Thirteen children in the care of the State are in residential units outside the jurisdiction because there is nowhere suitable for them in Ireland, it has emerged.
Most of the children have severe behavioural or psychiatric problems and have been placed in care centres in the UK, Sweden and the US.
These centres include Boystown in Omaha, Nebraska, USA, which provides specialised treatment for at-risk children and Hassela Gotland in Sweden, which runs an island-based community rehabilitation programme. The majority of these children were previously in the care of the State in Ireland. However, these placements either broke down or were unable to meet the needs of the children in question.
The practice of placing children in care abroad has been criticised by some campaigners and solicitors who say these services should be available in Ireland and that children should be placed as close to their families as possible.
However, the Health Service Executive (HSE) says the 13 children are a tiny proportion of the 5,000 children in care, the majority of whom are placed in foster care.
"In very rare circumstances we have to look abroad to find specialised treatment programmes for children, where there aren't sufficient numbers to development them here," said Aidan Waterstone, the HSE's national specialist for child and family services.
"There are some children with particularly difficult and challenging behaviour, or may have issues such as predatory sexual behaviour."
Mr Waterstone said the HSE's first preference was to offer care placements for children as close to their families or community as possible, but this needed to be balanced with the various treatment options available.
He added that health authorities were learning from examples of specialised care abroad and were establishing new ways of providing support to young people at risk.
This includes a new form of "multi-dimensional foster care", which provides treatment for children with more complex or challenging behaviour. Among the children being cared for abroad is a 16-year-old boy with psychiatric problems who set fire to a room in which there were other children. Another young person in care who suffered brain-damage and is incapable of independent living is in a specialised centre in the UK.
The Irish Association for Young People in Care said it was concerned that sending at-risk children abroad could have a destabilising effect.
"I don't think it's right that children should have to travel these distances," said Jennifer Gargan, the association's director.
"The emotional impact of going into care is huge . . . It raises a lot of issues such as a child's sense of identity, their attachment to home and the right of access for families." The Children's Rights Alliance also expressed concern at the lack of proper specialised services for troubled children in Ireland.
"Much more needs to be done to support children with mental health difficulties . . . through the provision of comprehensive preventive and early intervention services and through specialised and co-ordinated treatment services," said Jillian van Turnhout, chief executive of the alliance.