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Commentary From the Council on Immigrant Child and Family Health

September 27, 2023

Commentary From the Council on Immigrant Child and Family Health

The American Academy of Pediatrics (AAP) Council on Immigrant Child and Family Health (COICFH) was created in July 2019. The COICFH evolved from the work started in 2012 by the Immigrant Health Special Interest Group that was under the auspices of the Council on Community Pediatrics.

Approximately 500 AAP members have joined COICFH to participate in its mission to advance health equity for children and families whose lives are shaped by immigrant and refugee experiences. Advancing health equity embraces 2 domains: (1) developing, promoting, and advocating for access to high-quality health care, evidence-based, and experience-informed equitable policies and (2) educating and encouraging child health professionals in their support of the dignity, value, and full potential of children in immigrant and refugee families.

In this collection of commentaries, COICFH members provide thoughtful and diverse perspectives on the contributions of pediatricians to immigrant children and family health over the past 75 years.

Confronting Communicable Disease in the Aftermath of War

Daniel R. Neuspiel, MD, MPH, FAAP

Affiliation: Professor Emeritus of Pediatrics, Atrium Health

Highlighted Article From Pediatrics

In a 1949 article in Pediatrics, Nathhorst reported on a Mycobacterium bovis bacille Calmette-Guérin (BCG) immunization campaign led by Swedish health personnel in post-World War II Germany in response to a significant increase in tuberculosis (TB) infections, especially among children.1 This successful effort has important current implications, since international public health cooperation continues to be critically important in response to communicable disease outbreaks related to wars and other international crises.

Nathhorst described an increase in German TB mortality of 50%-100% above prewar levels, most markedly among children 0-3 and youth 15-25 years old. He attributed infection risk to lack of hospital beds, inadequate resources to treat or isolate infected patients, and overcrowded living conditions in bomb-damaged German towns. At the time, the Scandinavian countries had the most extensive experience with BCG. In 1947-1948, the Danish and Swedish Red Cross organized BCG vaccination campaigns in the American and British occupation zones in Germany, respectively. Nathhorst reports on the experience of the Swedish team, which successfully vaccinated tens of thousands of children. Local German physicians were trained to continue this campaign after the departure of Swedish personnel.

TB continues to be the leading global cause of death from bacterial infection.2 BCG, the sole immunization licensed to prevent TB, is a live-attenuated vaccine first administered to a newborn in Paris in 1921. It was developed by physician Léon Charles Albert Calmette and veterinarian Jean-Marie Camille Guérin, using similar techniques to those employed by Edward Jenner in developing the smallpox vaccine in 1796. BCG is reported to have been given to more people than any other vaccine. In 2019, BCG was received by 88% of children globally during their first year of life. It provides over 70% protection against disseminated TB and TB meningitis in young children but has lower efficacy in adults. Multiple studies have confirmed the effectiveness of BCG in preventing TB infections and deaths in high-risk populations.

In the United States, BCG is rarely recommended because of the low prevalence of TB, decreased efficacy in adults, and potential interference with tuberculin test reactivity.3 Yet US pediatricians should be aware that many of the immigrant and refugee children they care for have received BCG in their birth countries.

The use of BCG also illustrates abhorrent and tragic bigotry and discrimination of groups excluded from full participation in society. In 1930, 251 newborns in Lübeck, Germany received BCG that was inadvertently contaminated with virulent TB bacteria. Most of these newborns developed TB and 72 died.2 In Vienna in 1941-1942, Nazi pediatrician Elmar Türk intentionally infected 5 children whom he considered “severely damaged from birth trauma, unviable and idiotic” with TB.4 All 5 (3 who had received BCG and 2 “controls”) were then sent to the Nazi killing center at Spiegelgrund where they were murdered to provide post-mortem specimens for study. In Canada, First Nation infants of the Qu’Appelle reserves in Saskatchewan received BCG in an unethical trial from 1933-1945,5 conducted to show that “less evolved races” could be protected from TB. Though BCG shielded some from TB, nearly 20% of children in this trial died from the horrendous living conditions on the reserves. These examples point to the challenges of maintaining trust in vaccines, especially among groups affected by historical and structural oppression.

