Refugee and asylum-seeking children and young people: guidelines for use in the Royal Hospital for Children, Glasgow

History

Explore the following as part of a comprehensive history

• Details of their journey to the UK including their country of origin, reasons for leaving and route and means by which they have travelled to the UK. Please ensure a trauma informed approach and be aware of the potential distress that this discussion may cause.
• Accompanying family - who is with them and where the rest of the family are living? Details of other children in the family? Have they linked up with any local communities?
• Past Medical History with a focus on infections, previous admissions to hospital, current medication, and history of blood transfusions.
• Immunisation history. Is there a documented immunisation history and is there a BCG scar?
• Family history – consider consanguinity, chronic illness/ infectious disease, haemoglobinopathies.
• Safeguarding – is there any social work involvement or suggestion of trafficking/ sexual exploitation/ female genital mutilation.
• Mental Health – ask the family about the child’s sleep, mood, behaviour, and signs of PTSD i.e. flashbacks, nightmares, avoidance, anxiety, self-harm

Examination

A full physical examination is important, with particular attention to:

• Nutritional assessment – document and plot height and weight. For infants under 1 year measure and document head circumference.
• If you are concerned about severe acute malnutrition, please plot on a WHO weight-for-height chart
• If below -3 SDS admit under general paediatrics and discuss with someone with expertise in nutrition/acute management of severe acute malnutrition.
• WHO guidelines for SAM
• Pay attention to scars/ old injuries that may have been sustained prior to or during their journey as well as skin conditions associated with living in cramped conditions such as scabies.
• Be mindful of the possibility of FGM and examine where appropriate and consented. Please see the RCPCH guidance for recognition and escalation.

Patients being admitted

• Ensure documentation and communication of above to inpatient team.
• If bloods are being taken in the ED please consider screening for the following if they meet the criteria below:
  • HIV, Hepatitis B and Hepatitis C
  • Strongyloides
  • Schistosomiasis
  • Haemoglobinopathy
  • Tuberculosis
• Blood borne viruses
  • HIV – If prevalence in country of origin is >1% - UNAIDS: HIV estimates with uncertainty bounds 1990-Present 
    • Send - HIV antibody
  • Hepatitis B – If prevalence in country of origin is >2% - TravelHealthPro: Hepatitis B
    • Send - HepB surface Ag and coreAb
  • Hepatitis C – any patient at increased risk - UK Government: Hepatitis C information for GPs 
    • Send - Hep C antibody
  • If in any doubt or concern that the child may be at increased risk, screen for HIV, Hepatitis B and Hepatitis C
• TB screening
  • For any person from home/ transit country incidence >40/100,000 or high exposure risk e.g., TB contact, has been living in a refugee camp – UK Government: Tuberculosis by country - rates per 100,000 people 
    • For children over 2yrs old please arrange for an IGRA to be sent. The bottles can be obtained from the Microbiology Laboratory and need to be returned before 12pm. If out of hours, please liaise with ward 1C.
    • For children under 2years, please liaise with ward 1C for a Mantoux to be performed.
• Schistosomiasis screening
• For any person from a schistosoma endemic country, send serology for Schistosome IgG to Scottish Microbiology Reference Laboratories, Glasgow. Search ‘parasite serology’ on Trak and select from drop down list.
• If IgG positive, contact Paediatric ID for further advice - TravelHealthPro: Schistosomiasis
• Strongyloides screening
  • For any person from a strongyloides endemic country, send serology for Strongyloides IgG to Scottish Microbiology Reference Laboratories, Glasgow. Search ‘parasite serology’ on Trak and select from drop down list.
  • If IgG positive, contact Paediatric ID for further advice - CDC: Strongyloides 
• Haemoglobinopathy screening
  • All children originating from sub-Saharan Africa should be offered screening for sickle cell disease – send HbOS screen (Search ‘haemoglobinopathy’ on Trak) to haematology lab.
• Sexual health – Syphilis, gonorrhoea & chlamydia screening is recommended for all asymptomatic sexually active adolescents or children/adolescents subject to sexual exploitation. Please signpost to the Sandyford sexual health services or 0141 211 8130.
  • N.B. If the child/ young person is symptomatic, please liaise with Medical Paediatrics/ Paediatric Infectious diseases to arrange further investigation. Sexual health screen to include:
    • Urinary gonorrhea/ chlamydia PCR – these require specific sample containers to be requested from the Microbiology laboratory.
    • Syphilis serology

