Addressing medical needs of immigrant children

A recent surge in minors crossing on their own from Mexico into the United States has brought renewed interest in their health and how physicians can best care for them.

U.S. Customs and Border Protection reports that 23,553 minors were apprehended while crossing the border from Oct. 1, 2015, to March 1, 2016, an increase of 89 percent from the same period a year earlier. Though far smaller than the high tide of crossings in 2014, the surge raises some of the same concerns that surfaced then.

Unaccompanied alien children—“UACs” in the official jargon—have unique physical and mental health needs, according to a report by the Pew Charitable Trusts and the experience of physicians working with immigrant children.

“Unaccompanied children have often faced trauma prior to, during and/or after arriving to the United States,” said Julie Linton MD, chairperson of the Immigrant Health Special Interest Group of the American Academy of Pediatrics. “Trauma-informed care is essential as they access health services.”

Border crossings by unaccompanied minors, most of them from Central America, reached a peak in 2014, when 68,500 were apprehended at the border. The Centers for Disease Control and Prevention reported clusters of pneumonia and influenza at the time in temporary shelters in the Southwest.

Yet early warnings of a substantial health threat to the wider community seem to have been unfounded. Infectious diseases are no more common among unaccompanied children than they are among other immigrant children from low-resource nations, said Dr.Linton, who practices in Winston-Salem, N.C.

The Office of Refugee Resettlement (ORR), part of the U.S. Department of Health and Human Services, reports that unaccompanied minors pose little health risk to the wider community.

Still, meeting these children’s medical needs calls for heightened understanding of their particular experiences.

The AMA House of Delegates has characterized unaccompanied minor immigration as “a humanitarian issue” and resolved that the organization would work to identify obstacles to mental and physical care in cooperation with other organizations.

“Partnership with community-based organizations is essential when caring for unaccompanied children,” Dr. Linton said. To be effective, health care must work in tandem with the trauma, legal and institutional trust issues that child immigrants experience, she said.

While ORR pays for and provides services, including medical care for the children while they are at a shelter, once a child has been placed with a family member or sponsor, the care and well-being of the child becomes the responsibility of that sponsor.

ORR has helped large numbers of unaccompanied minors move during the past two years from temporary shelters into long-term housing, arranging places with family members and other sponsors. Pew reports that 97 percent of children apprehended in late 2015 and early 2016 have been placed in housing around the U.S.

Policies addressing health care for unaccompanied immigrant children vary by jurisdiction. Several states, including California, Illinois, Washington, Massachusetts and the District of Columbia, have sought a solution by providing child immigrants with Medicaid coverage.

“Many of these children struggle to effectively integrate into communities,” Dr. Linton said. “However, having successfully reached a potentially safe new home, they also have tremendous potential to contribute immensely to our community.”

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