In recent decades, we have witnessed major gains in combatting TB. Annual worldwide deaths have decreased by 45% from 2000-2019, but the COVID-19 pandemic and economic disparities have threatened this progress.6 TB reporting declined from 2019-2020, especially in the Southeast Asian and the Western Pacific regions. During this period, there was a 21% decrease in affected individuals who received TB preventive treatment and a 15% decrease in patients treated for drug-resistant TB. This has led to increased TB mortality, especially in Africa and Southeast Asia. Refugees in particular experience significant risks to their health and survival that lead to increased TB transmission, including poverty, crowding, poor nutrition, and lack of access to health services.7

The profound effect of war on public health is clear from the devastations inflicted on Ukraine,8 Afghanistan,9 and other regions experiencing wars and conflicts. As described in the Nathhorst study, the pediatrician has a critical role in providing international public health support and cooperation to prevent and treat communicable diseases in the aftermath of war, and to confront the social disparities and violent conflicts that endanger the health of children.


  1. Nathhorst H. The Swedish BCG expedition in Germany. Pediatrics. 1949;4(4):425-429
  2. Lange C, Aaby P, Behr MA, et al. 100 years of Mycobacterium bovis bacille Calmette-Guérin. Lancet Infect Dis. 2022;22:e2–12
  3. AAP Committee on Infectious Diseases. Tuberculosis. In: Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics, 2021
  4. Sheffer E. Asperger's children: The origins of autism in Nazi Vienna. Norton; 2018
  5. Lux M. Perfect subjects: race, tuberculosis, and the Qu'Appelle BCG Vaccine Trial. Can Bull Med Hist. 1998;15:277-295
  6. World Health Organization. World Health Statistics 2022: Monitoring Health for the SDGs, Sustainable Development Goals. World Health Organization; 2022.
  7. World Health Organization. Tuberculosis Prevention and Care Among Refugees and Other Populations in Humanitarian Settings: An Interagency Field Guide. World Health Organization; 2022.
  8. World Health Organization. WHO Ukraine Crisis Response: August 2022 bulletin. World Health Organization. Regional Office for Europe; 2022.
  9. Cousins S. Afghan health at risk as foreign troops withdraw. 2021;398:197-198


Caring For the Migrant Child Without Omission

John Harlow, MD, FAAP

Affiliation: Assistant Professor of Pediatrics, USC Keck School of Medicine, Children's Hospital Los Angeles

Highlighted Articles From Pediatrics

During the summer of 1975, the pioneering developmental pediatrician Thomas Berry Brazelton wrote to the editors of Pediatrics. Brazelton was concerned about a recent statement from the AAP, “Vietnamese Orphans Are No Threat to US Health.” As the letter notes, he was disturbed not so much by what the statement affirmed but by what it omitted.1

The AAP “concerns itself with the physical health of these infants and provides a comprehensive list of infectious diseases that may affect them,” Brazelton wrote.1 “[T]here is little concern expressed for the children except as victims of a number of infectious diseases, poor immunizations, and nutritional deficiencies with the conclusion that the only problems they will face are ‘manageable or self-limiting.’ This may well be true for the conditions considered in this report. However the most serious and most long-term risk for these children and their families is psychological.”

“This omission,” he wrote, “is deplorable.”

When it came to these issues, Brazelton was a zealot in all the best ways. Over the course of 5 decades of clinical practice and advocacy, he published more than 200 scholarly articles and dozens of best-selling books. He authored a nationally syndicated newspaper column, was a frequent television guest, and founded the influential Child Development Unit at Boston Children’s Hospital. Everywhere he went, Brazelton advocated for the inner lives of children—their exquisite vulnerabilities and their great capacities to adapt and grow.

Read today, Brazelton’s letter to Pediatrics is remarkable. In 3 brief paragraphs, he writes of the trauma of family separation, of the overlooked stressors inherent in acculturation, of the duty of American pediatricians to recontextualize the care of these children within the framework of their own, distinct set of experiences. Medical care “should capitalize on the unique cultural and psychological strengths of Vietnamese infants and children,” he declares credibly. “We must begin from their viewpoint rather than ours.” Most crucially, Brazelton places the child—the whole child, with their own complex and valuable set of familial relations and cultural traditions, their innate reservoir for resilience—at the center of the discussion.                                            

Today’s pediatrician practices in a world increasingly defined by the migration of children. Since 2011, the number of displaced persons worldwide has grown rapidly from less than 40 million to over 100 million, and children are predictably overrepresented in these groups. From 2011 to 2021 the number of unaccompanied children arriving at the US Southwest border increased from 6,000 to an estimated 147,000. Projections from 2022 indicate that this number will be even higher. While stories of refugee children from Afghanistan and Ukraine understandably attract our attention, the numbers of children migrating from El Salvador, Guatemala, Honduras, Ecuador, Brazil, Nicaragua, Venezuela, Haiti, and Cuba have all more than tripled in recent years. Although every individual’s story is unique, research tells us that this population is particularly at risk for exposure to complex trauma.2-7 What may have been a novel experience in Brazelton’s time—caring for the children from culturally distinct backgrounds, addressing the adversities that can drive migration—is an everyday experience for many physicians today. But even with this familiarity, how much has our standard of care improved?

Brazelton’s letter was not without context in its time. A review of Pediatrics in the years that follow demonstrate a niche but growing interest in the medical and mental health of Cambodian, Laotian, and Vietnamese children newly arrived in the United States. While much of the literature is focused narrowly on the infectious implications of child migration (tuberculosis and hepatitis, helminths and dysentery), many other publications, such as the case study “Marasmus in a 17-Month-Old Laotian: Impact of Folk Beliefs on Health,” begin to recognize respect for cultural difference in the immigrant family as a necessary component of pediatric care.8 The language may strike us as outdated, but the central concept is relevant and even vital: “By incorporating the traditional Lao ceremony with the Western treatment,” Oberg and Deinard write of their previously cachectic patient, “we were able to build rapport with our patient’s family and validate our approach to medicine. The benefit of such an approach had been demonstrated by the child’s continued growth and development.”

Less than 2 years later, enough had been previously published on the subject that a comprehensive review of psychiatric literature focusing on the population, “Southeast Asian Children in America: The Impact of Change,” appears in the August 1986 issue of Pediatrics.9 Here again the contemporary reader may encounter instances of awkward presumption or even outright stereotype in some of the article’s language, yet the authors make an admirable approach toward several topics with deep resonance today. With real care and understanding they write of adolescents “who may feel that their ‘life watches’ are off time”—an experience common for migrating youth and one which today’s provider terms ‘parentification.’ They argue for the creation of dynamic models of therapy to assist patients hesitant about more traditional modes of care, and foreshadow links between migration-related adversity and immunological disease burden. The authors touch on concepts of resilience and on the importance of connection to cultural and familial tradition as a source of strength for the health of migrant youth. Perhaps most remarkably, they directly implicate “discrimination, hostility, and racism in the host country” as a cause of illness.

At the time these authors were writing, little research existed with which to understand the implications of their concerns. Today we understand that exposure to trauma in childhood, whether associated with migration or not, is a profound driver of disease both in the pediatric and adult periods.10,11 We also know that many of the same children who are exposed to damaging adversity are also adaptive, resilient, and highly capable.12 Children can recover and thrive, but it is our imperative to create mechanisms to support that resilience. We also see from the literature that resilience is manifestation of skills and of circumstance—skills which must be developed and circumstance which must be supported.

Children need stable, nurturing relationships with adults.13 They need a sense that they are capable and in control of their lives.2 They need adaptive skills and mechanisms for self-regulation.14 To be resilient, children need to feel connected to hope and faith, to community and cultural tradition.2 None of these protective factors are possible if the threat of deportation hangs over a child’s head. We cannot promote our patients’ healing if they are lost to follow-up, they do not trust us, or they cannot pay the bus fare to reach an appointment. As a vulnerable medical population with a unique set of needs, unaccompanied children and other migrant youth must be treated with special models of care.

