Adolescent mothers in protective care more likely to have their children placed in care

1. Children born to adolescent mothers in the care of child protection services (CPS) were more likely to be taken into CPS care themselves when compared to other children in the first 2 years of life.

2. Most children born to adolescent mothers in CPS care were themselves placed in CPS care for more than 6 months within the first 2 years of life.       

Evidence Rating Level: 1 (Excellent)

Study Rundown: Previous studies have reported that adolescents in foster care have higher rates of pregnancy than other adolescents, and that children of adolescent mothers are more likely to be maltreated than other children. In this prospective cohort study, investigators sought to characterize an intergenerational cycle of CPS involvement for adolescents and their offspring using linkable administrative data to identify all adolescent mothers who gave birth to their first child in Manitoba, Canada between 1998 and 2013. Children born to mothers who were in CPS care at time of birth had greater odds of being placed in CPS care themselves before their second birthday when compared to children born to adolescent mothers not in care, especially in the first week after birth.

The study is strengthened by large sample size, good follow-up, and the collection of administrative data, independent of the study hypothesis, but is is weakened by the limited availability of detailed information on CPS operations, including where and why children and their mothers were placed in care. The data from the foster care system in Manitoba may not be generalizable to other systems. For physicians, these results suggest an intergenerational cycle of CPS involvement, and emphasize the need for early interventions to support adolescent mothers in order to improve outcomes for both mothers and their children.

Click to read the study, published today in Pediatrics

Click to read an accompanying commentary in Pediatrics

Relevant reading: Adult outcomes for children of teenage mothers

Study author, Elizabeth Wall-Wieler, MSc, speaks to 2 Minute Medicine: Department of Community Health Sciences, University of Manitoba.

“Pregnant teenagers in foster care have a lot of contact with health and social services leading up to the birth of their child. A better coordination of these services, addressing any underlying mental health or substance use, as well as financial, housing, and social supports, could prevent their children from also being placed in care.”

In-Depth [prospective cohort]: The study population comprised all mothers who gave birth to their first child in Manitoba between 1998 and 2013, who were younger than 18 at the time of birth, and lived in Manitoba for at least 2 years after the birth. Mothers who were in the care of CPS when they gave birth (n = 576) were compared to mothers who were not (n = 5 370) and their odds of having a child placed in CPS care before the age of 2 was assessed and then divided into 3 time periods: placed in care within 7 days of birth, between 7 days and 1 year of birth, and between 1 and 2 years of birth. Key covariates controlled for included maternal mental illness, prenatal care use, length of hospital stay, gestational age, and birth weight.

Mothers who were in CPS care when they gave birth had 7.53 times greater odds of having their child taken into care within 2 years compared to mothers not in CPS care (95%CI: 6.19-9.14). This effect was most pronounced in the first week of life (aOR 11.64, 95%CI: 8.83-15.34). Of the children placed in CPS care before their second birthday, 74.49% of those born to mothers who were in care stayed in care for at least 6 months, compared to 62.56% of those born to mothers not in care.

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