Objectives. To assess the healthcare needs of looked-after children in East Surrey. Methods. Epidemiological, comparative and corporate approaches were used to study the healthcare needs of looked-after children. Information was obtained from published and unpublished sources, case note review, cross-referencing with records from specialist services, and interviews with stakeholders. Results. Of the 136 children whose case notes were reviewed, only 64% had undergone statutory medical examinations. Several physical health problems were identified, emotional and behavioural problems were present in 34% of children, 25% of school-aged children had a statement of special educational need, and 36% had ever used child and adolescent mental health services. Immunization coverage was lower than that of children who were not in care. Several unmet needs and gaps in service provision were identified. Conclusions. Children in care have a higher degree of physical and mental health needs than their not-in-care counterparts. The local service for children in care needs to be improved to meet these health needs and lead to better health and health-related outcomes for the children.