Children

Editorial

4 pages, 165 KiB

Open AccessEditorial

The Arc of Migration and the Impact on Children’s Health and Well-Being: Forward to the Special Issue-Children on the Move

by Charles Oberg

Children 2019, 6(9), 100; https://doi.org/10.3390/children6090100 - 06 Sep 2019

Cited by 7 | Viewed by 3953

Abstract

Since the start of this millennium the diaspora of families with children has continued unabated. UNICEF estimates that nearly 31 million children have been forcibly displaced from their homes by the end of 2017. This includes 13 million child refugees, an estimated 17 [...] Read more.

Since the start of this millennium the diaspora of families with children has continued unabated. UNICEF estimates that nearly 31 million children have been forcibly displaced from their homes by the end of 2017. This includes 13 million child refugees, an estimated 17 million children internally displaced within their own countries and over 900 thousand children seeking asylum in a different country. Even more staggering is the 75 percent increase in the number of child refugees between 2010 and 2015. This Special Issue, Children on the Move: The Health of Refugee, Immigrant and Displaced Children, examines in detail the health and well-being of our most vulnerable children today. It follows the arc of migration from home country, through transit and finally the challenges experienced in a child’s new country. The papers explore a variety of acute and chronic health conditions as well as the mental health of these children and youth. The articles examine the trauma experienced in their home country, the fleeing of war, violence and/or poverty, the travails during their journey, the stress throughout their stay in detention centers and refugee camps, and finally the transition to a new home country. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

5 pages, 194 KiB

Open AccessEditorial

Constructing Invisible Walls through National and Global Policy

by Stephanie Ettinger de Cuba, Allison Bovell-Ammon and Diana Becker Cutts

Children 2019, 6(7), 83; https://doi.org/10.3390/children6070083 - 17 Jul 2019

Cited by 4 | Viewed by 3963

Abstract

Worldwide 37,000 people are forced to flee their homes every day due to conflict and persecution. The factors that lead people to leave their home countries often originate with economic deprivation and violence, escalated to a level that becomes a struggle for survival. [...] Read more.

Worldwide 37,000 people are forced to flee their homes every day due to conflict and persecution. The factors that lead people to leave their home countries often originate with economic deprivation and violence, escalated to a level that becomes a struggle for survival. Climate change, as it has accelerated over the last three to four decades and negatively impacted natural resources, contributes to a parallel increase in strife and migration. The US response to migration has been to construct an “Invisible Wall” of isolationist and xenophobic policies, many of which are especially harmful to children and their families. The southern US border is perhaps the most high profile location of the Invisible Wall’s construction, fortified by federal policies and a withdrawal from international cooperation. Global reengagement on climate change and migration, US ratification of the Convention on the Rights of the Child, and destruction of the Invisible Wall will help to create a world where children can thrive. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

Research

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8 pages, 1192 KiB

Open AccessArticle

Special Aspects in Pediatric Surgical Inpatient Care of Refugee Children: A Comparative Cohort Study

by Nina K. Friedl and Oliver J. Muensterer

Children 2019, 6(5), 62; https://doi.org/10.3390/children6050062 - 30 Apr 2019

Cited by 7 | Viewed by 4582

Abstract

Background: Recently, the number of refugees in Germany has skyrocketed, leading to a marked increase in refugee children admitted to hospitals. This study describes the special characteristics encountered in pediatric surgical inpatient refugees compared to locally residing patients. Methods: Hospital records of minor [...] Read more.

Background: Recently, the number of refugees in Germany has skyrocketed, leading to a marked increase in refugee children admitted to hospitals. This study describes the special characteristics encountered in pediatric surgical inpatient refugees compared to locally residing patients. Methods: Hospital records of minor refugees admitted to our department from 2005 up to and including 2015 were retrospectively reviewed. Demographic data, diagnoses, comorbidities, body mass indexes, hemoglobin values, and lengths of stay were extracted and statistically compared to local patients. Results: A total of 63 refugee children were analyzed and compared to 24,983 locally residing children. There was no difference in median body mass index (16.2 vs. 16.3, respectively, p = 0.26). However, refugee children had significantly lower hemoglobin values (11.95 vs. 12.79 g/dL, p < 0.0001) and were more likely to be colonized with methicillin-resistant Staphylococcus. aureus (8% vs. 0.04%, p < 0.01). Refugees were much more likely to present with burn injuries (16% versus 3% of admissions, p < 0.001), esophageal foreign bodies (4% vs. 0.5%, p < 0.001), as well as trauma, except for closed head injury. Conclusion: The cohort of refugee children in this study was found to be at a particular risk for suffering from burn injuries, trauma, foreign body aspirations, and anemia. Appropriate preventive measures and screening programs should be implemented accordingly. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

