Medical Traumatic Stress in Child Welfare

Providing Trauma Informed Care in Child Welfare

Do children in the child welfare system experience medical treatment in the same ways that children in the general population do? To some degree, yes, they do. At the same time, there are notable differences in the life experiences and family circumstances of children in foster care compared to their peers outside the child welfare system. It's important to understand what these differences are and how they may influence responses to medical events among children in foster care.

Three main issues affect how children in foster care experience medical treatment:

  • Level of medical and developmental need
  • How medical services are delivered
  • Experiences before, during, and after treatment


Level of Medical and Developmental Need

National data show that children in foster care, on average, have more medical needs than children in the general population. About one in four children in foster care has an ongoing medical condition, and about one in ten has two or more. Children in foster care are more likely to require repeated medical visits and may be at higher risk for medical trauma for that reason alone.

Most common health issues among children in foster care:
  • Asthma
  • Repeated ear infections
  • Other respiratory problems
  • Severe allergies
  • Epilepsy
  • Eczema or other skin diseases
Another layer to consider is developmental and behavioral health issues, or "special needs," among children in foster care. About one in every three children in care has a special need, and about one in every four has two or more special needs. The most common are behavior or emotional disorders, as well as neurodevelopmental conditions such as learning disabilities, attention deficit hyperactivity disorder (ADD and ADHD), speech-language impairment, intellectual disability (formerly known as mental retardation), hearing impairment, vision impairment, and autism. Developmental and behavioral health issues such as these can make it more difficult for children to cope with medical treatment.

Trauma Informed Care in Child Welfare : How Medical Services are Delivered

Emergency Room

All too often, children in foster care receive medical attention in Emergency Departments. The Emergency Department may be a first stop for children after being removed from their homes, or it may be a frequent destination for those who lack a consistent primary care provider due to multiple changes in foster care placement. Patient and family centered care may be disrupted in child welfare families due to this inconsistency, causing increased stress on the child and resource family. The sights and sounds of an Emergency Department can be frightening to any child, and even more so for one who has been separated from family members.

Trauma Informed Care in Child Welfare : Experiences Before, During, and After Treatment

Children typically become involved with the child welfare system because they have been abused or neglected, and these experiences affect their responses to medical care.

  • When medical treatment is invasive, painful, or prolonged, it may be a trigger or reminder of past traumas, such as physical or sexual abuse.
  • Even routine physical exams may be extremely uncomfortable for children who have been sexually abused.
  • Children who have been abused or neglected may not initially trust adults to keep them safe---even health care providers.

Thus, previous traumatic experiences may increase the risk for medical traumatic stress among children in care.

Children in foster care often lack the support of a consistent, nurturing caregiver during medical visits. Biological parents may be prevented by Court order from having contact with their children, or may be occupied with their own treatment goals that prevent their attending their child's medical appointments. Foster parents may be unable to take time off from work or may have difficulty attending all the appointments for multiple children in their care. Whatever the reason, the end result is that children in foster care often lack the type of family support that other children have, support that is crucial to coping with medical treatment and mitigating stress.

Not having an adult caregiver who is consistently present to provide support and information is one of the most critical differences in how these children experience medical care.

Absence of the child's parent and/or foster parent at medical appointments can also compromise quality of care. Pediatric health care providers rely heavily on children's health history in formulating a diagnosis or treatment plan for the child. They rely on the children's caregivers (parents or foster parents) to answer questions about the child's activities of daily living, including sleep, diet, elimination and various symptoms that cannot be answered by a child's caseworker. When children in foster care attend medical appointments without their biological or foster parent present, important information is unavailable to the health care provider, which can delay or derail the treatment the child needs. Lack of coordination impacts family centered care and may have negative impacts on the child and foster parents ability to cope with medical treatment.

More about Medical Traumatic Stress

The resources below will take you to more information about medical traumatic stress. As you review the information, keep in mind the ways in which children in foster care may experience medical treatment differently.