Just as Brazelton did nearly 50 years ago, we must begin with the premise that our medical obligations to newly arrived children extend well beyond catch-up vaccines and screening for tuberculosis. The conversation around our responsibilities as physicians must include the complex mix of factors that mediate our patients’ health years before they reach our clinic; factors of culture and adversity, mental health, and legal circumstance. Omitting this understanding would be, as Brazelton notes, deplorable.


  1. Brazelton TB. Psychological problems of Vietnamese orphans [Letter]. Pediatrics. 1975;56(3):485
  2. Rodriguez IM, Dobler V. Survivors of hell: Resilience amongst unaccompanied minor refugees and implications for treatment-a narrative review. J Child Adolesc Trauma. 2021;14(4):559-569
  3. Castañeda E, Jenks D, Chaikof J, et al. Symptoms of PTSD and depression among Central American immigrant youth. Trauma Care. 2021;1(2):99-118
  4. El Baba R, Colucci E. Post-traumatic stress disorders, depression, and anxiety in unaccompanied refugee minors exposed to war-related trauma: a systematic review. Int J Cult Ment Health. 2018;11(2):194-207
  5. Cohodes EM, Kribakaran S, Odriozola P, et al. Migration‐ related trauma and mental health among migrant children emigrating from Mexico and Central America to the United States: Effects on developmental neurobiology and implications for policy. Dev Psychobiol. 2021;63(6):e22158
  6. United Nations High Commissioner for Refugees. Women on the Run. First-Hand Accounts of Refugees Fleeing El Salvador, Guatemala, Honduras, and Mexico. United Nations High Commissioner for Refugees; 2015.
  7. United Nations High Commissioner for Refugees. Children on the Run. Unaccompanied Children Leaving Central America and Mexico and the Need for International Protection. United Nations High Commissioner for Refugees; 2016.
  8. Oberg CN, Deinard A. Marasmus in a 17-month-old Laotian: impact of folk beliefs on health. Pediatrics. 1984;73(2):254-257
  9. Messer MM, Rasmussen NH. Southeast Asian children in America: the impact of change. Pediatrics. 1986;78(2):323-329
  10. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258
  11. Jia H, Lubetkin EI. Impact of adverse childhood experiences on quality-adjusted life expectancy in the US population. Child Abuse Negl. 2020;102:104418
  12. Aldarondo E, Becker R. Promoting the well-being of unaccompanied immigrant minors. In: Buki LP, Piedra LM, eds. Creating Infrastructures for Latino Mental Health. Springer; 2011: 195-214
  13. Garner A, Yogman M; Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics, Council on Early Childhood. Preventing childhood toxic stress: partnering with families and communities to promote relational health. Pediatrics. 2021;148(2):e2021052582
  14. Carlson BE, Cacciatore J, Klimek B. A risk and resilience perspective on unaccompanied refugee minors. Social Work (New York). 2012;57(3):259-269


As Migration Patterns and Policies Change, the Pediatrician’s Role in Caring for Children in Immigrant Families Becomes More Relevant

Anahi Strader, MD, MMSc, FAAP

Affiliation: Global Health Program, Boston Children’s Hospital

Highlighted Articles From Pediatrics

Since its inception, the AAP has consistently advocated for access to comprehensive health care for all children living in the United States. In its 1997 policy statement “Health Care for Children of Immigrant Families,” the AAP clearly stated its commitment to health equity by denouncing policies hindering access to health care for children in immigrant families (CIF) and encouraging pediatricians to participate in advocacy and community-based activities to expand health care access for these families.1 Two decades later, the 2019 policy statement “Providing Care for Children in Immigrant Families” reiterated this position and strengthened their recommendations.2

The AAP’s policy statement from 1997 was written in the wake of the 1996 “Illegal Immigration Reform and Immigrant Responsibility Act,” which ordered the enforcement of border protection, encouraged deportation, and increased restrictions on public assistance for unauthorized immigrants. This legislation departed from progressive policies enacted during the second half of the 20th century, including the 1986 “Immigration Reform and Control Act” and the 1990 “Immigration Act.”3 The AAP statement encouraged pediatricians to oppose denying health care to children and recognized that the 1996 reforms increased the vulnerability of the pediatric immigrant population by blocking pathways to citizenship and access to public welfare services.

The 1997 policy statement shared some similarities to the 1995 Committee on Community Health Services policy statement “Health Care for Children of Farmworker Families,” which delineated the adverse social determinants of health experienced by children of migrant agricultural workers. The barriers to accessing health care for children in farmworker and immigrant families described nearly 30 years ago are remarkably similar to those noted today. These similarities reflect the ongoing need for progressive and inclusive immigration reform to ensure that all children residing in the United States can meet their basic needs. Immigrant families’ adverse social determinants of health, such as poverty, inadequate housing, health illiteracy, and food insecurity, are closely linked to their immigrant status. Therefore, pediatricians’ roles in advocating for more inclusive policies that promote pathways to citizenship and open access to public assistance services continue to be just as relevant today. Recognizing that pediatricians needed support to meet this population’s needs, the AAP outlined clinical practice and advocacy recommendations to facilitate access to high-quality health care for children in farmworker families.4

A notable aspect of the 1995 and 1997 statements is the use of the “legal” versus “illegal” nomenclature to describe immigrants. With a heightened reckoning of racism’s impact on the health and well-being of minoritized communities, it has become essential to recognize that the words we use can carry judgmental values and can precipitate sociopolitical debates. Immigration and racial justice advocates have led campaigns to “drop the ‘I’ word,” arguing that using terms such as “illegal” is “racially derogatory and dehumanizing.5” The Associated Press also modified its stylebook in 2013 to reflect this change, choosing the term “undocumented immigrant,” arguing that words such as “illegal” should be used to describe actions, not people.6 Political change has followed; in 2021, President Biden ordered immigration agencies to replace the terms “illegal alien” and “assimilation” with “undocumented noncitizen” and “integration.7

Two historical circumstances that distinguish the 2010s from the 1990s are the increased arrival of unaccompanied minors seen since the late 2010s and the separation of children from their families at the Southwest US border.8 President Trump, elected in 2016, based his campaign on a pro-American, anti-immigrant message and enacted harmful policies to deter people from specific world regions from entering the United States.9 His directives were responsible for the separation of families who crossed the Southern border, for the detention of immigrant children, and for the ban on immigration from Muslim-majority countries. The shift in the demographics of migrating individuals increased the responsibility of pediatricians to welcome and care for immigrant children and families. The 2019 updated policy statement, “Providing Care for Children in Immigrant Families” reflects not only the terminology change but the urgency in supporting pediatricians all around the country to provide excellent care for foreign-born children and CIF. The AAP statement discussed the effects of sociopolitical factors, such as immigration reforms, on the growing number of children in immigrant families. It equipped pediatric clinicians with tools to mitigate the harmful effects of discriminatory policies, such as family separation, enhanced deportation, and the Public Charge rule.

The concepts of cultural humility and safety were also central to the 2019 policy statement, underscoring the importance of becoming aware of intrinsic power differentials within clinical encounters. Cultural humility requires all of us to practice self-reflection to “recogniz[e] ourselves as cultural beings2” and identify unconscious personal and institutional biases that might influence our interactions. Cultural safety involves the awareness of historical, social, and political factors that have resulted in health inequities and intrinsic power differentials within clinical encounters. Furthermore, this statement highlighted a strengths-based approach to the care of immigrant families by identifying protective sociocultural factors and recognizing the courage, tenacity, and toughness of these communities. Emphasizing the strengths of immigrant communities was particularly relevant since it challenged the rhetoric of prominent politicians who propagated negative stereotypes of immigrants, mainly from Latin America, the Caribbean, and Muslim-majority countries. Lastly, the advocacy and policy recommendations expressed in the 2019 statement reiterated the practical ways clinicians can “step out” of the office and enact positive change in their patients’ lives.2

Policy around immigration-related issues is closely related to sociocultural phenomena and will undoubtedly continue to be contentious. In the face of racist animosity, the AAP has supported its members to speak up for children and to protect every child’s right to health care. The critical and evolving policies demonstrate a recognition of the effects of sociopolitical factors on children’s health and the AAP’s commitment to achieving equity in health care. The evolution of AAP policies for children in immigrant families makes clear that a pediatrician’s role in caring for immigrants and other minority populations extends beyond clinical care. We must engage in critical self-reflection to identify and respond to unconscious biases, learn to recognize power differentials and their effect on clinical interactions, and practice cultural humility. Furthermore, our responsibility to advocate for increased and improved access to health care at the local and national levels has never been clearer.


  1. Committee on Community Health Services. Health care for children of immigrant families. Pediatrics. 1997;100(1):153-156
  2. Linton JM, Green A, Chilton LA, et al. Providing care for children in immigrant families. Pediatrics. 2019;144(3):e20192077
  3. Baxter AM, Nowrasteh A. A Brief History of US Immigration Policy from the Colonial Period to the Present Day. CATO; 2021:32.
  4. Committee on Community Health Services. Health care for children in farmworker families. Pediatrics. 1995;95(6):952-953
  5. Race Forward. Drop the I-Word. Race Forward; 2013.
  6. Colford P. “Illegal immigrant” no more. Associated Press Stylebook blog. April 2, 2013.
  7. Rose J. Immigration agencies ordered not to use term “illegal alien” under new Biden policy. April 19, 2021.
  8. Robinson LK. Arrived: the crisis of unaccompanied children at our southern border. Pediatrics. 2015;135(2):205-207
  9. Historical Overview of Immigration Policy.


Creating and Galvanizing Clinician Advocates Through Policy Statements

Diana Montoya-Williams, MD, MSHP, FAAP1, Carmelle Wallace, MD, MPH, FAAP2

Affiliations: 1Department of Neonatology, Children’s Hospital of Philadelphia; 2Department of Pediatrics, Sections of Emergency Medicine and Child Abuse, University of Colorado School of Medicine

Highlighted Article From Pediatrics

In April 2017, the AAP Council on Community Pediatrics published the policy statement “Detention of Immigrant Children.”1 This policy statement comprehensively outlined how detention harms not only children’s mental and physical health, but also the well-being of their families. It provided both historical and contemporary contexts for recent waves of immigration. The statement explained the complexities of the immigration process, immigration policies, and the many agencies that children and families encounter when they immigrate into the United States. Importantly, this policy statement demonstrated how a professional medical organization can serve both to educate and galvanize pediatricians and other pediatric clinicians to become expert advocates for marginalized children.

The “Detention of Immigration Children” policy statement offered timely support for physician advocates. Exactly 1 year after it was published, the Zero Tolerance immigration policy was enacted to criminalize and penalize border crossing in an unprecedented way.2 Thousands of children, including infants, were forcibly separated from their parents and housed in cold steel cages.3 Amid forceful public outcry, including statements from Physicians for Human Rights and the president of the AAP, deeming the policy government-sanctioned torture4 and child abuse,5 the Zero Tolerance policy was rescinded. Despite this, the effects of the separation of children from their parents are still being felt, and other punitive policies have since emerged, such as the Migrant Protection Protocols of 20196 and the implementation of Title 42.7 Recent investigative reports have documented that approximately 650,000 children were detained between February 2017 and June 2021.8 Amidst a changing policy landscape, the principles laid out in the “Detention of Immigrant Children” remain applicable and continue to be an important advocacy tool for pediatric clinicians.

The policy statement primed pediatric clinicians to rise to the occasion presented by sociopolitical events with advocacy and research efforts. For instance, Dr. Dolly Sevier, a Brownsville community pediatrician, boldly reported to national media on the malnutrition, lack of basic hygiene, psychological trauma, and egregiously poor conditions at detention centers.9 Grassroots organizations such as Refugee Health Alliance and Global Response Medicine staffed pediatricians to provide care at the southern border and to relocate children and families across the country.10,11 The policy statement was also used by pediatricians for legislative advocacy both in congressional hearings12 and in federal testimony.13 In addition, within 2 years of the inception of the 2018 Zero Tolerance policy, researchers began publishing preliminary evidence confirming that the Zero Tolerance policy significantly threatened the socioemotional development of children and was associated with high rates of PTSD and other behavioral difficulties.14–16 In addition to psychological harm, a recent economic model suggested that punitive border patrol policies resulted in increased health care costs,17 highlighting the shortsightedness of such policies. Although immigration policies remain in flux, the 2017 policy statement on the “Detention of Immigrant Children” has remained a relevant and key document that has anchored ongoing advocacy work conducted by pediatricians and others.

