Detained Children: Part II

Jul 16, 2018

June 26, 2018

This is Part II of this blog, devoted to child detainees and their health issues. First, Christopher Sim, a faculty member in our Department of Physician Assistant Studies further describes some of the medical concerns for immigrant populations. The second contributor is Dr. Mary Thompson, a pediatric nurse practitioner and faculty member at the IHP. She continues with more specific information that may be useful to providers concerned with care of children who are in refugee situations.

Note: In Part III we will begin to focus on some of the specific developmental concerns and mental health issues facing these children and their families and caregivers.

From Christopher Sim, MPAS, PA-C, DFAAPA

Whether children arrive in the United States as part of a prearranged immigration with advanced notice, in a more urgent refugee crisis, or as undocumented emigres, they typically are at risk from multiple health factors. Approximately 3.7% of children living in the US were born in other countries. This includes 7.7% of Latino children and 16 % of Asian children (Yun, 2016).

Hepatitis B, tuberculosis, parasites, anemia and high lead levels are the most commonly encountered diseases in children new to the United States (McBride, 2016). This is complicated by the countries of origin from which these children travel from. Although some children from refugee populations benefit from government or non-governmental organizations in terms of nutritional support and preventive health services, most refugee children from Central American countries have not been as fortunate. These children would be susceptible on their own, but also pose the risk of transmitting disease amongst themselves in the housing environments currently operated by Immigration Control and Enforcement in the US. It is also conceivable that children who arrived without such infections may, if returned to their countries of origin, transmit preventable new infection in those settings.

Failure to address these issues when children are under the care of the United States is unethical, irresponsible, and contrary to acceptable standards of humanitarian treatment of refugees. At the very least, these children require baseline testing for the most common parasitic diseases, hepatitis, tuberculosis, and lead screening. In identifying preexisting disease, public health authorities would be able to make insights into epidemiologic patterns and document current health states amongst these populations. Vaccination among these children is also either difficult to verify, if not impossible. Such children should also receive the same immunizations required of native-born US children, in the common interest of public health.

Yun, K., Matheson, J., Payton, C., Scott, K. C., Stone, B. L., Song, L., . . . Mamo, B. (2016). Health Profiles of Newly Arrived Refugee Children in the United States, 2006–2012. American Journal of Public Health,106(1), 128-135. doi:10.2105/ajph.2015.302873
Mcbride, D. L. (2016). Large Study of Health Issues for Newly Arrived Child Refugees. Journal of Pediatric Nursing,31(2), 222-223. doi:10.1016/j.pedn.2015.11.014

From Mary Thompson, PhD, RN, CPNP-PC

The American Academy of Pediatrics (AAP) has adopted a Toolkit to inform health providers of “common matters” related to the healthcare needs of immigrant children.

According to the Toolkit, many children who are newly immigrated have not had regular medical care in their country of origin. They require specialized healthcare screening for: exposure to infectious diseases (such as tuberculosis, HIV, and parasitic infections), immunization history (if known), medical history (including birth history), nutrition history, medications and use of complementary and alternative treatments, environmental hazards (including lead exposure), exposure to (tobacco, opium/heroin, and other drug use), dental history, social history, educational history, and sexual or other abuse. Children who undergo forced separation due to immigrant enforcement may not be able to provide this information.

Many children who have newly immigrated have faced Adverse Childhood Experiences (ACEs) prior to immigrating from their country of origin, or during their immigration. Separation from parents further exacerbates the negative effects from the exposure of ACEs. These children demonstrate a number of health problems, including anxiety, depression, poor school performance, sleeping and eating disruptions. Table 1 from the Toolkit includes a list of Mental Health and Developmental Screening Instruments and Resources that can be used to assess the mental health needs of immigrant children separated from their parents.

The United Nations High Commissioner for Refugees (UNHCR) document Refugee Children: Guidelines on Protection and Care offers insight in how to be responsive and acknowledge the needs of children affected by separation from their caregivers during immigration. In the immediate, children should be provided with appropriate:

Play: “Play is vital to the healthy development of a child. It is a child's way of coping with what has happened, of relaxing and relieving tensions and of assimilating what (s)he has experienced and learned. . . Playgrounds Refugee camps, settlements or reception centers should have play areas from the outset.”

Infants: “Breast feeding should be facilitated. . . Children of about 10 months (who are just about to develop speech, crawl and walk) are particularly vulnerable. In such situations the integration of infant stimulation programmes in other emergency services, such as feeding programmes, has proven helpful.”

Developmental Screening: “. . . is needed to identify children whose development is delayed. This involves knowledge about what normal development in this specific culture means. A group of refugee mothers may be able to help you. - Intervention if there is abuse or neglect.”

Counseling and Support Groups: “Children will become anxious when they do not understand what is happening to them. . . When a child becomes depressed, anxious or upset, the right to participate may effectively be lost: a child may not be able to process the information, and may not be able to make realistic decisions. Counseling to reduce stress may be necessary before children can focus on and absorb information fully. - Support groups: Encourage the creation of support groups where children have an opportunity to talk about problems and ways of addressing them. It is important that they understand that they are not alone and that they are not responsible for what has happened.”

Restoring Normalcy: “Restoring normalcy for unaccompanied children requires that tracing for parents begin immediately. When parents or relatives are located, children need help in maintaining communication with them until they can be reunited. . . The threat to psychosocial well-being is inevitably increased when lengthy or permanent disruptions occur between child and primary care-giver, or child and family. The loss of the mother, or substitute mother figure, particularly at an early age, places a child at a higher psychological risk. Arranging for substitute family care or immediate family reunion is critical.”

Perhaps most important of all:

Helping children by helping the family: “The single best way to promote the well being of children is to support their family.” This includes preserving family unity, tracing parents who have been separated, providing family support, establishing parental support networks, and helping families prepare for reunion by offering counseling.

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