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12 pages, 1693 KiB

Open AccessArticle

Trends in Food Insecurity and SNAP Participation among Immigrant Families of U.S.-Born Young Children

by Allison Bovell-Ammon, Stephanie Ettinger de Cuba, Sharon Coleman, Nayab Ahmad, Maureen M. Black, Deborah A. Frank, Eduardo Ochoa, Jr. and Diana B. Cutts

Children 2019, 6(4), 55; https://doi.org/10.3390/children6040055 - 04 Apr 2019

Cited by 33 | Viewed by 9659

Abstract

Immigrant families are known to be at higher risk of food insecurity compared to non-immigrant families. Documented immigrants in the U.S. <5 years are ineligible for the Supplemental Nutrition Assistance Program (SNAP). Immigration enforcement, anti-immigrant rhetoric, and policies negatively targeting immigrants have increased [...] Read more.

Immigrant families are known to be at higher risk of food insecurity compared to non-immigrant families. Documented immigrants in the U.S. <5 years are ineligible for the Supplemental Nutrition Assistance Program (SNAP). Immigration enforcement, anti-immigrant rhetoric, and policies negatively targeting immigrants have increased in recent years. Anecdotal reports suggest immigrant families forgo assistance, even if eligible, related to fear of deportation or future ineligibility for citizenship. In the period of January 2007–June 2018, 37,570 caregivers of young children (ages 0–4) were interviewed in emergency rooms and primary care clinics in Boston, Baltimore, Philadelphia, Minneapolis, and Little Rock. Food insecurity was measured using the U.S. Department of Agriculture’s Food Security Survey Module. Overall, 21.4% of mothers were immigrants, including 3.8% in the U.S. <5 years (“<5 years”) and 17.64% ≥ 5 years (“5+ years”). SNAP participation among <5 years families increased in the period of 2007–2017 to 43% and declined in the first half of 2018 to 34.8%. For 5+ years families, SNAP participation increased to 44.7% in 2017 and decreased to 42.7% in 2018. SNAP decreases occurred concurrently with rising child food insecurity. Employment increased 2016–2018 among U.S.-born families and was stable among immigrant families. After steady increases in the prior 10 years, SNAP participation decreased in all immigrant families in 2018, but most markedly in more recent immigrants, while employment rates were unchanged. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

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8 pages, 1592 KiB

Open AccessArticle

Child Morbidity and Disease Burden in Refugee Camps in Mainland Greece

by Asterios Kampouras, Georgios Tzikos, Eustathios Partsanakis, Konstantinos Roukas, Stefanos Tsiamitros, Dimitrios Deligeorgakis, Elisavet Chorafa, Maria Schoina and Elias Iosifidis

Children 2019, 6(3), 46; https://doi.org/10.3390/children6030046 - 17 Mar 2019

Cited by 11 | Viewed by 5580

Abstract

The crisis conflicts in Syria have forced a lot of people to relocate and live in mainland Greece, where they are hosted in refugee camps. In the present study, our aim was to assess child morbidity and overall disease burden in two camps [...] Read more.

