The Forgotten PodcastFeb. 27, 2017

Season 2, Episode 8 | Conversation with a Pediatrician: Physical Issues Common in Children in Foster Care

As a pediatrician, I’m not judging you—I want to support you!

–Dr. Andrea Kane

Common Medical Issues for Children in Foster Care

Kids from hard places, whether they are in care due to neglect or abuse are at higher risk for a variety of health issues. “We see more issues of asthma, skin problems, nutritional deficiencies—things like that,” says Dr. Kane. These physical issues are often more prevalent in children from lower socioeconomic situations. Emotional and mental health disorders such as depression and anxiety can also affect a child’s physical health.

Anxiety, for example, can show up in children in the form of headaches, belly aches, separation anxiety and school avoidance. Depression often exhibits similar symptoms, along with irritability and anger, sleep issues and nightmares. “Of course, nightmares are also a typical childhood experience,” says Dr. Kane, “so the presence of these symptoms does not necessarily point to one specific malady.”

Sometimes the biggest signal of anxiety issues is not a physical one, but a situational one. “School truancy is a big sign that something is going on,” says Dr. Kane.

Finding out symptoms is not always easy. The child’s age has a lot to do with how Dr. Kane proceeds. “With an adolescent, I ask to talk with the child one-on-one, especially if I’ve known him or her for a while.” For school age children, she usually has a parent stay in the room and asks the child light, general questions to find out what might be going on. Questions about what they came in for, what grade they are in, what school they go to—topics that will help put the child at ease. Then she’ll ask the parent what they’ve been noticing and follow up with the child to see if they agree.

When talking with teens, Dr. Kane asks a lot of questions about their moods, diet, sleep patterns—even if they’ve been feeling suicidal or like no one likes or loves them. Asking questions enables her to follow the child or teen’s lead regarding their physical issues.

New Foster Parent Issues

One of the things many new foster parents encounter is food issues. Often neglected kids will be at one extreme or the other regarding food: either they are malnourished because they simply haven’t had access to good, healthful food options, or they are dealing with obesity issues due to a diet largely comprised of fast food or junk food. “For kids in foster care, their nutrition has not typically been great,” says Dr. Kane.

Sometimes the child needs education about nutrition: what fresh fruits and vegetables are, how to eat or prepare them, avoiding too many prepackaged foods, sitting down to a meal together with the family, getting enough milk, having healthful meals and snacks, getting vitamins or iron if they’re deficient in these nutrients.

Some children in care show extreme pickiness regarding their food choices, or may exhibit food hoarding or night feeding. Dr. Kane suggests talking through the different issues calmly with the child—but remembering to not make it a battle. For example, candy is a rare treat, not a regular component of mealtime, and the fact that we eat only during the day and sleep at night.

“Kids thrive on schedules and routines,” says Dr. Kane. “Give them a defined time period for specific activities and healthy options to choose from.” Acknowledge the child’s demeanor or worries, but don’t give in. Eating and sleeping cycles thrive with discipline and routine.

Asthma

Asthma is a condition that is seen relatively often in children in foster care, especially if the child was exposed to certain pollutants (for example, secondhand smoke, dirt, mold, cockroaches) or had multiple infections as a baby or prior to coming in to care. Good medical care can help control asthma symptoms.

Parents often wonder what the best strategy is regarding taking a child with breathing difficulties to the hospital—small children and babies especially, as their breathing complications can deteriorate and change so rapidly.

Dr. Kane suggests watching for specific signs of respiratory distress. Infants’ nostrils may flare, their tracheal notch (where their neck and chest come together) may “suck in,” or they may do a lot of tummy breathing. Older children may be able to verbalize that they are having trouble breathing; another symptom is unstoppable coughing.

Dr. Kane’s advice is to have them seen by a physician if they show these symptoms, especially if they’ve not been diagnosed. If they have been diagnosed with asthma, use a breathing machine and albuterol treatments if you have them—if you question the child’s ability to breathe, give them a treatment. Every child with asthma should have an asthma action plan.

Specific Questions

What are some tips/tricks for a smooth first visit with the doctor?
If you can go to the child’s doctor, do that. Also, help prepare your child in advance by discussing what is likely to happen during the appointment: the doctor will ask questions, listen to your heart/lungs, take height and weight measurements. Knowing what’s likely to happen will help put the child at ease. And if your child asks about shots, a safe answer is “I don’t know” because you don’t want the child to be overanxious about the possibility.

And Moms—remember that the doctor is not there to judge you. Any information you can give regarding the child is helpful, but there are things you may not know. “Relax,” says Dr. Kane. “We are here to support you—we’re happy that the child is in your care!”

One difficulty with children in foster care is that sometimes the foster parents don’t know the child’s medical history. A physical exam, using a growth chart, asking questions are all strategies that can help determine a child’s age and developmental level. But there are things you may not know at that initial visit—that’s okay. A closer follow-up appointment may be scheduled to gauge the child’s progress. “Sometimes you just have to be okay with the unknown,” says Dr. Kane.

How do you bulk up a malnourished child?
Many times, just providing healthy food options, plus milk and water instead of soda, will be enough for a child to reach a healthy weight. Having regular meals and snacks will also help.

How do I advocate for resources for a child with special needs?
It’s not uncommon for children in foster care to have developmental delays due to neglect or abuse when they were babies. If a child is younger than three, the doctor can refer them to an early interventionist who can come to their home for a screening. For children over the age of three, developmental screenings and interventional services such as speech therapy or occupational therapy are performed through the school district.

How do I get updated vaccination records?
In Illinois there is a website that shows vaccination records. The child’s caseworker can find out prior to the doctor’s appointment how current the child’s vaccinations are.

What can I do for a child with Oppositional Defiant Disorder?
There’s not a lot medically that can be done for a child with ODD—a child who is defiant toward any authoritative figure. These cases are usually referred to a counselor.

New Foster Mom Worries

Dr. Kane assures moms, whether they are referring to a biological child or a foster child, that it’s okay to make an appointment if you’re simply worried or not sure what is normal regarding your child’s health. “We see a lot of ‘worried wells,’” she says. “It’s okay to come in and find out they are completely fine—we want nothing to be wrong!” Trust your gut…no one will fault you for being cautious with your child’s health.

Check Out These Resources

American Academy of Pediatrics Bright Futures
Healthychildren.org
ICare

Meet our Guest | Dr. Andrea Kane

Dr. Andrea Kane has been a general pediatrician for Advocate Medical Group in Bloomington, Illinois, since 2008. Her passions include newborn care, nutrition, and preventative care with vaccines and development. Dr. Kane’s practice includes many foster families and she feels blessed to be able to get to provide continuity of care for the children in their care, as well as get to know the families who provide a loving home environment for foster children. Dr. Kane and her husband have three children.

Meet our Host | Jami Kaeb

Jami Kaeb is a dreamer and a coffee lover! She is married to Clint and the mother of seven–five through adoption. It was through a difficult season of waiting, that Clint and Jami’s eyes were opened to the foster care community. They became foster parents to three siblings who they eventually adopted, and in April of 2011, Jami founded The Forgotten Initiative. Follow Jami’s personal blog.

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