title: [Course and progression of children admitted before 4 years of age in a French child welfare center].
abstract: OBJECTIVE
  The purpose of this study was to determine the institutional trajectory and future of young children in child welfare.
  
  
  METHODS
  A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant.
  
  
  RESULTS
  We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2±4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures.
  
  
  CONCLUSIONS
  The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.
authors.affiliation: UFR de médecine, département universitaire de santé publique, 1, rue haute-de-reculée, 49045 Angers cedex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Tanguy
authors.affiliation: Foyer de l'enfance du Maine-et-Loire, 124, rue de Frémur, 49035 Angers, France; Unité de psychiatrie de l'enfant et de l'adolescent, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
authors.forename: D
authors.initials: D
authors.lastname: Rousseau
authors.affiliation: UFR de médecine, département universitaire de santé publique, 1, rue haute-de-reculée, 49045 Angers cedex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Roze
authors.affiliation: Unité de psychiatrie de l'enfant et de l'adolescent, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
authors.forename: P
authors.initials: P
authors.lastname: Duverger
authors.affiliation: Service de neurologie pédiatrique, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France.
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: UFR de médecine, département universitaire de santé publique, 1, rue haute-de-reculée, 49045 Angers cedex 01, France. Electronic address: sefanello@chu-angers.fr.
authors.forename: S
authors.initials: S
authors.lastname: Fanello
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002649:Child Abuse; D000068216:Child Protective Services; D002669:Child Welfare; D002675:Child, Preschool; D004522:Educational Status; D000069581:Exposure to Violence; D005260:Female; D005602:France / Q000453:epidemiology; D006130:Growth Disorders / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health; D012189:Retrospective Studies; D012917:Social Adjustment; D012946:Social Welfare