Skip to Main Content


Raising a child outside the child’s biological family of origin, as in foster care or adoption, presents a unique set of psychosocial challenges involving an interplay between transition and adaptation. The child must contend with separation from and possible reunification with the birth parent, adjustments to 1 or more families, and changes in physical environment, social support, and care providers. The foster or adoptive parents are challenged with helping the child integrate into a new family, taking into account the child’s previous experiences, and facing the possibility of further transitions in the future. The child’s and family’s success in adapting to these changes in care are influenced by a complex interaction between innate, individual capabilities and external resources. Nowhere is the traditional role of the pediatric provider more important in providing continuity of care, family guidance, and support for the physical, neurodevelopmental, and emotional needs of the child and family.


Foster Care


Approximately 500,000 children are in foster care on any given day with about 800,000 children being served by the foster care system in a year.1 In contrast to the early years of foster care when foster placement often resulted because of illness or death of parents or extreme poverty, approximately 70% of children today are placed because of parental abuse and/or neglect; more than 80% of children who enter foster care have a parent who abuses drugs or alcohol.


Children enter foster care for a variety of reasons, including the negative impact of acute and chronic family stressors, abandonment, parental inability to care for a child, homelessness, parental substance abuse, and increasingly, child neglect and/or physical and sexual abuse. Foster care is intended to be a temporary legal arrangement in which the child is protected and nurtured while supportive services are provided to the biological parent(s) to achieve family reunification.




As of 2004, an estimated 1.6 million children under 18 years of age lived with adoptive parents and approximately 2.5% of US families had an adopted child. Approximately 127,000 children are adopted in the United States each year. The percentage of all adoptions by type is represented in Figure 20-1. Public agency and intercountry adoptions have grown significantly and now account for more than half of all adoptions. Approximately 10% of all adoptions are voluntarily relinquished infant adoptions. Increasing numbers of children are being adopted by transracial, transcultural, single-parent, and same-sex couples.2 Slightly more girls than boys are adopted. The trend toward international adoption has also risen steadily with approximately 20,000 children having been adopted from foreign countries in 2006.3 Currently, the largest representation is from China, Guatemala, South Korea, Russia, and Ethiopia. The majority of children adopted internationally are under age 4 years, often under age 1, and female.

Figure 20-1.
Graphic Jump Location

Percentage of US adoptions by ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.