Mental Health of Newcomer Children and Adolescents: Pediatric Mental Health Minute Series

Newcomer children, immigrants and refugees to the United States, are at risk of psychological stress and consequently may develop symptoms of anxiety, depression or post-traumatic stress. Some children and families also experience traumatic separations during the process of migration or due to parental deportation. Many newcomer children and parents may have experienced discrimination at school or in the community. The role of the pediatrician includes helping to identify and collaborate in the provision of mental health and social services.

Scope in Pediatrics

• About 5.5 million children in this country have at least one parent who is undocumented. About 1 million children are themselves undocumented, while about 4.5 million are US-born citizens.
• Approximately 9.5 million people live in "mixed status" families that include American citizen children and undocumented immigrant parents. Children of Asian, Pacific Island, and Latin immigrant families have significantly higher rates of depression, anxiety, and post-traumatic stress disorder, up to twice the rate of their non-immigrant counterparts.

Teaching Points

• A culturally sensitive and trauma informed approach in which cultural norms are respected improves quality of the therapeutic relationship and effectiveness in patient engagement.  
• Actively collaborate with other providers and community members to offer resources to support children and their parents.  
• When a child or adolescent is expressing suicidal ideation and/or self-injury, presents with moderate to severe symptoms of depression or anxiety or severe and persistent school refusal or failure, a referral to behavioral health services is indicated.  
• Offering psychosocial supports and brief counseling can help with milder symptoms.  
• Build a trauma informed environment of trust for children and their family  
• Screen for mental health symptoms using universal screening tools such as the Patient Health Questionnaire (PHQ), listen to families’ stories and develop an understanding of how acculturative stress and other immigration stress threatens the emotional well-being of the child and family. 
• Work with others such as behavioral health clinicians, case manager, community programs to connect families to needed services and supports