How pediatricians can support health and well-being for children of immigrant families
One out of every 4 US children lives in an immigrant family, where either the child and/or at least one parent was born outside of the country. Along with special considerations related to legal status, housing and education, these children face added health risks. Pediatricians are positioned to help mitigate those risks and improve health equity for immigrant children. Physicians who lean on culturally competent communication, social interventions and advocacy can make a difference in the health and well-being of immigrant children and their families.
The pediatric health inequity challenge
The COVID-19 pandemic has increased concern about inequities faced by children in immigrant families. The effects of COVID-19 were exacerbated by limited access to health care, information and technology, and many families faced increased food insecurity during the crisis. The pandemic also put parents with frontline jobs at higher risk of infection. Mistrust of the medical system and government created additional barriers to COVID-19 testing and vaccination.
Pediatricians have seen the consequences of these inequities firsthand.
As pediatric health experts have noted, children were further affected by the challenges of remote learning, which were particularly acute for immigrant families. These families may face cultural and language barriers that limit their ability to help with schoolwork. They also tend to have less experience with the US education system, and they are less likely to be able to work from home or take on an active role in schoolwork.
Immigrant children faced greater social isolation during remote learning, and those new to the country were unable to make new friends at school. At the same time, those that did become comfortable with remote schooling likely had to take on tasks like helping parents apply for unemployment benefits and other assistance.
Even before the pandemic, immigrant children faced greater barriers to health and health care. Immigrant families often live in neighborhoods with lower food availability and access, as well as lower walkability. Immigrant children are also more likely to live in a more crowded, multigenerational household which, combined with other factors, can contribute to stress, anxiety and other mental health symptoms.
Meanwhile, federal immigration policies, racism and xenophobia have had a negative impact on health and health care. They have been linked to both psychological distress and physical effects, and they can create barriers to treatment. Even families that are eligible for health care coverage may avoid seeking care because of concerns about repercussions.
Citizen children with an immigrant parent are also less likely to have health coverage than those with a nonimmigrant parent, reducing their chances of having a trusted pediatrician.
Strategies for pediatricians to support health equity
Providing compassionate, culturally sensitive care can help improve health equity for immigrant children. Physicians should be aware of their own biases, systemic health inequities and different cultural perspectives, and they may want to offer staff training on immigrant health issues.
When possible, pediatricians should offer care and other information in families’ preferred language and via their preferred means of contact. The American Academy of Pediatrics advises against family, friends or children acting as interpreters between patients and their doctors. Instead, practices should provide trained interpreters in person, by phone or by video to improve communication. This approach has been shown to help patients better understand their diagnosis and treatment plan. It also may increase the likelihood that prescriptions will be filled and lead to fewer medical errors.
In addition to language barriers, limited health literacy can be a barrier to proper care. People of color, people with limited English proficiency and people with lower socioeconomic status are disproportionately affected. Physicians should ensure children and their families have a clear understanding of their medical conditions, treatment plans and any other relevant information.
Addressing social determinants of health
Pediatricians working with children in immigrant families should screen for social determinants of health, including access to healthful food, education and appropriate housing. They should also assess children’s development and behavior, and they should check for signs of trauma.
It is important to understand how stress, anxiety and trauma can affect children at different ages. Immigrant youth have high rates of posttraumatic stress disorder and depression, and as many as 85% of refugee youth are victims of bullying. Pediatricians should be able to provide trauma-informed care and use a holistic approach that accounts for the child’s family, mental health resources, community organizations and additional support networks.
For pediatricians who want to further advance health equity, AAP offers a variety of recommendations in a policy statement on advocating for immigrant children and families. Pediatricians should advocate for health coverage for all children, as well as public and private insurance coverage for medical interpretation and translation services. Collaboration with agencies and community partners is recommended.
They should also speak out against the detention and separation of families, which can have harmful effects on children’s health, says AAP. And they should advocate for increased research into the screening tools and interventions that best support the health and well-being of immigrant children.
In addition, physicians who are familiar with relevant immigration policies and immigrants’ rights will be better able answer patients’ questions and to address the well-being of the whole patient, and the whole family.
Pediatricians are in a unique position to see and help mitigate the challenges faced by these children and their families every day as they connect with patients. By committing to improved culturally sensitive communication, an enhanced focus on SDOH and advocacy for the best care for everyone, they can make a difference in health equity for some of their most vulnerable patients.
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April Hollis is a health care editor at SmartBrief. Connect with her on LinkedIn.