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  


For Physicians

Related AAP Policy

Detention of Immigrant Children
Promoting Optimal Development: Screening for Behavioral and Emotional Problems
Providing Care for Children in Immigrant Families

Related AAP Resources

Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians, 2nd Edition.
Mental Health Toolkit
Immigrant Health Toolkit
The Resilience Project: We Can Stop Toxic Stress
Trauma Informed Care

Other Resources

Child Migrant Protection Toolkit. National Association of Social Workers.
Local Agency Search. U.S. Committee for Refugees and Immigrants.
Refugee Trauma. The National Child Traumatic Stress Network.
A Social Worker’s Tool Kit for Working with Immigrant Families. The Center on Immigration and Child Welfare.
Table: Medical Assistance Programs for Immigrants in Various States. National Immigration Law Center.

References/Additional Reading

Chaudry A, Capps R, Pedroza JM, Castaneda RM, Santos R, Scott MM. Facing our future: children in the aftermath of immigration enforcement (research report). Washington, DC: National Council of La Raza; 2010. Available at: sites/default/files/publication/28331/412020-Facing-Our-Future.PDF. Accessed January 1, 2019.

Concepcion Zayas MT, Fortuna LR, Cullins LM. Immigrant Refugee Youth: Clinical Opportunities and Considerations. Child Adolesc Psychiatric Clin N Am 28 (2019) 483–495

Gulbas IE, Zayas LH, Yoon H, Szlyk H, Aguilar-Gaxiola S, Natera G. Deportation experiences and depression among US citizen-children with undocumented Mexican parents. Child Care Health Dev. 2015;42:220-230.

Henderson SW, Baily CDR. Parental deportation, families, and mental health. J Am AcadChild Adolesc Psychiatry. 2013;52:451-453.

Ortega AN, Fang H, Perez V, et al. Health care access, use of services, and experiences among undocumented Mexicans and other Latinos. Arch Intern Med. 2007;167:2354-2360.

Yoshikawa H, Kalil A. The effects of parental undocumented status on the developmental contexts of young children in immigrant families. Child Dev Perspect. 2011;5: 291-297.



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Special Acknowledgment

The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI.