Internal and international migration impacts family structure, parent–child relationships, and child care arrangements for the world’s ∼1 billion migrants.1 When parents migrate without their children, this experience of prolonged separation has profound repercussions on children’s development and well-being. Because international migration disrupts family systems globally, internal migration, such as rural-to-urban migration in low- and middle-income countries, also has massive impacts. In China alone, 61 million rural children are living apart from their parents who have migrated to urban areas.2 These so-called “left-behind children” comprise 34% of all rural children and 22% of the total child population in China.2 The well-being of children who are affected by parental migration has raised concerns worldwide. Although labor-related migration tends to improve a family’s socioeconomic circumstances, a prolonged separation from migrant parents can place children at an increased risk for psychosocial disorders.3 Even reunification with parents may lead to additional distress because of an abrupt restructuring of family dynamics.4,5 Despite the many clinical implications of parental migration and family separation, little information is available to help clinicians understand how parental migration may affect mental and behavioral development in children.
Parent–Child Separation and Reunification in Migrant Families
Migrant parents often leave their children behind in the pursuit of employment even in Asian cultures, in which family connection is emphasized as the major source of identity and protection. Factors that prevent migrant parents from bringing their children along include residence permit policies, a high cost of living, and a lack of access to child care and education.6,7 These barriers can exist even between different areas of the same country. For instance, in China, the urban–rural divide not only involves socioeconomic gaps but a household registration system in which rural residents’ access to health care and education is restricted in urban areas.8
Because of the uncertainties and costs for migrant families, migration is often serial and cyclical in nature. If children subsequently migrate to rejoin their parents, the enduring effects of the experience of prolonged separation from their parents are often overlooked in research and clinical practice. An estimated 200 million people in China, or 15% of the entire population, have experienced being left behind by migrant parents.9 Although many children will ultimately rejoin their parents in urban areas, reunification can also occur after the migrant parents’ permanent return to their hometowns, forcing the children to adapt to the family structure change.
Sending infants who are born in host countries back to their countries of origin has become another significant pattern in global migration.10 For instance, although nearly 20% of left-behind children in China were separated from their parents before their first birthday,2 ≤57% of infants who are born in some Chinese immigrant communities in the United States are sent back to China11 to be cared for by their grandparents, primarily because of the lack of affordable child care options and the desire to preserve the family’s culture.10,11 After a few years, most of these so-called satellite infants are brought back to the United States to attend full-time preschool programs10,11 in which staff members are often not equipped to understand or respond to the unique experiences and needs of these children.
Impact of Parental Migration on Child Well-being
Many children experience parental migration as a form of abandonment or rejection, becoming emotionally displaced, and may exhibit signs of disordered behavior.3 Coping ability with migration-related stress depends on the child’s personality traits, family functioning, and support within the extended family and the community.3,12 Substantial research on the mental and psychological well-being of left-behind children has been conducted in many low- and middle-income countries, especially in China. The results reveal increased risks of depression and anxiety,13 behavioral problems,14 injuries,15 substance use,16 and suicide attempts17 among left-behind children.
More than one-half of the left-behind children of migrant families in China see their mothers no more than twice per year.18 The prolonged separation disrupts parent–child attachment and can significantly limit parental roles in child development. Left-behind children are usually cared for by their grandparents. Yet, unlike the parents, rural grandparents are often ill equipped to serve as the sole guardians of children, with limited understanding about the children’s school life and emotional experience in the rapidly modernizing rural China. Additionally, some frail grandparents are cared for by left-behind children; heavy domestic chores occupy the children’s time and conflict with potential opportunities for social–emotional and educational development.19,20
In the absence of their parents, many left-behind children develop a strong attachment relationship with their grandparents. Parents’ return to primary caregiving roles may cause distress in children who are taken from their familiar caregivers. When children migrate to join their parents, emotional displacement may be exacerbated by drastic life changes in the new environment, including exposure to racism and anti-immigrant prejudice after transnational migration.21,22
Separation and reunification during infancy and early childhood may be particularly damaging to child social–emotional development, with long-term adverse impacts. Although some clinical reports in the United States suggest that the Chinese satellite infants have increased psychosocial risks after reuniting with parents,11 few studies on left-behind children in China included preschool children. Effects of prolonged parent–child separation may also be compounded by additional adversities, such as parents’ divorce and a lack of socioeconomic support.23 Similarly, parental incarceration was shown to impact child well-being through economic strain and disrupted interparental relationships.24,25 Meanwhile, protective factors, such as strong social support ties, may enhance children’s coping mechanisms.26
Implications for Intervention Programs and Clinical Practice
Despite the substantial literature on the impact of parental migration, research on policy and interventions that have been used to provide psychosocial support for left-behind children has been scarce. The Chinese government has called on local authorities to prioritize improvements in education and social support for left-behind children27 and to strengthen social workers’ services for left-behind children and their families.28 These policy announcements have galvanized local pilot programs that are used to serve vulnerable left-behind children and strengthen China’s child protection system.29 However, Zhao et al30 have been the only authors of an evaluation study to offer evidence on a specific intervention, demonstrating the feasibility and benefits of “children’s clubs.” In these clubs, children participate in fun learning activities under the care and supervision of local volunteers, who coordinate a community support network.30 In Mexico, authors of 1 report31 described a similar community care program comprising activities for left-behind children and participatory workshops for their caregivers. Existing early childhood development interventions may also benefit left-behind children by incorporating an understanding of the lived experience of family separation and providing equitable access in low-resource contexts.
Further policy and program efforts are needed to systematically identify children who are affected by parental migration at population levels and to examine the features of separation and reunification, such as the onset and duration of separation from parents. For social workers and primary care providers in communities that are affected by migration, these data are crucial in screening for children’s psychosocial risks and can be used to identify appropriate areas for referral and support. Besides the common patterns of migration, clinicians should account for the cultural norms in child care and family processes, including the desire to preserve the family’s culture of origin while adapting to a new environment.
As a toll of our increasingly mobile societies, children’s experiences of separation and reunification need to be recognized and validated.32 Emerging evidence suggests that the migratory separation from parents and the subsequent changes in family structure have long-term negative impacts on child development and mental health. Across countries and cultures, parental migration leads to similar challenges in child care arrangements and comparable patterns of risk to the children’s well-being.6,33 The explicit inclusion of mental health in the targets of the Sustainable Development Goals reveals an urgency to address children’s mental health problems alongside the goals and metrics that are overtly associated with child mortalities.34 In addition to the wider efforts for community mental health, clinicians should play an active role in identifying and managing the specific risks that are associated with prolonged separation and reunification. Those in clinical and family services should help address parenting stress and adjustment problems in reunified families. Heightened awareness of the hidden challenges and joint actions across health and social sectors are required to enable children who are affected by parental migration to thrive in their new homes.
Drs Zhao and McGregor conceptualized the manuscript and contributed to the writing of the draft; Drs Egger and Stein contributed to the writing and editing of the draft; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.