Children of immigrant families experience developmental processes in the contexts of migration and settlement, presenting immigration-specific challenges. Child health providers can use awareness of the cultural-ecological model of immigrant child development to explore how acculturation, ethnic identity formation, and bilingualism affect the children and families under their care. Cross-cultural strategies for evaluating and supporting immigrant child development are presented to guide the provider in clinical interactions and community efforts.
Key points
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Understanding contexts of migration and settlement is an essential component in the developmental and behavioral evaluation of an immigrant child.
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Acculturation, ethnic identity formation, and bilingualism are fundamental developmental processes for the immigrant child.
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Although bilingualism brings multiple cognitive and social benefits, dual-language learners are at increased risk of low academic achievement.
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Risks of stereotyping and unconscious bias are high in cross-cultural interactions; understanding the unique experience of each immigrant child relies on applying general knowledge to the specific interaction from a stance of cultural humility.
Introduction
Immigration is one of the major societal issues of the day, bringing challenge and opportunity to those working to support the health and well-being of children. In the United States, the youngest segment of society has diversified fastest, with children from immigrant families increasing from 15% to 24% of the younger than age 18 population between 1994 and 2014. By 2050, they are expected to make up one-third of all US children ( Fig. 1 ). Parents of immigrant children in the United States come from all regions of the world and show diverse settlement patterns ( Fig. 2 ), whereas refugee families tend to come from specific regions in the Middle East, Africa, and Asia. Just less than two-thirds of refugees who resettled in the United States in 2014 came from Iraq, Burma, and Somalia.
In pediatric settings, as the number of children from immigrant families increases, the need to understand the special issues they face becomes more pressing. Recent publications, such as the Immigrant Child Health Toolkit from the American Academy of Pediatrics (AAP) and the article by Linton and colleagues, address the broad health needs of children of immigrant families. Here we focus on what is known about the effects of immigration on child development. Understanding of this area has expanded rapidly through work in multiple disciplines, including psychology, sociology, psychiatry, public health, public policy, and developmental pediatrics.
This article offers the practicing pediatric provider an orientation to current knowledge about child development in the immigrant context and a clinical approach to caring for immigrant children. In it, we provide a description of how child development theories have incorporated immigration, followed by a discussion of issues with special relevance to children living in an immigrant context. Finally, we outline tools and interventions applicable in the clinical setting.
Variations of “child of an immigrant family” are used throughout this article, as the phrase captures two distinct situations of interest to the pediatric practitioner: a child who immigrates from one country to another, also called first generation; and a child who is born in a new country to which a family has immigrated, or second generation. For brevity, the term “immigrant child” is also used to denote a child of an immigrant family, regardless of generational status. Although developmental processes and outcomes can differ widely for first- and second-generation immigrant children, research in this area is not yet well-developed, so generally they are treated together here (except where noted). Specific types of immigrant children, including refugees, asylum-seekers, stateless persons, unaccompanied immigrant children, and undocumented immigrants, are defined in Box 1 .
| Term | Definition |
|---|---|
| Child of an immigrant family | A child who has at least one foreign-born parent |
| First-generation immigrant child | A child born outside the country to which they immigrated |
| Second-generation immigrant child | A child born in the settlement country to a foreign-born parent |
| Refugee/asylum-seeker a | Someone who has been forced to flee his or her country because of persecution, war, or violence and has or seeks legal residence in another country b |
| Stateless person | Someone who is not considered as a national by any country b |
| Unaccompanied immigrant child | A child who immigrates without a parent or adult guardian |
| Unauthorized immigrant | A foreign-born resident without legal status (eg, temporary worker, lawful permanent resident, citizen) |
a By definition, refugees have received legal status, whereas asylum seekers are requesting it based on perceived persecution or danger in their home country.
b For details of refugee, asylum-seeker, and stateless person demographics and procedures, see United Nations High Commissioner for Refugees (UNHCR) Web site: www.unhcr.org and US State Department Refugee Admissions Web site: http://www.state.gov/j/prm/ra/index.htm .
