Refugee children deserve compassionate care

Politics aside, pediatricians have a crucial role to play in the health and well-being of children who come to the United States to flee violence and persecution. Abrupt changes to immigration policy and enforcement can disrupt long-standing processes, and a new statement reminds practitioners that they are at the forefront in ensuring children get the basic care they need.

In a new statement published in Pediatrics, the American Academy of Pediatrics (AAP) Council on Community Pediatrics offers a detailed guide on the treatment of children seeking refugee status in the United States, with recommendations for pediatricians on the care and integration of those children throughout the immigration process.

“The children I see in my practice are, first and foremost, children. They do not choose where they or their parents are born,” says Julie M. Linton, MD, FAAP, assistant professor of pediatrics at Wake Forest School of Medicine, Winston-Salem, North Carolina, and one of the lead authors of the statement. “As a pediatrician and a mother, I can only imagine what it would be like for the immediate safety, health, education, and future of my child to be imminently threatened by inescapable violence and abject poverty. It's not a choice. If you are fleeing violence threatening the life of your child, you're not making a choice. As pediatricians, we can stand with immigrant children and families, provide compassionate care, and advocate for local and national policies that protect their health and well-being.”

In 2014, US Customs and Border Protection detained 68,631 unaccompanied children and another 68,684 children who arrived with parents or guardians. According to the report, contrary to what is presented in politics and the mainstream media, more than 95% of the undocumented children that have arrived in the United States since 2014 have been from the Central American “Northern Triangle” countries of Guatemala, Honduras, and El Salvador. Increased efforts by the United States to curb immigration along the southern borders resulted in a decrease in these numbers in 2015, but by 2016 they began to climb again, with 59,692 unaccompanied children and 77,674 children with parents or guardians detained that year. According to the AAP’s report, 58% of the children crossing the border from the Northern Triangle countries and Mexico had fear sufficient to merit them protections under international law, and 77% cited violence as the reason for fleeing their home countries.

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Linton says not all children seeking safe haven have refugee status while seeking asylum or other forms of legal relief. It’s important to note, she says, that children in detention while seeking refugee status aren’t necessarily there by choice.

“Children do not immigrate, they flee,” Linton says. “Pediatricians and other child advocates have visited families in detention and interviewed them about their experiences. Central American Northern Triangle countries are among the poorest countries in the hemisphere and have some of the highest rates of homicide in the world. Children, ethnic minorities, girls, and women are especially targeted by criminal elements. There is little to no protection for these vulnerable populations. Children and parents describe fleeing extremely violent situations, including witnessing the killing of immediate family members and threats of violence to their children.”

These difficult experiences are compounded when children and their families are apprehended and placed into our complicated immigration system, including various forms of detention, before being released to the community and to face pending immigration hearings, she says. At this point, she says, pediatricians can play a vital role in the health and welfare of these children.

“From the moment children are in the custody of the United States, they deserve healthcare that meets guideline-based standards, treatment that mitigates further harm or traumatization, and services that support their health and well-being,” Linton says. “Pediatricians in the community play a critical role in caring for these families in communities, including connecting them to other resources and professionals.”

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This includes promoting the AAP’s recommendations that children and their families not be separated and that children-whether accompanied or unaccompanied-not be detained within Department of Homeland Security processing facilities.

“There is no evidence that any amount of time in detention is ‘safe’ for children. Even short periods of detention can cause psychological trauma and short- and long-term health risks for children. These detention facilities do not meet the basic standards of care of children in residential settings, and the AAP recommends children not be housed in them,” Linton says.

The AAP also recommends that all immigrant children have access to medical and legal care. In order to help immigrant children in these areas and beyond, Linton says pediatricians should become familiar with the 4 phases of immigration children will face-premigration, migration, detention, and postrelease community placement pending court proceedings-as well as the risks faced by immigrant children in each phase.

Interviewing children can be difficult, as they may not identify themselves as seeking safe haven LInton adds. Pediatricians must be able to gather a sensitive immigration history that can determine whether the child is accompanied, or has faced abuse, neglect, abandonment, persecution, trafficking, or violence.

Medical-legal partnerships in these kinds of situations have proved to be an excellent model in ensuring that children get both the medical and legal help they require. Pediatricians and legal resources also can set children on a path to receive education and community integration while they await the outcome of their immigration proceedings.

“As immigrant children integrate into communities, parents and caregivers can help children to overcome stress and build healthy brains through enduring, supportive relationships with caregivers,” Linton says. “Pediatricians can help parents to provide buffering support to children by talking, singing, and reading to children every day; planning activities to do together as a family; and engaging in care of themselves so that they can care for their children.

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As immigration policy in the United States evolves, Linton says it’s more important than ever for pediatricians to play a role in ensuring children who are seeking safe haven in our country are cared for properly.

“The situation is evolving and will become more complicated as rules and regulations shift, including definitions of asylum and who qualifies. As a pediatrician, I know that detention threatens children’s health and well-being,” Linton says. “The confusion surrounding immigration policies creates more fear and stress among an already fearful and stressed population. As providers, it’s difficult to know how to counsel families about how to stay safe and healthy as rules, definitions, and regulations are shifting.”

Linton says the AAP and other leading medical organizations share the opinion that government decision makers and the administration should prioritize the best interests of children seeking safe haven and continue to ensure that children fleeing violence are able to seek refuge in the United States. Pediatricians should stay up-to-date on the changing political landscape and the effect changes have on the health and well-being of children seeking refuge.

“Executive orders have had a chilling effect on access to health care for undocumented immigrants and immigrant families due to fears of being apprehended by immigration officials,” Linton says. “It is critical that ‘sensitive locations’ such as schools, healthcare facilities, court houses, and houses of worship are not used as targets for Immigration and Customs Enforcement activities.”