Caring for Children in Immigration Detention

The National Commission on Correctional Health Care’s updated position statement, Health Care for Children in Immigration Detention (formerly Detention of Immigrant Children), offers clear recommendations to support the health and safety of children in immigration detention in instances when such detention occurs. For the purpose of the statement, “child” refers to any young person under 18, encompassing the lifespan from infancy to adolescence. The position statement was initially adopted in 2019 in response to alarming family separations to help ensure that children migrating to the United States, either unaccompanied or with family, receive appropriate and potentially lifesaving health care.

The updated position statement reasserts the organization’s stance that NCCHC does not support detention of any child due to immigration status. That position aligns with the best interest of the child, a fundamental and inalienable human rights principle. Furthermore, the statement prescribes that “any detainment should be in the least restrictive setting, and safe release to the community should occur as soon as possible.” The stance is also in accordance with recommendations from the American Academy of Pediatrics and other health professional societies that have addressed the needs of children who are seeking safe haven in the United States.

In recognition that the detention of children in immigration facilities is likely to occur, the position statement encourages full compliance with the Flores Settlement Agreement, and offers six key recommendations regarding health care. The focus is on ensuring that all children who are detained in confined settings through the U.S. immigration system receive medical and mental health care that is developmentally appropriate and meets their social and life skills needs.

Six Key Recommendations
The first recommendation is the timely delivery of quality care that addresses urgent needs and includes a procedure for identifying serious conditions that require a higher level of care. Immediate transfer for emergency care and time-sensitive transfer is crucial to avoid preventable deaths of children in immigration detention. A mechanism for continuity of care is also recommended: the transfer of medical records upon a child’s release from immigration custody or transfer to another health care setting.

The second recommendation is that medications be dispensed in a timely fashion. To ensure that children, especially children with chronic diseases, receive needed medications, the statement recommends that whenever possible, authorities avoid confiscating medications that children travel with.

The updated statement also strengthens the recommendation regarding a healthy housing environment for children and prescribes developmentally appropriate housing that is safe and supports children’s development, meeting basic needs such as appropriate access to water and food, as well as socioemotional and developmental needs such as learning and playing.

The fourth recommendation, for safe supervision by appropriately trained staff, is vital to ensuring a safe housing environment that meets children’s health and health care needs.

The fifth recommendation centers around family togetherness. NCCHC’s updated statement recommends “preservation of family unity and the opportunity for unaccompanied children to be reunited with their families or sponsors as quickly and safely as possible.” The intent is to minimize trauma and support health care delivery since care for children, especially young children and those with serious illnesses, is most often best delivered in collaboration with a parent or guardian.

The final recommendation is for implementation of quality assurance processes and systematic monitoring to ensure the NCCHC standards are met and procedures refined as needed.

Read the position statement here.

Find a list of all NCCHC position statements here.

By Elizabeth Barnert, MD, MPH, chair of the NCCHC Juvenile Health Committee