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January/February 2001Vol. 2, No. 1Pediatricians Advised About Enhancing Brain Development in Young Foster Children

New recommendations from the American Academy of Pediatrics (AAP) urge pediatricians to be "proactive advisors" to help caregivers, social workers, and the legal community meet the needs of young children in foster care.

The recommendations, published in the November 2000 issue of Pediatrics, address the needs of children from birth to age 5, described by AAP as the developmental period when brain growth is most active and when personality traits, learning processes, and stress and emotional coping mechanisms are permanently established.

The conditions that lead to a child's removal from his home—abuse, neglect, family violence—can harm a child's brain development, the AAP statement notes, and an increasing number of children enter foster care with serious physical, mental, and developmental health problems.

AAP stresses to pediatricians the importance and challenges of:

  • Establishing a child's attachment to foster caregivers
  • Considering the child's changing sense of time
  • Understanding the child's response to stress.

The statement also addresses placement issues and the comprehensive assessment and treatment of a child's development and mental health needs.

The following guiding concepts are offered to pediatricians who provide care for foster children:

  • Biologic parenthood does not necessarily confer the desire or ability to care for a child adequately.
  • Supportive nurturing by primary caregivers is crucial to early brain growth and to the physical, emotional, and developmental needs of children.
  • Children need continuity, consistency, and predictability from their caregiver. Multiple placements are injurious.
  • Attachment, understanding of time, and developmental level of the child are key factors in their adjustment to environmental and internal stresses.
  • Pediatricians can play a constructive role in the referral, assessment, and treatment of children who are at risk for being abused, neglected, or abandoned or who are involved in the protective services system.
  • Pediatricians need to encourage caregivers to nurture their foster children by
    --Giving plenty of love and attention
    --Disciplining appropriately and consistently
    --Playing with, holding, and talking to the child
    --Providing stimulation with developmentally appropriate music, books, and toys
    --Matching the environment to the child's disposition
  • Parents should be given reasonable assistance and opportunity to maintain their family, while the present and future best interests of the child should determine what is appropriate.
  • A child's attachment history and understanding of time should guide the pace of decision-making.
  • Foster care placements should always maximize the healing aspects of foster care and be based on the needs of the child.
  • Foster care placement with relatives should be based on a careful assessment of the needs of the child and of the ability of the kinship care to meet those needs. As with all foster care placements, kinship care must be supported and supervised adequately.

Access a copy of Developmental Issues for Young Children in Foster Care online at:

Related Items

For more information related to early brain development, see these articles in the current issue of the Children's Bureau Express:

  • "Study Calls for Reexamining How We Treat Young Children"
  • "Survey Shows Parents Confused About Child Development"

Search for more CB Express articles on early childhood development using the Search feature on this website.

Visit the National Governors' Association Center for Best Practices new website, "The First Three Years: A Governor's Guide to Early Childhood," for tools to convey the importance of investing in a child's first three years to legislators, parents, businesses, and other community members at: