Children with greater social needs are at higher risk for poor health outcomes. Such factors in a child’s home and local community, called “social determinants of health,” like access to healthy food, a clean local environment, steady housing, and even a family’s access to child care, can influence a child’s health and development. Among agricultural worker communities, parents’ very low incomes and long working hours, language and cultural barriers, environmental and occupational exposures, and the need to move for work may increase the efforts needed to assure a healthy childhood. Yet, several programs are using promising models to address some of the social determinants of child health by leveraging community programs already in place and increasing the linkages between community partners to better serve the community -- and improve children’s health. In partnership with Farmworker Justice, Migrant Clinicians Network looks into the lives of some of the community members involved in these initiatives to see how the programs work.

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Through an examination of utilization data from the federal Migrant Education Program and Migrant Head Start, we are able to estimate that there are at least one million migrant children in the United States.¹ Like their parents, migrant children experience unique health challenges that are compounded by factors such as immigration status, substandard housing conditions, and language barriers.

Although migrant children have special health care concerns, they also benefit from the same basic health maintenance and anticipatory guidance as non-migrant children do.  For example, migration is a serious barrier for children to receive their vaccinations on time.¹ Conversely, the inability to easily transfer medical records may result in over-immunization. Many immigrant children come from countries with very high rates of vaccination, but without medical records, a child’s vaccination history is lost. Well-child visits are vitally important for all migrant children, offering an opportunity to positively impact the child's health and establish a valuable medical home (or one of many medical homes) where the family is comfortable, the child is known, and the child's records are available.

The health status of migrant children is best understood in a social determinants of health framework. For example, parent immigration status can affect utilization of health care services. One study looking at children of migrant farmworkers found that 77 percent of these children had a parent who was unauthorized to live or work in the United States.³ Fear of parental separation through deportation results in chronic stress and other serious health complications.⁴ Other conditions that affect health status include:

• parental poverty;
• frequent moves;
• interrupted schooling;
• overcrowded or substandard living conditions;
• poor sanitation facilities1;
• food insecurity^5,6.

Immigration status and fear of deportation can deter some migrant parents from seeking health care for themselves or their children. However, health centers are required to provide culturally appropriate primary care and to provide a Patient Centered Medical Home despite mobility or residency status. In 2014, approximately 892,056 farmworkers and their dependents were served by Federally Qualified Health Centers.¹¹

Migrant health centers report that adolescents are among the hardest to reach populations. A regional study of unaccompanied minor farmworkers showed health care access was limited due to minors’ inexperience with caring for themselves, among other factors.¹² In a California study of unaccompanied minor farmworkers, youth reported that they feared sickness, as it would impair their earning capacity, but that they did not know how to access care when they did need it.¹³ Adolescent males typically seek care for acute injuries or illnesses, but do not seek preventative care. Adolescent workers in California reported limited knowledge of occupational hazards such as heat stress and chemical exposures.¹³

Overall, health access for migrant children has improved in recent years. A recent research brief found that children identified at health centers from migrant and seasonal agricultural worker families are benefiting greatly from the Affordable Care Act. In 2000, 90 percent of migratory and seasonal agricultural worker children patients were uninsured; the figure fell to just 18 percent uninsured by 2012. However, these migrant children remain uninsured at rates far greater than that of other low-income children.

Food insecurity is a threat to the health of migrant children. One study based in Georgia found that farmworker families with children were 50 percent more likely to be food insecure than other families living in poverty.⁵ Another study estimated half of farmworker households are food insecure, with higher rates (56 percent) noted in households with children. Seventy-eight percent were found to be nutrient deficient. In comparison, the average rate of childhood food insecurity in the United States was found to be 11 percent in the same study.⁶

Please see our behavioral health page for more on children’s behavioral health.

Approximately half of all crop farmworkers are parents, and most of these parents have minor children who reside with them year-round. These children migrate with their parents as agricultural work shifts around the country.⁷ Migrant children experience an elevated risk for certain conditions due to their mobile lifestyle or due to exposures associated with their parents’ work. Many farmworkers live on or near farms, often in crowded homes that are substandard in terms of sanitation. This housing situation exposes migrant children to pesticide drift and other hazards associated with agriculture.

Parents who are not able to access affordable, high quality childcare are sometimes forced to bring their children with them to farms. These non-working children are exposed to various hazards on farms, including:

• pesticide exposure,
• heat stress,
• sun exposure,
• dusts,
• zoonosis.⁸

Thousands of children are injured and more than 100 are killed every year when they are exposed to hazards on a farm. While some children are working on the farm, most children who are injured or killed on farms are non-working. When agricultural workers have limited access to childcare, they often have no choice but to bring their children to work where the children are exposed to risks such as livestock, pesticides, machinery and more. It is not uncommon to see children waiting alongside fields or around employee parking lots.

