Several studies have highlighted the high level of health need in looked-after children, which is not surprising given the backgrounds of neglect, poor parenting and chaotic lifestyles that many of these children have experienced. However, while there is strong evidence for high rates of mental health and developmental problems, evidence for the prevalence of physical disorders is conflicting, probably reflecting the different time points during a child's period of care at which studies are undertaken. The physical health of children at care entry is often poor,1 ,2 but many issues will resolve with appropriate intervention within a few months.3 ,4

A large national epidemiological survey was undertaken in 2003, the primary aim of which was to identify the prevalence and impact of mental health disorder in children looked after by local authorities.4 Data were also collected on a range of physical and developmental problems, to examine the extent to which these co-occurred with mental disorders. Martin et al5 have selected the data pertaining to these carer-reported physical illnesses for further investigation, to compare the prevalence in looked-after children with children living in their own homes. They found excess reporting of cerebral palsy, epilepsy and cystic fibrosis, although additional analysis after comparison with a group of children from socio-economically disadvantaged backgrounds living in their own homes rendered a statistically significant difference only for cerebral palsy. This could be a reflection of the extra stress of coping with the disability as well as multiple medical needs in children with severe cerebral palsy. It would be interesting to know whether the children with epilepsy also had a comorbid neurodisability such as profound learning difficulty or autism. Furthermore, children with severe neurodisability, particularly older children …