Promoting Health Equity for Children With Special Health Care Needs and Child Welfare Involvement.

Noah, an 18-month-old infant with trisomy 21, was brought to the emergency department for adenovirus bronchiolitis. He was found to meet criteria for severe malnutrition, and his medical team called Child Protective Services (CPS) with concern for neglect. He remained hospitalized for 1 month while a safe discharge was coordinated by the medical and CPS teams. Through this case, we explore racism as a root cause of discharge delays among children with special health care needs who interact with the child welfare system. Our discussion delves into the origins and consequences of racial disproportionality within the child welfare system. We describe how Black children, including those with special health care needs, are disproportionately involved with the child welfare system and highlight the potential role of the health care system in these inequities. Ultimately, this racial disproportionality in CPS involvement may contribute to a cycle of oppression for Black families, undermining family and child health, well-being, and trust in the health care system. Understanding the role of racism in both the child welfare and health care systems can empower pediatric providers to be agents of change. Noah's case underscores the potential for pediatric providers to either perpetuate or mitigate racial disparities. We propose actions at the individual, institutional, and structural levels, emphasizing the importance of equitable family-centered care practices and trauma-informed care, establishing protocols for the management of potential abuse or neglect, and advocating for policies that reduce racial disparities in child welfare referral, support families, and prevent abuse and neglect.