The sentiments expressed by Lynn Eaton are very welcome ('Waterhouse watershed', news focus, page 13, 24 February), but the article on the same topic by Michael White (politics) reminds us that we cannot easily legislate for the safety and wellbeing of these children. Children who are looked after can fall through all the nets imaginable.

The worst affected are those severely damaged children who are sent to small private residential homes, usually out of their home area, by courts and by desperate social services departments.

These establishments seem to be springing up in remote areas (no worries from the neighbours objecting) - several have recently opened in rural mid-Wales. These children abscond, so one wonders how happy they are being made.

Worse, they are not known to the local health services, least of all to school nurses, community paediatricians or school doctors. They are not included in routine health screening. They have no health professional to act as their advocate and befriend them, so the routine annual health review will no longer seem to be a threat but more an opportunity to express how they are feeling.

The initiatives of Dr Heather Payne in Caerphilly and of Birmingham Community trust are warmly welcomed - community paediatricians are ideally placed to co-ordinate things. Community children's services can often obtain past health files on children from distant trusts within days, in comparison to the months it may take to transfer GP files. In my own area much detective work goes into tracking down a child's community pre-school and school health files, and a great deal of the child's social history is consolidated in this way, giving a clearer understanding of the issues to be faced.

Many trusts are introducing a personal child health record, owned by the child, which does not have the disadvantage of the centrally held files (if only health and social service workers would use it properly).

It is important that small privately run establishments are open to regular inspection by health authorities. There has to be a close link with community child services so that any child coming into the area is immediately notified and welcomed.

Far from being stigmatised, these children can be made to feel part of local routine services and immunisations for school-aged children. Vision and hearing checks can be carried out and pathology treated - urgent referrals can be fast-tracked, as Dr Payne suggests, and local services can be linked so the young people feel somebody cares about how they are feeling.

We are hopeful that the National Assembly for Wales will create a commissioner for children soon. The job description has yet to be worked out, but it is to be hoped that it will include examining all legislation to look at the child's perspective. Tom Cox has the right idea about this, and I hope he will not be fobbed off by promises of a 'taskforce' and a 'scheme'.

Dr Clare Jenkins Newtown Powys