PERSPECTIVES

Our Baby: Commentary on Foster Care for YoungChildren: Why It Must Be Developmentally Informed

Anonymous

C hild and adolescent psychiatry shouldadvocate for foster care for young chil-dren that is child centered and develop-

mentally informed. The evidence is clearly laid outin a recent edition of the Journal.1 We know thepractical meaning of attachment theory and re-search. We can assert that the foster parent, as theprimary attachment figure for a young child, mustprovide substantial and sustained contact—literalphysical contact—for the child. Primary caregiversmust be substantially emotionally invested in thechild and psychologically committed to the child’swell-being. The caregivers must be present to helpthe child through potentially traumatic events,such as the visitation of biological parents andtransitions to alternative placements.

Our recommendations will significantly affectothers involved in the lives of young children infoster care. On this, the recent Journal articlemakes no comment. There is no discussion of theinterventions foster families might need to re-peatedly provide the care necessary for a series offoster babies and young children. That omissionmay be deliberate. There may be a cohort ofpotential foster families willing and able to takeon these responsibilities without any additionalrecognition or support. Maybe we should thinkonly of our patients, the children, when we makeour recommendations. Maybe the authors be-lieved that addressing the needs of foster families(and biological families) might dilute the powerof their message.

I am a child and adolescent psychiatrist andfor some years was a foster mother. I wrote thispiece because I believe, very strongly, that weshould make our professional recommendationswith a clear understanding of the potential emo-tional and psychological cost to all those in-volved. Although our patients are the children,their families are also our charge. The stigma of

foster care is directed even more at foster families

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than at the children in foster care. The vastmajority of foster families are motivated, like us,by altruism and the unsatisfied need to care for avulnerable human being. Common sense showsus that it is impossible to make a financial profitfrom being a foster parent. I have watched toomany television shows and movies in whichfoster parents are depicted as monstrous anduncaring. I have heard experienced and influen-tial child psychiatrists insist that foster parentsare in it only for the money. I want to speak hereas a foster mother so that my fellow professionalsknow something about the potential effects ofour advocacy on foster families. This is about me,and our baby.

Our baby came to live with my family when shewas younger than 1 week old. She stayed for morethan a year. Because I was a knowledgeable pro-fessional and an experienced parent, I decided thatI would, and could, do all the things that a childpsychiatrist would recommend. We provided sub-stantial and sustained physical contact for ourbaby. One of us stayed home until she was oldenough to go to daycare. We changed her, we fedher, and we bathed her. We took her to daycareevery day and picked her up at night. I slept on thecouch in the evening so I could get up at nightwhen she woke. When she did not sleep, wewrapped her in her blanket and rocked her. She saton my lap while I studied for the child psychiatryexaminations and on her foster father’s lap whilehe checked on the progress of the ballgame. Wetook her with us on vacations, rather than seekingrespite foster care with a stranger. We took her toher doctor’s appointments, rather than letting hergo with her social worker, who she did not know.We deliberately set out to provide her with what Iknew she needed to be able to form and maintainattachments later in life. Our baby had consistentcaregivers at home and at her daycare center. She

knew we were her family, and she knew her

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PERSPECTIVES

babysitters. Our baby was tightly wound into ourlives. She thrived.

We had decided to be significantly emotion-ally invested in our baby, and that was ourproblem. Although I knew that she might notgrow up with us, I could not help but let her intomy heart. I fell in love with her. I loved her roundperfect arms and legs. I loved her big eyes. Iloved her for her independent spirit, her athleti-cism, her determination. I followed every devel-opmental milestone, just like any other parent.Her first steps, her first words. I was happy thatshe came to me for comfort. I was proud of herprogress, her ability to recognize the people whocared for her, and to be suspicious of those shedid not know.

I remember the day they found her biologicalfamily. I remember being told that she would go tolive with them. I knew I had to help her through thetransition. We were there for the first visits. We saidgoodbye when she went to stay with them for thefirst weekends. We helped transport her. We wel-comed her back afterward. When it came time to gofor good, we packed her clothes, her toys, and herfavorite blanket so she would have them in hernew home. We said goodbye. I told her that shewould always be our baby.

After our baby left us, we grieved. I thoughtabout her all the time. For a while, I did not sleepwell. I cried easily. I lay awake and wondered ifshe woke in the night and missed us. Sometimesmy chest hurt. Our baby had asthma and colic. Iworried that her family would not understandhow to help her when she wheezed andcramped. My own daughter was irritable andsnappy. Her grades deteriorated. My husbandretreated to his computer in the basement. Wasour baby being stubborn and difficult? Could shestill use her spoon and take off her socks? Wasshe still using her words? We talked about ourbaby every day. We looked at her photographs.No one called us to ask how we were coping. Noone called us to tell us how our baby was coping.I did not know if she was happy and adjustingwell, or angry and tearful. How do babies grieve?

After a while, things got easier. I carried onworking, going to the gym, making meals, play-ing music. I am not depressed, and I think we area happy family. I have seen our baby since sheleft us. She still has the same round perfect armsand legs, the same big eyes, the same athleticism,the same determination. I know the people she

lives with. I know that she is well looked after, c

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that she is not abused or deprived or neglected. Iknow that she does well at school, has friends. Iknow that she loves her family.

Soon after our baby left, we decided to stopbeing foster parents. We gave people the usualreasons—our jobs were too demanding, weneeded to spend more time together as a family,we might move out of state. The real reason wasthat our baby’s departure was too painful tocontemplate repeating. Sometimes people ask mewhat it was like to be a foster parent, andwhether they should be foster parents for babiesand young children. I tell them that it, for me,was a terrible thing. I tell them that it will breaktheir hearts. I tell them that they will have nohelp and no support from any professional whenthey need it most. I tell them that it was the mostpainful thing I have ever done, and that it wasthe most worthwhile. I know that I did what I setout to do, and that, whatever happens in the restof her life, our baby’s ability to make relation-ships is intact. &

Accepted February 8, 2012.

Disclosure: The author reports no biomedical financial interests orpotential conflicts of interest.

This commentary is published anonymously to protect those involved.Correspondence will be forwarded to the author.

Correspondence to JAACAP Editorial Office, 3615 Wisconsin Ave-nue NW, Washington, D.C. 20016; e-mail: support@jaacap.org

0890-8567/$36.00/©2012 American Academy of Child andAdolescent Psychiatry

DOI: 10.1016/j.jaac.2012.02.010

REFERENCE1. Zeanah CH, Shauffer C, Dozier M. Foster care for young children:

why it must be developmentally informed. J Am Acad ChildAdolesc Psychiatry. 2011;50:1199-1201.

Coda to Our Baby

Dr. Zeanah and colleagues reply:

W e appreciate the thoughtful, inspiring,and important response to our Transla-tions article about foster care for young

hildren.1 We wholeheartedly agree that we didot do justice to the issues for foster parents—notecause they are unimportant—but only because,

n a short, focused piece, we targeted only theeeds of children. Our overarching point is that ourociety neither values nor supports the importancef foster care (including foster parents) for young

hildren. Fortunately, this Perspective more fully

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