The crisis conflicts in Syria have forced a lot of people to relocate and live in mainland Greece, where they are hosted in refugee camps. In the present study, our aim was to assess child morbidity and overall disease burden in two camps in northern Greece during a six-month winter period. A primary health care office was founded in each camp. Refugees of all ages with health problems were examined daily by specialty doctors. Cases were classified into two categories: Infectious or non-infectious. In total, 2631 patients were examined during this period (out of the 3760 refugees hosted). Of these patients, 9.8% were infants, 12.7% were toddlers, and 13.4% were children. Most of the visits for children aged less than 12 years old were due to infectious diseases (80.8%). The most common sites of communicable diseases among children were the respiratory tract (66.8%), the skin (23.2%), and the urinary (3.2%) and gastrointestinal tracts (6.2%). Non-communicable diseases were mostly due to gastrointestinal (20.2%), respiratory (18.2%), surgical (13.1%), and allergic (10.3%) disorders. Infants, toddlers, and children suffered more frequently from respiratory infections, while in adolescents and adults, non-infectious diseases were more common. Toddlers and children were more likely to fall ill in comparison to infants. Conclusions: During the winter period, infectious diseases, especially of the respiratory tract, are the main reason for care seeking among refugees in Greek camps, with toddlers suffering more than other age groups. The overall mortality and referral percentage were low, indicating that adequate primary care is provided in this newly established refugee hosting model. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

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16 pages, 239 KiB

Open AccessArticle

Addressing Marginality and Exclusion: The Resettlement Experiences of War-Affected Young People in Quebec, Canada

by Andie (Saša) Buccitelli and Myriam Denov

Children 2019, 6(2), 18; https://doi.org/10.3390/children6020018 - 30 Jan 2019

Cited by 9 | Viewed by 4724

Abstract

Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their [...] Read more.

Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their unique needs, values, beliefs, and intersectional experiences of oppression. Drawing on interviews with 22 young people from war-affected areas living in Quebec, Canada, this paper critically examines how dominant cultural norms and social relations in Quebec’s health, social and educational services network shape their experiences in seeking care, healing and belonging. Alternative care systems and approaches, as proposed by the participants, are then explored. The findings emphasize the need for spaces and care services where war-affected young people’s identities and lived realities are validated and represented. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

Review

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21 pages, 369 KiB

Open AccessReview

Infectious Diseases among Refugee Children

by Avinash K. Shetty

Children 2019, 6(12), 129; https://doi.org/10.3390/children6120129 - 27 Nov 2019

Cited by 22 | Viewed by 6938

Abstract

In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the [...] Read more.

In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

6 pages, 196 KiB

Open AccessReview

The Importance of Oral Health in Immigrant and Refugee Children

by Eileen Crespo

Children 2019, 6(9), 102; https://doi.org/10.3390/children6090102 - 09 Sep 2019

Cited by 16 | Viewed by 6143

Abstract

According to the Migration Policy Institute, 2017 data revealed that a historic high 44.5 million people living in the United States (US) were foreign-born [1], more than double the number from 1990 [2]. Since the creation of the Refugee Resettlement Program in 1980, [...] Read more.

According to the Migration Policy Institute, 2017 data revealed that a historic high 44.5 million people living in the United States (US) were foreign-born [1], more than double the number from 1990 [2]. Since the creation of the Refugee Resettlement Program in 1980, refugee families have settled in the US more than in any other country in the world [3]. In 2018, for the first time, Canada overtook the US in numbers of refugees accepted [1]. Foreign-born people now account for 13.7% of the total US population [1]. Further, a quarter of children in the United States currently live in households with at least one foreign-born parent [4]. These population shifts are important to note because immigrant and refugee families bring cultural influences and health experiences from their home countries which can greatly affect the overall health and well-being of children. For these new arrivals, oral health is often a significant health issue. The severity of dental disease varies with country of origin as well as cultural beliefs that can hinder access to care even once it is available to them [5,6]. As pediatricians and primary care providers, we should acknowledge that oral health is important and impacts overall health. Healthcare providers should be able to recognize oral health problems, make appropriate referrals, and effectively communicate with families to address knowledge gaps in high-risk communities. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

11 pages, 260 KiB

Open AccessReview

Applying Trauma-Informed Practices to the Care of Refugee and Immigrant Youth: 10 Clinical Pearls

by Kathleen K. Miller, Calla R. Brown, Maura Shramko and Maria Veronica Svetaz

Children 2019, 6(8), 94; https://doi.org/10.3390/children6080094 - 20 Aug 2019

Cited by 55 | Viewed by 15436

Abstract

Immigrant and refugee youth have higher rates of trauma than youth who are not transnational. While youth are incredibly resilient, trauma and toxic stress can result in poor health outcomes that persist throughout life. However, clinical interventions can promote resilience and decrease the [...] Read more.

