Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments

Abstract

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries. In addition, guidelines from Australia, Canada, and the United States were reviewed. Evidence on recommendations to be considered for inclusion was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anemia, micronturient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, posttraumatic stress disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation. Conclusion: The current document provides recommendations based on expert opinion and evidence for medical care for migrant children in Europe. These include general topics on ethical standards, use of interpreters, follow-up and documentation and specific recommendations for communicable and non-communicable conditions and diseases. Keywords ; The author would like to thank Ayesha Kadir and Anders Hjern for helpful comments on the manuscript. We would like to thank René-Marie Meignan for designing the icons.

Infectious Diseases among Refugee Children

“…The prevalence of HIV infection in newly arrived migrant children depends on the risk factors from their countries of origin (such as prevalence of maternal HIV infection and risk of mother-to-infant HIV transmission, maternal drug use, receipt of blood products) [5,23]. Studies from Germany, Italy, and Canada have documented an HIV prevalence of 0.4% to 2% among migrant children [39][40][41].…”

“…Migrants often arrive from countries with a high incidence of TB [5,44]. In addition, the long travel and housing in overcrowded settings during re-settlement increases the risk of exposure to TB [45].…”

“…Therefore, screening for latent TB infection and early diagnosis and treatment of TB disease is crucial to reduce morbidity and mortality [47]. Studies from EU/EEA have reported a higher incidence of active TB is higher in migrant children compared with non-migrant children [5,48,49]. In one study from Germany, of 968 asylum-seeking children screened for TB, 66 (6.8%) children were diagnosed with TB infection (58 latent TB infection, 8 active TB) [48].…”

“…In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents, and children to the European Union (EU)/European Economic Area (EEA) and the U.S. [1][2][3][4][5]. The Global Trends Report of the United Nations High Commissioner for Refugees (UNHCR) reported that by the end of 2017 approximately 68.5 million people were forcibly displaced across the globe, including 25.4 million refugees, 40 million internally displaced persons (IDPs), and 3.1 million asylum seekers [6].…”

“…Across Europe, children account for more than 30% of all asylum-seeking people [5]. In EU/EEA countries, an estimated 200,000 to 400,000 children sought asylum annually from 2015 to 2017; an additional 800,000 asylum-seeking children and adolescents arrived in 2015 to 2016 [1].…”