Another opportunity for medical review and consideration of the social history of a looked after child occurs during routine health checks conducted at school alongside peers.
These are conducted twice a year for children under 5 and annually when over 5 years old ( Carmichael et al., 2016 Department of Health, 2009). Review assessments can be carried out by midwives, nurses, social workers, foster or residential carers. The Department of Health advises that a child entering care should have an initial health assessment by a doctor and a care plan created within 4 weeks. These factors can be identified by the multi-disciplinary team. Complex pregnancies, pregnancies involving foetal abnormalities or physical deformities and unplanned pregnancies have been associated with poorer mental health outcomes ( NHSEFS, 2016). Some of the potential factors include but are not limited to: post-natal depression puerperal psychosis traumatic births resulting in post-traumatic stress disorder prolonged stay in hospital and trauma-related experiences in conflict zones. Broadly speaking, these can be divided into three main factors: parental mental health maternal and neonatal physical health and family and social context ( NHS Education for Scotland (NHSEFS), 2016). All of these reasons can influence the development of child attachment, especially when they compound one another.Ī variety of factors can influence the extent to which adult caregivers notice and respond to children’s signals of alarm, illness or distress. Less common reasons include family dysfunction, family in acute stress, absent parenting, parental illness, parental disability or the child’s disability ( Meltzer et al., 2003). The main reason for being taken into care, affecting 62% of children in care, was abuse or neglect ( Meltzer et al., 2003). Children in care, or on the edge of care, often have complex experiences of care, and they may not feel that they have available and supportive caregivers. Attachment research has shown that early experiences of care can influence our later assumptions about the availability of others to help us when we are alarmed, sick or in distress ( Fraley, 2002). Whereas if children receive care that gives them a lack of confidence that their signals will be noticed and responded to, they are described as having an ‘insecure’ attachment. If children receive care that gives them confidence that their signals will be noticed and responded to, they are described as having a ‘secure’ attachment. Attachment theory suggests that children are predisposed to signal to their familiar caregiver or caregivers when alarmed, sick or in distress ( Bowlby, 1969). Human infants are vulnerable and dependent on their caregivers for nurturing and safety.
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