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AAP: Armed Conflict Is a Pediatric Issue

— Group encourages clinicians to address impact on physical and mental health

MedpageToday

ORLANDO -- Armed conflict is "both a toxic stress and a significant social determinant of child health," and pediatricians need to treat it as "a critical and priority issue," according to the American Academy of Pediatrics (AAP).

The AAP released its on children and armed conflict during the.

"Armed conflict is any organized dispute that involves the use of weapons violence or force," said co-author Jeffrey Goldhagen, MD, MPH, of the University of Florida's Jacksonville campus, at an AAP press conference. "Violence associated with groups exists all around the world. It is very important to recognize that we are also talking about the United States."

"It is critically important that we recognize that there is a substantial impact of armed conflict, and in particular on issues related to gangs, [human] trafficking, narcotics traffic in the United States," he told 鶹ý. "This is not an issue that we can say belongs to the 'other world.' It does belong to our world as a result of complex social and political issues."

While the AAP policy statement encourages pediatricians to address the impact of armed conflict on children, the authors acknowledged that "evidence base for interventions used to prevent and mitigate the effects of conflict on children remains limited." Potential ways to assist these patients include:

  • Develop familiarity with immigrant health conditions and health determinants
  • Use child-friendly spaces for psychosocial and educational interventions to promote child mental health both during and after conflicts
  • Implement vaccination programs
  • Establish surveillance systems to detect conflict- and displacement-related morbidity, and develop interventions to mitigate their effects on population health

Goldhagen also pointed out that children "now are not just casualties [of armed conflicts]; they are now being targeted and are being engaged as combatants."

The conditions that families face after fleeing armed conflicts may include family separations and detention, which could lead to stress-inducing change in sleep, eating, and behavior, noted Julie Linton, MD, co-chair of the AAP immigrant health special interest group.

Linton, of Wake Forest Baptist Health in Greenville, South Carolina, told 鶹ý that conditions at the U.S. southern border with refugees seeking asylum may fall outside the conditions mandated for protecting children by the . The U.S. is the only nation in the world that has not ratified that declaration.

She noted that the U.S. has agreed to other child protective measures such as the

"Experience has shown that strong collaboration between the health sector and other sectors, including immigration, civil protection authorities, education, and nongovernmental organizations, results in a more effective management of complex emergencies and better health outcomes for people who are displaced and for receiving population," the authors stressed in the technical report. "It is incumbent on pediatricians, allied child health care providers, public health professionals, researchers, and policy makers to address the impact of armed conflict on children as a critical and priority issue. Children must be counted."

"Children are resilient, and they do have a future, if we can provide them with the right environment," Goldhagen stated.

Disclosures

All AAP technical reports automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Goldhagen and Linton disclosed no relevant relationships with industry.

Primary Source

Pediatrics

Kadir A, et al “The effects of armed conflict on children” Pediatrics 2018; DOI:10.1542/peds.2018-2586