In 2015, MCN launched a collaboration with long-time partner National Children’s Center for Rural Agricultural Health and Safety (NCCRAHS) on a five-year outreach project to provide safe places for children while their parents are working. The project engages agricultural employers and child care providers to facilitate the availability of and access to services for children of migrant and immigrant agricultural workers.

A 2012 survey of agricultural workers -- the most recent data available -- shows that 18% of farmworkers are between 14 and 24 years old. While some of these young people are unaccompanied minors who have found work in the United States, many are actually working alongside their parents in the fields. It is important to note that these numbers are most likely a conservative estimate, due to the fact that young children working alongside their parents are not always considered actual youth labor, and because the National Agricultural Workers Survey (NAWS) disregards working children under the age of 14. Many children of farmworkers report beginning to work regularly as early as age 10.¹⁰ Injuries to children working in agriculture may be misclassified as nonoccupational if clinicians do not explicitly assess and record work practices of youth.

Since 2014, thousands of children have arrived at the United States-Mexico border in search of a better life. Many of these children, some as young as six years old, have arrived without an adult companion and are seeking asylum from growing violence and political unrest in Central America’s Northern Triangle. Here, we examine the health concerns of these unaccompanied minors as a whole, followed by a closer look at teen migrants who have come to the US in search of employment.

As the number of unaccompanied minors arriving at the United States-Mexico border continues to rise, clinician advocates are calling for their peers to serve these children with compassion and empathy. Loren K. Robinson, MD calls for action, stating, “the true need is provision of compassionate pediatric primary care in our clinics and emergency rooms...We can build capacity and resilience in our home communities by addressing the needs of these children, as we would do for any child. Our dedication to improving the health of children should not come with stipulations of citizenship status.”¹⁴

Experts anticipate that the number of incoming unaccompanied minors will continue to grow, and will surpass 140,000 in coming years.15 Currently, most unaccompanied minors come from countries that are experiencing extreme poverty and violence, including Guatemala, El Salvador, Honduras, and Mexico.¹⁶ In some cases, parental exposure to trauma in sending countries is a more salient determinant of a child’s mental health status than the child’s own experiences; this is especially true of children from Central America whose parents have been tortured.¹⁷

Once they have arrived, some unaccompanied minors are placed with a relative while they await a deportation hearing, while others are held in detainment facilities.¹⁴ Newer studies indicate that immigrant children who have been detained experience stress and in some cases serious trauma, even if the detainment was for a short period of time.²⁶

For those who are not detained, there is significant mental trauma that is associated with resettlement during childhood, and perceived acceptance or discrimination within the host country is especially relevant.¹⁸ Clinician advocates call for the promotion of Spanish-speaking community resources, so that unaccompanied minors can immediately feel connected with a positive and accepting community to minimize psychological trauma.¹⁴ Not surprisingly, unaccompanied minors are more at risk for adverse psychological symptoms than minors who are accompanied during resettlement.^{20, 21}

Clinicians and health justice advocates can assist in the many health needs of unaccompanied minors, but they can be advocates for this vulnerable population outside the health realm as well. It is important to recognize that when other life needs are met, serious health concerns like stress and trauma may be reduced. Consequently, as clinicians, we recognize that issues like lack of legal representation, interrupted formal education, and the continued separation of family members and/or sponsors are serious concerns that need to be simultaneously addressed.

• Cultivate Safety / https://cultivatesafety.org/ offers resources and reports. Produced by the National Children's Center for Rural and Agricultural Health and Safety.
• Childhood Agricultural Safety Network / http://www.childagsafety.org/
  CASN is a coalition of organizations that work together to help keep children safe on the farm. These organizations represent the agricultural community, child injury prevention groups, minority-serving associations and related industry organizations.
  Childhood Agricultural Safety Network / http://www.childagsafety.org/CASN is a coalition of organizations that work together to help keep children safe on the farm. These organizations represent the agricultural community, child injury prevention groups, minority-serving associations and related industry organizations.
• National Children’s Center for Rural and Agricultural Health and Safety / https://www3.marshfieldclinic.org/NCCRAHS/ NCCRAHS strives to enhance the health and safety of all children exposed to hazards associated with agricultural work and rural environments.
• Center for Health and Health Care in Schools CHHCS has a fact sheet called “Children of Immigrants and Refugees: What the research tells us (Updated April 2011)” available for download at http://healthinschools.org/en/Tools/Fact-Sheet.aspx.
• American Academy of Pediatric’s Immigrant Child Health Toolkit AAP’s webpage has lots of resources and FAQs on a wide range of topics including clinical care, immigration status concerns, and state-by-state resources for immigrant families.
• Forgotten Citizens, a book by MCN External Advisory Board member Luis Zayas, MD, chronicles the plight of US citizen children of deported parents.  

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