AAP reaffirms commitment to immigrant children with guidance on their care
J. RaulGutierrez, M.D., M.P.H., FAAP
Walking into a new patient appointment, you encounter a mother with two children ages
8 and 14 years old. The mother and older sibling understand some Spanish, but primarily
speak Mam, a Mayan dialect for which there are no medical interpreters at the moment.
The younger sibling speaks English. Your medical assistant explains that the family
moved to your town two months ago to afford better housing. The older sibling emigrated
from Guatemala on her own four months ago and reunited with her mother after nine
years. She is enrolling in school and needs a routine physical and vaccines, and she
is not sleeping well. Mom has behavioral concerns regarding the younger sibling, and
you also note a body mass index above the 95th percentile.
Children in immigrant families (CIF) represent a growing population across the country,
with children and families seeking asylum at the highest numbers in recent history.
While states like California, New York and Texas hold a significant number of immigrant
families, other states are becoming home to many CIF at a rapid rate.
As health care providers increasingly encounter this diverse and dynamic patient population,
they may experience scenarios like the one above but may not have a foundation from
which to construct a clinical strategy.
Pediatricians need to establish a clinical approach that acknowledges the potential
health effects of migration, particularly forced migration, as well as how the sociopolitical
environment influences health outcomes for CIF.
A new AAP policy statement Providing Care for Children in Immigrant Families, from the Council on Community Pediatrics, updates and expands on concepts presented
in the 2013 policy Providing Care for Immigrant, Migrant, and Border Children. Since then, the practice and evolution of immigrant health has gained traction with
exploration of evidence-based clinical approaches; the interplay of social determinants
of health and biopsychosocial development, particularly as it relates to the legal
and political constructs of immigration status; and the importance of advocacy.
The term “children in immigrant families” allows for the consideration that family
structures vary by composition and immigration status. It invites practitioners to
broadly consider the dynamics and implications of immigration status for the child
and how that shifts depending on the status of primary caretakers and family members.
For example, how might social determinants of health and the general well-being of
a U.S.-born child with parents who have yet to obtain protected legal status differ
from that of a child whose parents have been granted asylum? And how might this child’s
health trajectory change if immigration enforcement actions led to the removal of
a family member from the home? Additionally, the term CIF reflects the subpopulations
within immigrant health.
While CIF present with a variety of experiences, all may face inequities that threaten
their health and contribute to population-level disparities. As such, the policy statement
offers core competencies and the opportunity for experts and practitioners to develop
unifying principles and guidelines that apply to the care of CIF whether they are
refugees or migrant farm workers, for example.
Through the policy, the AAP continues to recognize the importance of human rights
and frameworks that align with its commitment to diversity, inclusion and health equity.
The AAP endorses the United Nations Convention on the Rights of the Child, an internationally
recognized legal framework for the protection of children’s basic rights that has
not been ratified by the United States. Along with using the frameworks of cultural
humility and cultural safety, the policy statement grounds itself in health equity
and recognizing the resilience and cultural assets of CIF.
The policy also highlights common barriers to the care of CIF, many of which are rooted
in structural barriers defined by discriminatory legal and policy constructs.
The recommendations aim to strengthen the medical home for CIF and ensure that health
care is being delivered in an equitable manner where families feel that they are participants
in their care.
Recommendations for pediatricians
Recognize inherent biases and improve skills in cultural humility and effective communication
through professional development.
Consider co-located or integrated mental health, social work, patient navigation and
Use trained medical interpreters — via phone, tablet or in-person — to facilitate
mutual understanding and a high quality of communication.
Remain sensitive to and screen for multigenerational trauma.
Screen for social determinants of health, including risks and protective factors.
Interagency collaboration among service providers (e.g., medical, mental health, public
health, legal, education, social work, ethnic community-based) can enhance care, prevent
marginalization of immigrant families and build resilience.
Health coverage should be provided for all children regardless of immigration status.
Immigration policy that prioritizes children and families by ensuring access to health
care, educational and economic supports, keeping families together, and protecting
vulnerable unaccompanied children is fundamental for comprehensive immigration reform.
Medical education should promote core competencies for the care of immigrant populations
and advocacy curricula.
AAP chapters can work with state governments to adopt policies that protect and prioritize
immigrant children’s health, well-being and safety.
Dr. Gutierrez is a member of the AAP Council on Immigrant Child and Family Health