• If there are concerns regarding ongoing engagement with healthcare or welfare, please take a pragmatic approach i.e. if performing blood tests in ED, consider doing the above screening bloods.
• If there are concerns regarding ability to attend follow up, please discuss with the on call medical consultant (or senior paediatric registrar after midnight). It may be appropriate to admit to CDU to complete assessment and ensure follow up is facilitated.
• For concerns regarding mental health please refer to CAMHS and the Glasgow Psychological Trauma Service (Anchor service). Anchor will accept any young person who is "unaccompanied" with indicators of PTSD. CAMHS will accept any young person (unaccompanied or not) under 18 years with moderate to severe mental health concerns.
• If there are safeguarding concerns, please discuss with the consultant on call. You should be happy that the child has a safe place for discharge. Children under 16 years who are not with their parents should be referred to the social work team. A Notification of Concern (NOC) should be submitted.
• Ensure follow up with GP or General Paediatric or Paediatric Infectious Disease clinic as appropriate.
  • General Paediatric clinic – for children requiring ongoing assessment in secondary/ tertiary care. Please dictate a referral for vetting.
  • Paediatric Infectious Disease clinic – for any children whose ID screening tests are positive. Please dictate a referral for vetting.
• For those being discharged, please ensure that your discharge letter includes recommendations for further action as relevant from the following:

Medications:

• Vitamin D/multivitamin prophylaxis in high-risk groups: Scottish government guidance is that all people from high-risk groups (children <5 years, all pregnant and breastfeeding women, people from ethnic minority groups with dark skin, people who have low or no exposure to sun) should have vitamin D supplementation all year round, not just in the winter months as is recommended in the document – 400 IU per day. We also recommend multivitamins for children <5 years of age.
• Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10mcg of Vitamin D e.g., Calciforte.
• Albendazole for all children in the family over 2years of age. Up to a third of children arriving in the UK have intestinal helminthic infections. BNFc advises a single dose of 400mg.

Health Promotion:

• Immunisations – where immunisation status is unknown the child should undergo catch up as per the UK immunisation schedule. This will include BCG vaccinations. This can be arranged by the GP practice through referral to the childhood vaccination service.
• If there are specific immunisations identified, then these can be arranged by emailing: screening@ggc.scot.nhs.uk with an attached letter on the child’s Clinical Portal record from their consultant. Letter should state which immunisations the child is to have. 

Inform parents regarding access to dental and visual health services:

• Dental health – all children should be registered with an NHS dentist. All children are entitled to free NHS dental health care.
• Vision – all children should be registered with an optometrist. All children are entitled to free eye tests and glasses if required.

Provide parents with information regarding local community support services – see below:

Information in other languages
https://www.nhs.uk/about-us/health-information-in-other-languages/

https://www.nhsinform.scot/translations

https://www.sandyford.scot/sexual-health-services/information-in-community-languages/

Community Link Workers – see attached sheet for contact details CLW’s.

Barnados – Boloh helpline (0800 151 2605) providing advice, signposting and emotional support and 8 free sessions of therapy. 

British Red Cross – offers emergency one-to-one support and casework, special services for children and families, and reuniting assistance. Can also help with food, toiletries and assistance accessing education and healthcare. 

Govan Community Project – advice on applying for Home Office support, emergency accommodation, information on foodbanks, online English classes and online social groups. 

Kids in Need of Defense – free expert legal help to undocumented children, young people and families. 

Migrant Help – advice on how to claim asylum, applying for asylum support, and reporting problems. 

Refuweegee – welcome packs

Scottish Refugee Council – an independent charity dedicated to supporting refugees in Scotland. Services include support for families, helpline, and an employability programme. The website also has a series of translated factsheets on accommodation, health rights and health information. 

Resources for supporting children and young people and their families.

British Red Cross | Afghanistan – Information and support for people from Afghanistan settling into life in the UK. Resources translated into Dari and Pashto. Includes information on the Red Cross’ Family Tracing service, videos about life in the UK, and information on how to contact ARAP, the Afghan Relocation Scheme.

British Red Cross | Help for Ukrainian nationals – Information and support for people from Ukraine, including the family migration visa and the Ukrainian family scheme. Download ‘Advice for Ukrainians arriving in the UK’ and ‘How to talk to children about war’ in Ukrainian.

Doing What Matters in Times of Stress (who.int) – A free stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. It has been translated into 19 languages, including Arabic, Chinese, Dari, Farsi, and French.

Mental Health and Psycho Social Support network | Caring for Children through Conflict and Displacement – Resource translated in Ukrainian, Russian, Polish and German. Additional relevant resources translated in multiple languages in the resources section.

University of Manchester | Information for adults looking after a child or children through conflict and displacement – Two page leaflet developed based on the experience of displaced Syrian parents translated into Ukrainian, Russian, English, German and Polish

Beacon House | Talking to children about war and conflict (PDF) – Guidance for adults supporting a child or teen on how to respond to their reactions and questions.

Phoenix Australia | Helping a friend or family member after a disaster (PDF) – A factsheet with simple and practical advice for those providing support.

Asylum Seeker: a person who has lodged an application for protection under the Geneva convention  (U.N.T.S, 1951) or Article 3 of the European Convention of Human Rights  (European Court of Human Rights, 2021) and is waiting for their claim to be processed.

Refugee: a person who due to a ‘well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside of the country of his nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it’  (U.N.T.S, 1951).

UASC: a child or young person seeking asylum in the absence of a parent or legal guardian. A child is a person under the age of 18 years or who, in the absence of documentary evidence, appears to be under the age of 18 years.