AAP issues policy statement on caring for children in immigrant families

Crossposted from the Healio Infectious Diseases in Children

In a new policy statement, the AAP provided guidance for pediatricians and local organizations to improve care for immigrant children and their families through practice-level changes and advocacy efforts.

According to Julie M. Linton, MD, FAAP, lead author of the policy statement and co-chair of the AAP Immigrant Health Special Interest Group, and colleagues, one in four children in the United States is either born outside the country or has at least one foreign-born parent.

“Children in immigrant families have incredible strengths and potential to contribute immensely to our communities,” Linton told Infectious Diseases in Children. “Additionally, children in immigrant families have often been exposed to trauma, adversity and toxic stress at high rates and are being subjected to federal policies that threaten their health and safety.”

According to the authors of the policy statement, children immigrate to the U.S. for many reasons, including economic disparity, educational opportunities, international adoption, human trafficking or the search for safe haven. There are several legal protections offered to these children and families, but Linton and colleagues noted that their immigration status often influences their access to and use of health care, their perceived health status and health outcomes.

Linton said that children born outside the U.S. have “unique health considerations,” which may include their exposures within their country of origin, during their travel to the U.S. or upon arrival in the U.S. Linton, who has visited the facilities where children and families are kept after arrival to the country, said that no child should have to be subject to the conditions currently faced.

“In my own clinic, I care for children who have been processed through these facilities. They speak of being separated from parents and siblings for days at a time, inedible food and personal belongings — including medical records — being ‘lost,’” she said. “The re-traumatization of the processing experience can have short- and long-term health effects. As a pediatrician, it is my duty to support children who are beginning to heal from extended trauma.”

The status of immigrant children and families has also been linked to poverty, food insecurity, housing instability, discrimination and health literacy, Linton and colleagues wrote in the statement.

To improve the care of immigrant children, the AAP provided several practice-level recommendations, including:

  • Examining their own inherent biases;
  • Integrating mental health, social work, patient navigation and legal services to reduce barriers to care;
  • Providing medical interpreters who are not family members, friends and children who can be accessed in-person, on the phone or by tablet to improve understanding and communication;
  • Participating in professional development activities centered on immigrant and global health as well as integrative and travel medicine;
  • Applying a “trauma-informed lens,” which includes sensitivity and screening for trauma throughout generations of the family; and
  • Examining immigrant children’s development, learning and behavior regardless of age.

In addition, the AAP recommended several topics that pediatricians and organizations can advocate for, including:

  • Health care for all children, regardless of immigration status;
  • Medical interpretation and translation service coverage through private and public health insurance;
  • The end of child separation and detention of children with parents as a means of law enforcement;
  • Stopping immigration enforcement at locations like hospitals, health care facilities, schools, including child care and Head Start, places of worship and other sensitive locations; and
  • Free legal representation for children in immigration proceedings.

“Pediatricians will oppose any proposal or policy that puts children’s health at risk, and we will continue to speak out to ensure that all children, no matter where they or their parents were born, are healthy and safe,” Linton said.

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