
are more common and often more
complicated than for children who
live with their biologic parents.
•Families may need information
about supports and help accessing
legal, health insurance and financial
• Consent and confidentiality roles
may need to be specifically defined.
The policy statement provides information to help pediatricians learn more
about resources available in their own
states and communities, and how to
connect families to those resources.
Advocacy opportunities also are reviewed in the policy, such as working
with policymakers and others to eliminate barriers so children can be placed
with kin, when appropriate, and ensuring funding to support provision of care
and health and social services.
The pediatrician’s role in meeting the
health needs of children in kinship care
is especially important because most of
the families are not connected to child
welfare or other formal services.
Dr. Springer, a lead
author of the policy, is a
member and former chair
of the AAP Council on
Foster Care, Adoption
and Kinship Care. She
also chaired the former Task Force on
•AAP Healthy Foster Care America,
• AAP manual Fostering Health: Health
Care for Children and Adolescents in
Foster Care, http://bit.ly/1U4wuaO
• Kinship care, Child Welfare Information
Gate way, http://bit.ly/2mi4CkI, includ-
ing kinship navigator programs, http://
• AAP clinical report Consent by Proxy
for Nonurgent Pediatric Care, http://
• Fostering Connections: Kinship/guard-
ianship, National Resource Center for
Permanency and Family Connections,