Children become looked after for a small number of recurring reasons: abuse or neglect, parental illness or substance misuse, domestic violence, or bereavement. By the time the placement starts, most have already lived through a stretch of childhood the rest of us would find unimaginable. The health and developmental picture follows from that — and so does the difficulty of getting the right support in place quickly enough. This is what foster carers, adopters, and professionals most need to know about how the system works in England, with more on family life at Healthbooq. For broader context, see our complete guide to family life.
Who Counts as Looked After
A child is legally "looked after" when the local authority has parental responsibility or shares it. That covers care orders, voluntary section 20 arrangements, emergency protection orders, and remand. In England in 2023, around 82,000 children were in care — a rise of more than 20% over ten years.
Roughly 75% live with foster families. The rest are in residential children's homes, with kinship carers (relatives or family friends approved as carers), or — for older teenagers — in semi-independent living. Most children in care are aged 10 or over; a meaningful proportion enter as teenagers; about a quarter are under five.
The Health Picture
Children in care carry substantially more health and developmental burden than the general child population. The pattern is not random — it reflects what happened before placement.
Physical health. Untreated dental decay, undetected vision and hearing problems, gaps in immunisation records, and growth issues from chronic stress or nutritional neglect are all common findings at first health assessment. These are usually fixable once they are noticed.
Mental health. ONS data put around 50% of looked after children at the threshold for a diagnosable mental health condition, against roughly 10% in the general child population. Conduct disorders, anxiety and depression, trauma symptoms, attachment difficulties, and ADHD account for most of it. Many have lived through complex developmental trauma — repeated, early, relational harm from caregivers — which does not always sit neatly inside a single diagnostic category and tends to need attachment-informed treatment rather than off-the-shelf CBT.
Neurodevelopmental conditions. ADHD, autism, and learning difficulties are heavily overrepresented. Foetal alcohol spectrum disorder (FASD) is the one most often missed — it is far more prevalent in the care population than the general one and frequently arrives undiagnosed at age 7 or 12.
What the Statutory Framework Promises
Under the Children Act 1989 and subsequent guidance, every looked after child is entitled to:
- An initial health assessment within 20 working days of entering care
- Annual review health assessments (six-monthly for under-fives)
- Coordination by the Designated Doctor and Designated Nurse for Looked After Children in each area
- Priority access to CAMHS assessment
- Educational oversight from the local authority's virtual school head, who is responsible for the educational outcomes of every looked after child in that area
The LAC review health assessment covers physical health, development, immunisations, dental health, mental and emotional health, and education, and produces a written health plan with named actions. On paper the entitlements are clear. In practice CAMHS waits, social work caseloads, and placement instability frequently interrupt them — and the carer or adopter is often the one who has to chase.
Trauma-Informed Care, Without the Buzzword
"Trauma-informed care" has become standard language in children's services. The useful core: behaviour that looks like defiance, withdrawal, or attention-seeking in a child who has lived through early relational harm is usually the nervous system doing what it learned to do to stay safe. Punishment-led approaches make it worse.
Two practitioner names recur in UK practice. Dan Hughes developed Dyadic Developmental Psychotherapy (DDP), which works with the parent–child dyad using PACE — Playfulness, Acceptance, Curiosity, Empathy. Kim Golding adapted DDP for UK foster carers and adoptive parents in the Nurturing Attachments programme, now widely commissioned by local authorities. Standard short-course CBT, designed for single-incident trauma or straightforward anxiety, is often less effective for children with complex developmental trauma than attachment-informed work like DDP, theraplay, or longer-term sensorimotor approaches.
Transitions
Each placement move is a loss, and looked after children typically experience several. Each one disrupts attachment, schooling, peer relationships, and continuity of medical and therapeutic care. Care leavers — young people who have left the system, ages 18 to 25 — keep entitlement to a personal adviser and a pathway plan. The Staying Put arrangement lets young people remain with their foster family up to age 21, which substantially improves outcomes against the "leave at 18" alternative. Care leavers also retain priority for social housing and have access to financial support.
Where to Get Help
- Fostering Network (fostering.net) and Action for Children for foster carers
- Adoption UK (adoptionuk.org) for adoptive families, including specialist post-adoption support
- National FASD (nationalfasd.org.uk) and the FASD Hub for FASD-specific guidance and referral routes
- Coram BAAF for legal and policy questions on adoption and fostering
- The Anna Freud Centre runs trauma- and attachment-informed training and resources used widely across CAMHS
If the statutory health assessment has not happened within 20 working days of placement, that is the Designated Nurse for Looked After Children in your local authority — they are the person to chase, and they generally welcome being called.
Key Takeaways
About 82,000 children are looked after by local authorities in England at any one time, up more than 20% in a decade. Around half have a diagnosable mental health condition, against roughly 10% in the general child population. Foetal alcohol spectrum disorder, ADHD, autism, and unaddressed dental, vision, and hearing problems are all heavily overrepresented. The statutory framework — initial health assessment within 20 working days, annual reviews (six-monthly under five), Designated Doctor and Nurse, virtual school head, priority CAMHS access — is on paper. The challenge is making it work in practice.
