Post-arrival health assessment: children and adolescents

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All refugee and asylum seeker arrivals should be offered a comprehensive health assessment within 1 month of arrival,[3, 8] or expediently if there is any clinical indication or health alert. This assessment can be offered at any time after arrival if initial contact with healthcare is delayed. Families (and adolescents individually) need to understand the importance and implications of health screening and give informed consent. This means explaining all tests, the conditions being screened, the meaning of a positive test, and the next step in management.

Assessment of newly arrived refugee children and adolescents should focus on:

  • Parent (or self-identified) concerns
  • Excluding acute illness
  • Immunisation status and catch-up vaccination
  • Tuberculosis screening
  • Other infections, including parasites, malaria and hepatitis
  • Nutritional status and growth
  • Oral health
  • Concerns about development, vision and hearing
  • Mental health, trauma and violence exposure
  • Previous severe or chronic childhood illness or physical trauma
  • Confirming the reported birth date
  • Education history
  • Issues arising during resettlement in Australia.

Initial screening investigations

Suggested initial screening investigations are:[3, 8, 9]

All children and adolescents:

  • Full blood examination (FBE) and film
  • Ferritin
  • Hepatitis B serology – surface antigen (HBsAg), surface antibody (HBsAb) and core antibody (HBcAb)
  • Strongyloides serology
  • TB screening – TST or interferon gamma release assay (IGRA). TST is preferred in children less than 5 years
  • Faecal specimen – ova, cysts and parasites (OCP)

Country-based screening

  • Malaria – rapid diagnostic test (RDT) and thick/thin film, if arrival less than 3 months from endemic area* or later if symptoms
  • Hepatitis C serology – Hepatitis C virus (HCV) antibodies, if from endemic area or if clinical risk factors
  • Schistosoma serology – if travel from/through endemic area*

Age/risk-based screening

  • Vitamin D, calcium, phosphate, ALP – if risk factors for low vitamin D (lack of skin exposure to sunlight, dark skin, conditions affecting vitamin D metabolism, and exclusively breastfed infants where there is maternal deficiency and at least one other risk factor)
  • Serum active vitamin B12 – if arrival less than 6 months, food insecurity, vegan, from Bhutan, Afghanistan, Iran, or Horn of Africa
  • Varicella serology – if age 14 years and older if no history clinical varicella infection and no documented varicella vaccination
  • Rubella serology – females of childbearing age. Consider in late adolescence, although not needed if catch-up vaccination in place
  • Sexually transmitted infection (STI) screen – N. gonorrhoea and C. trachomatis urine nucleic acid detection, syphilis serology (note: also HIV, hepatitis B) in sexually active adolescents, or if there is a history of sexual violence/abuse.
  • Syphilis screening should be completed in all unaccompanied/separated children, and children should also be screened for syphilis if their mother has positive serology
  • HIV testing – age 15 years and older, less than 15 years if unaccompanied/separated minor, or clinical risk factors (sexually active, history of sexual violence/abuse, where parents are deceased/missing/known to be HIV positive, other STIs, history of blood transfusions, or where there are clinical symptoms/signs)
  • Helicobacter pylori screening (faecal antigen test on fresh specimen) in children with family history gastric cancer, or symptoms/signs dyspepsia/ulcer disease. 

Urgent specialist assessment/advice is required in children and adolescents with the following presentations:

  • Unwell/febrile (this requires urgent exclusion of malaria and other severe infection)
  • Symptoms suggesting active TB disease (fevers, weight loss/poor weight gain, prolonged cough, other localising symptoms)
  • Malnutrition
  • Clinical rickets or hypocalcaemia
  • Low B12 levels in infants/young children (also maternal deficiency during exclusive breastfeeding)
  • Developmental issues or disability
  • Severe mental health concerns

Produced by

in consultation with

                  Refugee Health Network of Australia

Endorsed by

Funded by

The Australian Refugee Health Practice Guide was produced with funds from the Australian Government Department of Health.

Disclaimer

The information set out in the Australian Refugee Health Practice Guide (“the Guide”) is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is the Guide exhaustive of the subject matter. Persons implementing any recommendations contained in the Guide must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. The statements or opinions that are expressed in the Guide reflect the views of the contributing authors and do not necessarily represent the views of the editors or Foundation House. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the information is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly, Foundation House and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in the Guide for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in the Guide and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Although every effort has been made to ensure that drug doses and other information are presented accurately in the Guide, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer.