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.
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.
Percentage of US adoptions by ...
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