A clinical perspective published in the Journal of the American Academy of Child & Adolescent Psychiatry outlines the psychosocial adversity faced by children of undocumented immigrants in the United States. Shawn S. Sidhu, MD, from the University of New Mexico, Albuquerque, and Suzan J. Song, MD, MPH, PhD, from the George Washington University Medical Center in Washington, DC, described the vulnerabilities of this population and offered appropriate clinical practice guidelines.
Per longitudinal survey data from the Pew Research Center, 7% to 9% of all children born in the United States between 2003 and 2014 have at least 1 undocumented parent. Pediatricians are likely to encounter children of undocumented parents during practice, making it essential for practitioners to be aware of the unique vulnerabilities faced by this population and clinical procedure.
Compared with their peers, children of undocumented parents in America are more likely to suffer from poverty, a significant risk factor for adverse childhood experiences, including food insecurity and malnourishment, community violence, and parental depression and stress. Unexpected parental arrest and deportation exacerbate existing problems, and caregivers who remain after deportation of a parent typically report difficulties in supporting children. Other vulnerabilities specific to children of undocumented immigrants include reduced eligibility for social services, difficulties with education, and acculturation stress.
For healthcare practitioners, knowledge of a family’s immigration status is helpful in case management, and clinicians may carefully and sensitively inquire about immigration status. Patient immigration status is protected under the Health Insurance Portability and Accountability Act, a fact that should be relayed to families and their children. As the authors note, providers are under no obligation to report patient immigration status. The authors also emphasize the importance of interpreter services, which can avoid the issue of children having to translate for their parents in clinical settings, a potential confidentiality violation and source of stress.
Beyond in-clinic care procedures, undocumented families are typically eligible for a number of community-based services, including school programming, healthcare, and housing. In these cases, the authors wrote, physicians should advocate for the child directly. Clinics in areas with high concentrations of undocumented immigrants have an opportunity to facilitate community relationships. Provision of educational information to undocumented families can also improve care access.
The authors described a “family-centered, trauma-informed, and culturally sensitive” approach as the cornerstone of care for undocumented families. Clinicians have an opportunity to advocate publicly for undocumented families, as the authors wrote. In 2017 and 2018, the American Academy of Child and Adolescent Psychiatry publicly denounced immigration executive orders and the separation of children from their families through policy statements.
Sidhu SS, Song SJ. Growing up with an undocumented parent in America: psychosocial adversity in domestically residing immigrant children. J Am Acad Child Adolesc Psychiatry. 2019;58(10):933-935.