Introduction
Immigration is one of the major societal issues of the day, bringing challenge and opportunity to those working to support the health and well-being of children. In the United States, the youngest segment of society has diversified fastest, with children from immigrant families increasing from 15% to 24% of the younger than age 18 population between 1994 and 2014. By 2050, they are expected to make up one-third of all US children ( Fig. 1 ). Parents of immigrant children in the United States come from all regions of the world and show diverse settlement patterns ( Fig. 2 ), whereas refugee families tend to come from specific regions in the Middle East, Africa, and Asia. Just less than two-thirds of refugees who resettled in the United States in 2014 came from Iraq, Burma, and Somalia.
In pediatric settings, as the number of children from immigrant families increases, the need to understand the special issues they face becomes more pressing. Recent publications, such as the Immigrant Child Health Toolkit from the American Academy of Pediatrics (AAP) and the article by Linton and colleagues, address the broad health needs of children of immigrant families. Here we focus on what is known about the effects of immigration on child development. Understanding of this area has expanded rapidly through work in multiple disciplines, including psychology, sociology, psychiatry, public health, public policy, and developmental pediatrics.
This article offers the practicing pediatric provider an orientation to current knowledge about child development in the immigrant context and a clinical approach to caring for immigrant children. In it, we provide a description of how child development theories have incorporated immigration, followed by a discussion of issues with special relevance to children living in an immigrant context. Finally, we outline tools and interventions applicable in the clinical setting.
Variations of “child of an immigrant family” are used throughout this article, as the phrase captures two distinct situations of interest to the pediatric practitioner: a child who immigrates from one country to another, also called first generation; and a child who is born in a new country to which a family has immigrated, or second generation. For brevity, the term “immigrant child” is also used to denote a child of an immigrant family, regardless of generational status. Although developmental processes and outcomes can differ widely for first- and second-generation immigrant children, research in this area is not yet well-developed, so generally they are treated together here (except where noted). Specific types of immigrant children, including refugees, asylum-seekers, stateless persons, unaccompanied immigrant children, and undocumented immigrants, are defined in Box 1 .
| Term | Definition |
|---|---|
| Child of an immigrant family | A child who has at least one foreign-born parent |
| First-generation immigrant child | A child born outside the country to which they immigrated |
| Second-generation immigrant child | A child born in the settlement country to a foreign-born parent |
| Refugee/asylum-seeker a | Someone who has been forced to flee his or her country because of persecution, war, or violence and has or seeks legal residence in another country b |
| Stateless person | Someone who is not considered as a national by any country b |
| Unaccompanied immigrant child | A child who immigrates without a parent or adult guardian |
| Unauthorized immigrant | A foreign-born resident without legal status (eg, temporary worker, lawful permanent resident, citizen) |
a By definition, refugees have received legal status, whereas asylum seekers are requesting it based on perceived persecution or danger in their home country.
b For details of refugee, asylum-seeker, and stateless person demographics and procedures, see United Nations High Commissioner for Refugees (UNHCR) Web site: www.unhcr.org and US State Department Refugee Admissions Web site: http://www.state.gov/j/prm/ra/index.htm .
Incorporating immigration into child development theory
Early theories of child development focused on defining the processes a child goes through between infancy and adolescence: the physical, cognitive, psychosocial, and moral changes experienced in a common, expected progression. In recent decades, the role of a child’s environment has become a more prominent part of developmental modeling, especially since the emergence of the ecological model of human development, first described in 1979 by Bronfenbrenner. The ecological model, based on the interactions between an individual and the multiple environments around them, offers important perspectives on how the processes of development are affected by the contexts in which children live.
The ecological model describes four nested levels of the environment (microsystem, mesosystem, exosystem, and macrosystem) that impact a child’s development at all ages ( Fig. 3 ). The microsystems are the most immediate contexts of a child’s life (family, school, peer relations, religious setting) in which they are affected by direct interactions with others. The mesosystem is formed by interactions between microsystems (eg, parents interacting with teachers or monitoring a child’s peer interactions). The exosystem includes elements, such as extended family, neighborhoods, parents’ workplaces, local policies, mass media, and industry, which indirectly affect children through interactions with microsystems.The macrosystem is the overarching cultural setting that a child experiences through its influence on the other contexts. It includes cultural beliefs and ideologies; societal structure; and social, political, and economic conditions, among other things.
For a child growing up in a stable setting, these systems create a complex set of influences that play a formative role in development. When children emigrate from one country to another, the complexity increases considerably. Some microsystems fall away and are replaced by new ones, resulting in mesosytem shifts and fractures. Exosystems and macrosystems collide, opening questions of identity, belonging, and the reconciliation of differing cultural beliefs and norms.
