Table 3

Review articles

First author and yearStudy populationStudy designSample size (children only)Summary of findings
Aynsley-Green et al 53 (2012)Refugee and asylum-seeking children and young peopleReview without information on search strategy or inclusion criteriaN/AEvidence that X-ray examination of bones and teeth is imprecise and unethical and should not be used. Further research needed on a holistic multidisciplinary approach to age assessment.
Bollini et al 29 (2009)Immigrant women(a) who delivered an infant EuropeSystematic review and meta-analysis18 322 978 pregnancies in 65 studies61 studies were cross-sectional design and 27 were from single facilities. Compared data on 1.6 million in immigrant women with 16.7 million native women. Immigrant women had 43% higher risk of low birth weight, 24% of preterm delivery, 50% of perinatal mortality and 61% of congenital malformations compared with native European women.
Cole54 (2015)UASCReview article of methods for age assessmentN/AMost individuals are mature before age 18 in hand-wrist X-rays. On MRI of the wrist and orthopantomogram of the third molar, the mean age of attainment is over 19 years; however, if there is immature appearance, these methods are uninformative about likely age; as such, the MRI and third molars have high specificity but low sensitivity.
Derluyn et al 43 (2008)UASCReview without information on search strategy or inclusion criteriaN/AUASC are a vulnerable population with considerable need for psychological support and therefore need a strong and stable reception system. The creation of such a system would be greatly facilitated if the legal system considered them children first and refugees/migrants second.
Devi12 (2016)UASCOpinion pieceN/ASummarises findings on infectious diseases affecting unaccompanied minors based on two Unicef and one Human Rights Watch reports.
Eiset17 (2017)Refugees and asylum seekers - all agesNarrative reviewNot specified51 studies of infectious conditions in refugees and asylum seekers including children and adults. Findings related to children: limited evidence on infectious diseases among refugee and asylum-seeking children; relatively low vaccination rates with one study showing 52.5% of migrant children needing triple vaccine and 13.2% needing MMR and a further study showing low levels of rubella immunity among refugee children. The review reports on rates of TB, HIV, hepatitis B and C, malaria and less common infections; however, rates are not reported by age group.
Fazel et al 35 (2012)Refugee children and young peopleSystematic review5776 children and youth in 44 studiesExposure to violence, both direct and indirect (through parents), are important risk factors for adverse mental health outcomes in refugee children and adolescents. Protective factors include being accompanied by an adult caregiver, experiencing stable settlement and social support in the host country.
Hjern55 (in press)UASCNarrative reviewN/AMany UASC come from ‘failed states’ like Somalia and Afghanistan where official documents with exact birth dates are rarely issued. No currently available medical method has the accuracy needed to replace such documents. Unclear guidelines and arbitrary practices may lead to alarming shortcomings in the protection of this high-risk group of children and adolescents in Europe. Medical participation, as well as non-participation, in these dubious decisions raises a number of ethical questions.
ISSOP Migration Working Group6 (2017)Migrant children in EuropeNarrative review and position statementN/ABased on a comprehensive literature search and a rights-based approach, policy statement identifies magnitude of specific health and social problems affecting migrant children in Europe and recommends action by government and professionals to help every migrant child to achieve their potential to live a happy and healthy life, by preventing disease, providing appropriate medical treatment and supporting social rehabilitation.
Markkula et al 9 (2018)First and second generation migrant children compared with non-migrant childrenSystematic review10 030 311 children in 93 studies57% of included studies were from Europe and 36% from North America. Use of non-emergency healthcare services was less common among migrant compared with non-migrant children: in 19/27 studies reporting on general access to care, 9/19 reporting on vaccine uptake, 9/16 reporting on mental health service use, 9/14 reporting on oral health service use, 10/14 reporting on primary care and other service use. Migrant children were reported to be more likely to use Emergency and Hospital services in 9/15 studies.
Mipatrini et al 21 (2017)Migrants and refugeesSystematic reviewN/AThe study reports primarily on data in adults or where age classification is not specified. Overall, migrants and refugees were found to have lower immunisation rates compared with European-born individuals. Studies in migrant children found lower rates of MMR, Polio and tetanus vaccination. Reasons cited include low vaccination coverage in the country of origin and barriers in access to care in Europe.
Sauer et al 56 (2016)UASCEditorial/Position statementN/APosition statement by the European Academy of Paediatrics outlining medical, ethical and legal reasons for recommending that physicians should not participate in age determination of unaccompanied and separated children seeking asylum.
Slone36 (2016)Children aged 0–6 years exposed to war, terrorism or armed conflictSystematic review4365 children in 35 studiesYoung children suffer from substantial distress including elevated Risk for PTSD or PTS symptoms, non-specific behavioural and emotional reactions and disturbance of sleep and play rituals. Parental and children’s psychopathology correlated and family environment and parental functioning moderates exposure–outcome association for children. The authors conclude that longitudinal studies are needed to describe the developmental trajectories of exposed children.
Williams et al 34 (2016)Refugee children in EuropeReview without information on search strategy or inclusion criteriaN/AIncreased rates of depression, anxiety disorders and PTSD among refugee children, as well as high levels of dental decay and low immunisation coverage.
  • PTSD, post-traumatic stress disorder; TB, tuberculosis; UASC, unaccompanied and separated children; FGM, female genital mutilation;  NGO, nongovernmental organisation; MMR, Measles, mumps and rubella vaccination.