Foster Care Clinical Pathway — Outpatient Specialty Care

Anticipatory Guidance

Transition Into Foster Care or Kinship Care	Remind caregivers that this is a difficult time for children Remind them that there may be an initial honeymoon period followed by acting out behaviors Symptoms and behaviors that may be related to prior trauma experiences: tantrums, food hoarding, constipation, or sleep difficulties Do not take these behaviors personally Provide consistency in access to food, bedtime routines, discipline, and toileting Remain calm when children have difficult behaviors, avoid yelling Learn to notice and avoid triggers Recognize the child's strengths and provide positive reinforcement Give messages that the child is safe Discuss available resources in the community Additional Information: APP Safe and Sound: Responding to the Experiences of Children Adopted or in Foster Care
Visits with Biological Parents	Provide a transitional object Help child make do art project to give to their parent Reassure children you look forward to seeing them after the visit Welcome child home
Foster Parents Express Concerns About the Birth Parents	The pediatrician can: Advise foster parents against making negative comments about the child's birth parents in front of the child Instead of voicing concerns in front of the child, the foster parent should discuss as necessary with the appropriate agency representative outside of the child's presence Should the foster parent feel the need to express frustration or anger, they should do so with another supportive adult rather than in front of the child
Resources for the Medical Home Related to Providing Care for Children in Foster Care	Visit the AAP foster care site for primary care resources, including background information, office management information (coding, foster care friendly office tip sheet), and communication.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.