Given that immigrant and refugee children live in every state, this policy statement affirmed pediatric clinicians’ abilities to support the health and rights of immigrant children and families across the country. The statement’s comprehensive explanation of the structural and operational complexities surrounding detention of immigrant children equipped pediatric clinicians with the knowledge necessary for the provision of holistic high-quality care. Critically, the statement showed us how we can act on behalf of the immigrant children all of us care for. We can use our spoken and written words to highlight how policies harm children. We can learn about and work with the immigrant children and families in our local communities. Finally, we can advocate on behalf of all children by voting for legislators who support policies that optimize children’s health.18

Bolstered by evidence1 and grounded in the fundamental rights of children,19 we must continue to act and speak on behalf of all children who live in this country, not just the ones born on one side of a human-drawn border.


  1. Linton JM, Griffin M, Shapiro AJ, Council on Community Pediatrics. Detention of immigrant children. Pediatrics. 2017;139(5):e20170483
  2. Kandel WA. The Trump Administration’s “Zero Tolerance” Immigration Enforcement Policy. Congressional Research Service; 2021.
  3. Written Testimony: “Kids in Cages: Inhumane Treatment at the Border.” Human Rights Watch. July 11, 2019.
  4. Bringuez B, Hampton K, Mishori R, Pompa C, Ramanathan V, Robles B. “Part of My Heart Was Torn Away”: What the U.S. Government Owes the Tortured Survivors of Family Separation. Physicians for Human Rights; 2022.
  5. Wise J. American Academy of Pediatrics president: Trump family separation policy is “child abuse.” June 18, 2018.
  6. The “Migrant Protection Protocols.” American Immigration Council. January 22, 2021.
  7. Cheatham A. US Detention of Child Migrants. Council on Foreign Relations. August 28, 2014.
  8. “No Place for a Child”: 1 in 3 Migrants Held in Border Patrol Facilities Is a Minor. POLITICO.
  9. Raff J. What a Pediatrician Saw Inside a Border Patrol Warehouse. The Atlantic. July 3, 2019.
  10. Martinez C, Carruth L, Janeway H, et al. How should clinicians express solidarity with asylum seekers at the US-Mexico border? AMA J Ethics. 2022;24(4):E275-E282
  11. Mexico. Global Response Medicine. November 8, 2022.
  12. The Department of Homeland Security’s family separation policy: perspectives from the border. March 26, 2019.
  13. Testimony of Julie M. Linton, MD, FAAP on behalf of the American Academy of Pediatrics. Oversight of the Customs and Border Protection’s Response to the Smuggling of Persons at the Southern Border. In: Committee on the Judiciary. 2019.
  14. Patel SG, Bouche V, Martinez W, et al. “Se extraña todo:” Family separation and reunification experiences among unaccompanied adolescent migrants from Central America. New Dir Child Adolesc Dev. 2021;2021(176):227-244
  15. Sidamon-Eristoff AE, Cohodes EM, Gee DG, Peña CJ. Trauma exposure and mental health outcomes among Central American and Mexican children held in immigration detention at the United States-Mexico border. Dev Psychobiol. 2022;64(1):e22227
  16. MacLean SA, Agyeman PO, Walther J, Singer EK, Baranowski KA, Katz CL. Characterization of the mental health of immigrant children separated from their mothers at the US-Mexico border. Psychiatry Res. 2020;286:112555
  17. Mattingly TJ II, Kiser L, Hill S, et al. Unseen costs: the direct and indirect impact of US immigration policies on child and adolescent health and well-being. J Trauma Stress. 2020;33(6):873-881
  18. Jones MN, Beck AF. Vote like your health depends on it: voter engagement in the healthcare setting. J Hosp Med. 2022;17(7):577-579
  19. The United States has not ratified the UN Convention on the Rights of the Child.


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