Adaptations to the basic ecological model have been made to account for the way immigration affects the nested systems. In 2007, Perreira and Smith described the cultural-ecological model of migration and development, in which they introduced the migration context and the settlement context, each with specific characteristics that influence ethnic identification, psychosocial outcomes, and general well-being of the immigrant child ( Fig. 4 ). The migration context includes migration motives (eg, voluntary vs forced) and migration events (what happens along the way). The settlement context is characterized by acculturation strategies (assimilation, separation, marginalization, or biculturation) and acculturation experiences (how the settlement community’s policies, school/work conditions, and attitude toward ethnicity and immigration affect the child).
In this model, migration and settlement contexts are not elements of a microsystem, exosystem, or macrosystem, but represent modifiers of these systems, or lenses through which developmental challenges specific to the immigrant child are identified. For the clinician assessing an immigrant child’s progress through the standard developmental processes (physical, cognitive, psychosocial, and so forth), the ecological model and its migration-specific adaptation offer a framework for considering forces at play in an immigrant child’s developmental trajectory.
Developmental challenges related to immigration
The interplay between universal developmental processes and migrant and settlement contexts results in experiences specific to the children of immigrants. Three fundamental immigrant developmental processes are (1) acculturation, (2) ethnic identity formation, and (3) bilingualism.
Acculturation
Acculturation was originally described as a unilateral process by which immigrant communities could assimilate into the dominant receiving culture. Newer theories reject the idea of unilateral acculturation in favor of a bilateral exchange, in which immigrants both affect and are affected by the environment where they settle. Two current acculturation models can help the clinician frame an immigrant child’s experience: the four-fold model and the interactive acculturation model.
In the four-fold model, there are four basic strategies available to immigrant families and their children : (1) assimilation (replacement of the original culture with the new); (2) separation (rejection of the new culture while maintaining the original); (3) marginalization (rejection or denial of access to the new culture along with loss of the original, either willingly or by force); and (4) integration (acceptance of the new culture while maintaining the culture of origin).
The interactive acculturation model considers not only the viewpoint of the newcomer (as in the four-fold model), but also the orientation of the host community to the acculturation of immigrants. This model underlies the description of the settlement context in the cultural-ecological approach described previously. The orientation to acculturation among immigrants (Do they wish to retain their culture? Adopt the new culture? Both?) can be compared with the readiness of the host community to accommodate newcomers (Are there policies that are proimmigration or anti-immigration? Are school and work structures set up to receive those from different cultures? What are the pre-existing attitudes about racial/ethnic interactions?), resulting in a dynamic set of possibilities representative of experiences in a multicultural society.
Children and parents in immigrant families often experience acculturation in different ways. As children go to school, they are rapidly socialized (ie, explicitly taught values, norms, and behaviors) and enculturated (ie, implicitly pick up cultural nuances) in the host culture, and are unlikely to “choose” an acculturation strategy the way an adult might. Parents often continue to socialize them at home in the ways of their culture of origin, but lack the same opportunities for either socialization or enculturation in their new environment. These differences in experience can lead to acculturation gaps in the family, with children more strongly tied to the new culture and parents struggling to maintain what they see as an appropriate balance between cultures, for themselves and their children.
In addition to the “how” of acculturation, a clinician also should consider to which host culture a child or family is acculturating. In a multicultural US society, new immigrants may acculturate to the mainstream white culture or to an existing ethnic minority culture, especially when there is geographic isolation, cultural affinity, or a large coethnic community. Discrimination is a common experience for immigrant children, particularly when the receiving culture is negatively oriented to immigration and minorities and when they acculturate to an existing ethnic minority. Such discrimination exemplifies how the settlement context plays a critical role in an immigrant child’s developmental trajectory.
Ethnic Identity Formation
For the child of an immigrant family, feeling different and being treated differently in the receiving culture can provide the basis for a sense of ethnic identity. This typically begins in preadolescence and continues throughout the adolescent years, when the confluence of personal identity (Who am I?) and social identity (To what groups do I belong?) leads to an abstract sense of self. By definition, ethnic identity relates to ethnic group belonging, but the labels used to self-categorize are dynamic and multilayered. Although panethnic categories, such as Latino and Asian, are commonly used in the United States, they usually do not exist in the heritage country immigrants leave behind, creating a potentially confusing situation for immigrant youth. More specific identities, such as Mexican American or Chinese American, and multiethnic combinations (eg, American, black, and Somali or Latino, Argentinian, and white) provide more precise terms for expression of identity, although individuals also move through varied expressions of ethnic identity depending on the context.
