The health needs of children in foster care (FC) have been well described and pathways to health assessment established. Such pathways for other vulnerable children are scarce. We aimed to describe the health and service needs of children attending community paediatric (CP) clinics specifically set up for children exposed to psychosocial risk factors in South Western Sydney (SWS), and to compare the needs of children in FC to those in parental care. We analysed the clinic records of all children attending CP clinics for vulnerable children in SWS in 2008. Of the 98 children seen, the mean age was 4.6 years, the majority (88%) had abuse documented and 57 per cent were in FC. Family risk factors included parental substance use (65%), domestic violence (57%) and parental mental health disorder (33%). Health needs identified included speech delay (45%), developmental delay (39%) and incomplete immunisation (34%); many children required specialist referral. Behavioural and educational difficulties were encountered in almost one‐half of the children. There were no significant differences in health/support needs between those in FC and those in parental care. Pathways to early identification/intervention need to be broadened beyond those established for children in FC, to include those exposed to a range of psychosocial adversities. Copyright © 2014 John Wiley & Sons, Ltd. ‘Behavioural and educational difficulties were encountered in almost one‐half of the children’ Key Practitioner Messages Children in FC and children exposed to psychosocial adversities have a range of health, developmental and psychosocial problems. There are no differences in health or service needs of children exposed to psychosocial adversities, whether they are in FC or parental care. Early identification can lead to intervention and the amelioration of risks. Improving access to paediatric and psychosocial assessments for all vulnerable children rather than just children in care is crucial. ‘Early identification can lead to intervention and the amelioration of risks.’