When children arrive at the U.S. border seeking safety, the systems that receive and care for them should put children's health, well-being and best interests first, according to a new policy statement from the American Academy of Pediatrics (AAP).
"Children and families fleeing violence, persecution and environmental crises have a recognized right to seek humanitarian protection," said lead author J. Raul Gutierrez, MD, FAAP.
Challenges immigrant children face
The AAP notes that many children face physical and emotional challenges throughout the migration journey. Those challenges can be made worse by immigration policies and enforcement practices that do not focus on children's best interests. Instead, the Academy recommends approaches guided by child welfare and health experts.
The AAP says children's needs should guide every part of the reception and assessment process.
The policy statement recommends using Best Interest of the Child (BIOTC) framework, the U.N. Convention on the Rights of the Child principles and trauma-informed care when making decisions that affect immigrant children and families.
"No matter how far they are from the border, pediatricians see the effects of immigration policies in their exam rooms," said Sural Shah, MD, FAAP, chair of the AAP Council on Immigrant Child and Family Health. "Poor conditions, limited access to care and traumatic custody experiences can affect the health and well-being of children seeking safety."
What the AAP recommends
The AAP policy statement calls for:
A humanitarian response rather than a law enforcement process.
Decisions guided by the best interests of the child.
Timely medical and mental health care informed by pediatric expertise.
Trauma-informed care at every stage of reception.
Safe reception settings that meet established child welfare standards.
Ongoing oversight to improve quality, safety and accountability.
Keeping families together unless child welfare experts identify an immediate safety concern.
Protecting children's ability to seek humanitarian protection.
Keeping families together when possible
The AAP says detaining children and separating them from their families can cause real harm to children's health and well-being. The policy statement points to safer, proven community-based alternatives that can support children's safety, health and access to services while preserving family unity.
Detaining children and separating them from their families also causes real harm, and there are safer, proven, community-based alternatives. Detention should never happen, and family separation should be a last resort—not an automatic default, according to AAP.
"To be clear, this is about children's lives, not political points," Dr. Gutierrez said. "It's about aligning U.S. policy with the best evidence and our shared responsibility to protect children. Our communities are stronger when children are healthy and supported, wherever they may be."
The policy statement, which is published in the September 2026 issue of Pediatrics, was developed by medical experts from the AAP Council on Immigrant Child and Family Health. It reflects current research and evidence, underwent peer review and was approved by the AAP Board of Directors before publication in Pediatrics.
More information