Strong ethnic identity generally has been shown to be protective for immigrant adolescents and young adults, particularly against anxiety, depression, conduct problems, and substance abuse. Biculturalism, which can occur when ethnic identity includes both heritage and receiving cultures (eg, Nigerian and US identification), also is associated with enhanced well-being, although details of how it differs among ethnic groups, between first- and second-generation immigrants, and across the age span is not well understood.
A challenge facing many immigrant children is the perpetual foreigner syndrome, which describes the way ethnic minority members can be treated as foreign by the dominant ethnic group in a community, no matter their birthplace or citizenship. When a Japanese, Indian, or Mexican American is asked where they “really” come from, or are complimented on how they speak English without an accent, their sense of identity and belonging can be threatened as they try to reconcile their US identity with the assumptions others make about who they are. Although this can be hurtful, it also can push immigrant youth toward an ethnic identity that becomes central to a strong sense of self.
Bilingualism
As the population of immigrant children grows, so does the need to understand how to support dual-language learners (DLLs), a diverse group of children and youth either learning two languages from the start (simultaneous bilinguals) or a second language on top of a first (sequential bilinguals). Neurocognitive and psycholinguistic research has shown that children can successfully learn two languages simultaneously from birth, naturally laying down separate, but connected language systems. The basic stages of DLL language development are similar to monolinguals; however, some important distinctions have been found. Although simultaneous bilinguals may begin speaking later than monolinguals, they are not thought to have language delay. Instead, processes by which DLLs access linguistic information could explain the observations that they can lag in vocabulary and word retrieval, but match or exceed monolinguals in phonologic awareness and word decoding. Given sufficient quality and quantity of exposure, DLLs can reach native level proficiency in both languages. Evidence of cognitive and behavioral advantages also have been found among DLLs, including superior executive function, inhibitory control, task-orientation, instruction-following, and sociolinguistic awareness.
Growing research on DLL development has revealed a complex picture that shows the utility of the ecological model in considering children’s language development paths. DLLs have a wide variety of language outcomes influenced by individual characteristics; the home, school, and peer settings; the interactions between parents and school; the larger social sphere; and the timing of their exposure to a second language. Such complexity makes it unlikely that a single multilingual learning theory will be able to explain the diversity of outcomes for DLLs. Nevertheless, certain factors seem to be helpful for achieving bilingual proficiency, including individual (younger age, motivation, aptitude), family (value placed on heritage language and bilingualism; higher parental education, literacy, and socioeconomic status), and school (experienced and supportive of DLLs) characteristics. When support for bilingualism is lacking, young children may never develop proficiency in their heritage language. Older children and youth who immigrate with established heritage language proficiency may experience a subtractive process, replacing their heritage language with the new language, rather than the additive process that leads to bilingualism.
As with acculturation and ethnic identity, language gaps can form between members of immigrant families because of differences in language ability and in the value placed on heritage language maintenance. Adolescents might use the ability to speak the dominant cultural language (eg, English) to isolate parents from their activities and might refuse to speak their heritage language as a form of separation from parental authority. Conversely, shared language and cultural value in the family can offer immigrant children and adolescents the benefits of bilingualism, biculturalism, and a strong ethnic identity, and family cohesion.
Common Pitfalls for the Provider
The child development theories and immigration-related processes described above provide only a brief introduction to the challenges faced by immigrant children. A variety of other theories also can be used to understand immigrant children’s development and behavior, which is influenced by a wide range of factors not explored here. Two potential pitfalls exist for the provider: not knowing enough about immigrant children’s development, and knowing just enough to think in generalizations. Stereotyping, automatic thinking, and unconscious bias put us at risk of treating families from an unfamiliar culture too simplistically. As with all families, the best approach is to ask specific questions without assumption, based on knowledge of the questions that should be asked to those living the dynamic, multicultural reality of immigration. In this way, culturally and linguistically individualized care be given to all children, no matter their families’ origins.
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