Immigrant and refugee youth have higher rates of trauma than youth who are not transnational. While youth are incredibly resilient, trauma and toxic stress can result in poor health outcomes that persist throughout life. However, clinical interventions can promote resilience and decrease the negative impact of trauma. This article will review the principles of trauma-informed care and its application for the care of immigrant and refugee youth and their families by sharing concrete and feasible strategies for primary care providers and systems. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

Other

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16 pages, 236 KiB

Open AccessViewpoint

Refugee and Asylum-Seeking Children: Interrupted Child Development and Unfulfilled Child Rights

by Ziba Vaghri, Zoë Tessier and Christian Whalen

Children 2019, 6(11), 120; https://doi.org/10.3390/children6110120 - 30 Oct 2019

Cited by 14 | Viewed by 8330

Abstract

The 21st century phenomenon of “global displacement” is particularly concerning when it comes to children. Childhood is a critical period of accelerated growth and development. These processes can be negatively affected by the many stressors to which refugee and asylum-seeking children are subjected. [...] Read more.

The 21st century phenomenon of “global displacement” is particularly concerning when it comes to children. Childhood is a critical period of accelerated growth and development. These processes can be negatively affected by the many stressors to which refugee and asylum-seeking children are subjected. The United Nations Convention on the Rights of the Child (CRC) is the most ratified human rights treaty in history, with 196 States Parties (SPs). The CRC provides a framework of 54 articles outlining government responsibilities to ensure the protection, promotion, and fulfillment of rights of all children within their jurisdictions. Among these are the rights of refugee and asylum-seeking children, declared under Article 22 of the CRC. Refugee and asylum-seeking children, similarly to all other children, are entitled to their rights under the CRC and do not forgo any right by virtue of moving between borders. The hosting governments, as SPs to the CRC, are the primary duty bearers to fulfill these rights for the children entering their country. This manuscript provides an overview of the health and developmental ramification of being displaced for refugee and asylum-seeking children. Then, an in-depth analysis of the provisions under Article 22 is presented and the responsibilities of SPs under this article are described. The paper provides some international examples of strengths and shortcomings relating to these responsibilities and closes with a few concluding remarks and recommendations. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

9 pages, 226 KiB

Open AccessBrief Report

by Melissa Diamond and Charles Oberg

Children 2019, 6(10), 110; https://doi.org/10.3390/children6100110 - 07 Oct 2019

Cited by 4 | Viewed by 5229

Abstract

Since 2012, more than three million Syrian refugees have fled to Turkey. While these refugees vary in socioeconomic background, it is notable that 50% of Syrian refugee children in Turkey display symptoms of post-traumatic stress and that more than 663,138 of these children [...] Read more.

Since 2012, more than three million Syrian refugees have fled to Turkey. While these refugees vary in socioeconomic background, it is notable that 50% of Syrian refugee children in Turkey display symptoms of post-traumatic stress and that more than 663,138 of these children between the ages of six and seventeen are not enrolled in school. For those children who are in school, high levels of trauma have significant implications for the education system as trauma alters the brain and affects the way children learn. A Global Voice for Autism is an international non-governmental relief and development organization that exists to equip teachers and families in conflict-affected communities. Its intent is to support the development and success of children with autism and trauma-related behavioral challenges in their classrooms, home, and communities. The instabilities inherent in the Syrian refugee experience pose a number of challenges to the organization’s effective implementation of programming. The experiences of refugees in Turkey are highly gendered. Therefore, a qualitative gender analysis was conducted to address and better understand the challenges faced when carrying out these educational interventions. The article examines domestic violence, sexual violence, and masculinity as gender-driven constructs that influence how refugees experience trauma. In addition, structural issues in existing support systems all present significant challenges to Syrian refugee parents that impede effective program implementation. It is imperative to assess structural issues in existing support services to address these challenges and to successfully carry out meaningful and impactful programming. This Brief Report provides a series of recommendations in order to ameliorate these challenges and increase the efficacy of educational interventions with Syrian refugee parents of trauma-affected and vulnerable children in Turkey. It concludes with a call for policy changes that protect refugees from deportation when accessing support services and a network of services that do not require residency permits. It calls for increased integration of parent trauma support in educational intervention trainings and the creation of safe spaces where mothers and fathers can discuss their own trauma and challenges in the hope of significantly enhancing program efficacy. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

5 pages, 185 KiB

Open AccessOpinion

Challenges in Caring for Linguistic Minorities in the Pediatric Population

by Logan DeBord, Kali Ann Hopkins and Padma Swamy

Children 2019, 6(8), 87; https://doi.org/10.3390/children6080087 - 25 Jul 2019

Cited by 1 | Viewed by 4042

Abstract

Physicians in the United States (U.S.) face unique obstacles in providing care for persons with limited English proficiency (LEP), especially speakers of rare languages. Lack of professional resources is not a problem exclusive to health care delivery, with speakers of Mayan dialects receiving [...] Read more.

