Providing Care for Children in Immigrant Families

Abstract

Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and wellbeing, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and systemlevel support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF. DEMOGRAPHICS Health care of children in immigrant families (CIF) in the United States has received increasing attention over the past decade, in part because of increasing migration of children caused by conflicts globally, greater diversity among migrant populations, and divisive sociopolitical discussion regarding immigration policy. Definitions regarding immigrant children vary, but for the purposes of this policy statement, immigrant

Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families

“…Here we apply a health equity framework 5 to evaluate the impact of COVID-19 on CIF and 1 highlight opportunities for advocacy and action for pediatricians, hospitals and healthcare 2 systems, and policymakers to mitigate the unique risks faced by CIF (Table). 3 Health Impacts 4 Amidst unprecedented challenges presented by COVID-19, baseline inequities in at least one non-citizen parent are more often uninsured than children with citizen parents (8% 9 vs. 4%). 6 The Families First Coronavirus Response Act (FFCRA), passed on March 18, 2020, 10 provides COVID-19 testing for uninsured individuals through Medicaid.…”

“…8 Furthermore, parental limited English proficiency (LEP) is a risk factor for poor outcomes 17 among children, including less diagnostic testing and higher rates of complications and adverse 18 events. 3 Professional interpreters are underutilized, and LEP families report poor access to health 19 information and education resources. The current milieu of limited in-person interpreter capacity 20 due to social distancing, insufficient multilingual resources, and lack of interpretation standards 21 for telehealth may impede healthcare delivery for LEP families.…”

International Experience of US Pediatricians and Level of Comfort Caring for Immigrant Children and Children Traveling Internationally

“…Professional societies also may consider evaluating their content for what is currently included to address issues of cultural humility, the use of interpreters, trauma-informed care, promotion of protective factors in immigrant and refugee children, and the specific health needs of these 3 populations of patients. 4,34,35 This study was not without limitations. Survey respondents were asked to self-report what types of patients they cared for in their practice and not the volume of those patients, introducing the possibility of response bias and inconsistencies in distinguishing among immigrant and refugee populations, leading to possible over-or under-reporting of experience with these populations.…”

“…9 Given the recent treatment of children at the US border and the mental health 10 impact of immigration policies, 11 pediatric organizations like the AAP have advocated for policies that promote the health and well-being of immigrant children. 4,12,13 In addition to policies that support the well-being of immigrant children, addressing the gap between practice and comfort in caring for immigrant children is important, as pediatricians may be initial points of contact with the healthcare system for a large number of immigrant children.…”

BCG Vaccine Protection against TB Infection among Children Older than 5 Years in Close Contact with an Infectious Adult TB Case

“…Children in immigrant families are also at high risk for TB, and they may share similar vulnerabilities with foreign-born children. Pour living conditions, home visits by relatives or traveling to the country of origin with high TB incidence are all considered as risk factors for communicable diseases like TB [ 25 ].…”