Physicians in the United States (U.S.) face unique obstacles in providing care for persons with limited English proficiency (LEP), especially speakers of rare languages. Lack of professional resources is not a problem exclusive to health care delivery, with speakers of Mayan dialects receiving increasingly narrow representation in detention centers and immigration courts at the U.S.–Mexico border. Parent-child dynamics and other crucial information related to pediatric care may be lost in translation in the event of inadequate interpreter services. Several strategies could address disparities in medical care faced by persons with LEP, speaking rare as well as more common languages. These include increasing the availability of professional interpreters via expanded and/or incentivized training programs, providing focused education in interpreter services for medical students, and unifying interpretation services provided by local consulates and nonprofit agencies for both medical and legal purposes. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

5 pages, 168 KiB

Open AccessCase Report

The Use of Age Assessment in the Context of Child Migration: Imprecise, Inaccurate, Inconclusive and Endangers Children’s Rights

by Ranit Mishori

Children 2019, 6(7), 85; https://doi.org/10.3390/children6070085 - 23 Jul 2019

Cited by 10 | Viewed by 4981

Abstract

Anecdotal reports suggest migrant children at the US border have had to undergo age assessment procedures to prove to immigration officials they qualify for special protections afforded to those under age 18. There are a variety of methods to assess the chronological ages [...] Read more.

Anecdotal reports suggest migrant children at the US border have had to undergo age assessment procedures to prove to immigration officials they qualify for special protections afforded to those under age 18. There are a variety of methods to assess the chronological ages of minors, including imaging studies such as X-rays of the wrist, teeth, or collarbone. However, these procedures have come under great scrutiny for being arbitrary and inaccurate, with a significant margin of error, because they are generally based on reference materials that do not take into account ethnicity, nutritional status, disease, and developmental history, considerations which are especially relevant for individuals coming from conflict and/or resource-constrained environments. Using these procedures for migration purposes represent an unethical use of science and medicine, which can potentially deprive minors with the protections that they are owed under US and international laws, and which may have devastating consequences. We should advocate for the creation special protocols, educate law enforcement and legal actors, ensure such procedures are carried out only as a last resort and by independent actors, emphasize child protection and always put the child’s best interest at the core. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

5 pages, 201 KiB

Open AccessOpinion

The Rights of Children on the Move and the Budapest Declaration

by Charles Oberg

Children 2018, 5(5), 61; https://doi.org/10.3390/children5050061 - 17 May 2018

Cited by 1 | Viewed by 3559

Abstract

It has been estimated that more than 50,000,000 children and youth have migrated across borders or been forcibly displaced within their own country. They consist of refugees, asylum seekers, internally displaced persons (IDP), economic migrants, and exploited trafficked children. They are virtually “stateless”, [...] Read more.

It has been estimated that more than 50,000,000 children and youth have migrated across borders or been forcibly displaced within their own country. They consist of refugees, asylum seekers, internally displaced persons (IDP), economic migrants, and exploited trafficked children. They are virtually “stateless”, children deprived of the protective structures of state and family that they need and deserve and unrecognized by either their country of origin or the international community. This opinion piece starts with the personal reflections of its author on his recent work in Middle East refugee camps. It then explores the prevalence and demographics of these children and their plight. It examines the United Nation’s Convention on the Rights of the Child (CRC) and other international conventions designed to protect them. It also summarizes the International Society of Social Pediatrics and Child Health (ISSOP) Budapest Declaration on the Rights, Health andWell-Being of Children and Youth on the Move as a framework for improved care and vehicle for change. Full article

(This article belongs to the Special Issue Children on the Move: The Health of Refugee, Immigrant and Displaced Children)

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