Why is it important?
The number of children forcibly displaced from their homes because of conflict, violence, and persecution is increasing globally. In the year ending December 2024 the UK received 20 899 asylum claims from young people under 18 years; 68% were aged under 14 years and 20% were unaccompanied.1
Forcibly displaced children often have poorer physical and mental health than children in the host population due to their experiences pre-, during, and post-migration. Common health problems include communicable diseases, malnutrition and micronutrient deficiencies, anaemia, musculoskeletal complaints, oral disease, and psychological disturbances.2 They are often living in vulnerable circumstances as a consequence of hostile immigration policies, poverty, poor housing, social marginalisation, and separation from their family or community. Yet, despite having greater needs, and being entitled to free NHS primary and secondary care, these children face challenges accessing quality care including: difficulties registering with a GP; language and cultural barriers; digital exclusion; inadequate provider knowledge; and health system interpersonal, institutional, and structural level racism, xenophobia, and discrimination.3
In England, unaccompanied children seeking asylum are ‘looked after children’ and should receive a statutory comprehensive initial health assessment (IHA), usually by a paediatrician, within 28 days of registering with the local authority. The young person receives a personal health plan, and necessary referrals are made to specialists, including the GP responsible for ongoing care. There is no formal pathway for asylum-seeking or refugee children accompanied by parents or family members. Their needs should be identified and addressed as part of a new patient health check when they register with a GP. This article offers the GP pragmatic approaches to assess and manage the health of refugee and asylum-seeking (RAS) children.
Facilitating access
GPs can improve primary care service access by facilitating easy and inclusive registration irrespective of immigration status, displaying posters that reassure patients that the surgery is a welcoming space, and empowering clinical and administrative staff to provide inclusive services. Doctors of the World UK offers a free ‘Safe Surgeries’ training programme for GP practices to support this.4 Refusing GP registration on the grounds of inability to provide identity documents or proof of address is against NHS policy. GP practices should work closely with housing providers, local faith leaders, support workers, and voluntary sector providers to facilitate registration.
Newly arrived migrants may struggle with making appointments. GP practices can address this by being proactive in contacting children and families, using a professional interpreter when required, and inviting them for a new patient health check. Explaining what to expect and showing care and compassion build trust. Continuation of care, for example, by the same healthcare professional, and continuity of support is crucial. Patient communications and health information should always meet language and literacy needs.
Clinical assessment
The NHS has published translated GP new-patient health questionnaires for migrant children and young people who have newly arrived in the UK. These could be completed in advance of clinical contact to increase effectiveness and efficiency of consultation time.5
It may be necessary to book longer appointments if an interpreter is required and for new-patient health checks. Only professional interpreters should be used, and patients should be given a choice whether they prefer face-to-face, telephone, or videocall interpretation. It is crucial to explain the principle of confidentiality at the start of clinical assessments to increase trust and engagement. While it is important to respect a child’s autonomy in healthcare encounters, there may be circumstances where assessing parents and children together in a longer joint appointment is beneficial and efficient.
A comprehensive physical and mental health assessment is needed, including measurement of growth and development. Guidance on health assessments of child migrants is available and includes recommendations on screening, investigations, and catch-up immunisations.6–8 Clinicians should be conscious of possible safeguarding issues (for example, physical chastisement, domestic abuse, substance use, female genital mutilation, and criminal and sexual exploitation) and seek advice as appropriate. Families should be informed of parenting expectations and child protection processes in the UK. Early-help social needs should be identified.
HEADSSS and SSHADESS (Box 1) are frameworks used in adolescent psychosocial assessments and can be applied in primary care settings. HEADSSS stands for Home, Education/Employment, Activities, Drugs, Sex, Sexuality, and Safety, while SSHADESS expands on this to include Strengths, School, and Emotions/Eating/Depression.9 SSHADESS focuses on strengths, abilities, and resilience factors such as school and peer support, and allows for integration of a trauma-informed approach making it a more appropriate tool to use with migrant young people. However, clinicians need to be wary that questions about ‘home’ may be difficult for displaced young people and could impact rapport building.
Box 1. SSHADESS consultation frameworks9
The authors propose a novel 6-step ABCDEF framework for consultations with RAS children (Box 2). Information obtained can be used to shape future consultations and to agree healthcare plans. This is not a didactic tool, but a mnemonic device designed to guide conversations to support young person-centred assessments, keep track of consultations, liaise between healthcare professionals, and check that agreed aims have been met.
Box 2. The ABCDEF framework for medical consulting with migrant young people Involvement of the wider practice team enables a multidisciplinary approach as the patient may require input from social prescribing, nursing, and social care, as well as medical input. Supporting access to nursery or school, leisure activities, promoting integration into local communities, and making young people feel safe greatly contribute to stabilising mental health. If required, children should be referred to local child mental health services.
Be trauma informed
Clinicians can help young people by creating a safe and welcoming environment, acknowledging resilience and strengths, asking for permission to discuss difficult subjects, involving the young person in decision making, and recognising the pervasive impact of trauma and the potential for it to continue post-migration.10 Clinicians should review existing clinical documents prior to the consultation to understand how psychological trauma may have impacted the young person’s health and avoid re-traumatisation during assessment.
Deliver culturally responsive and inclusive care
Different cultural health beliefs can mask the emergence of new diseases that may be overlooked and mislabelled. Professionals should seek to understand different cultural beliefs, values, and practices related to health, and suitably adapt their communication and care practices. Where possible, young people should be offered a choice in the gender of their clinician and interpreter. Culturally responsive and inclusive care necessitates that clinicians acknowledge and address their own biases. Healthcare professionals should take action to address discriminatory behaviours by colleagues and at service practice level.
Advocate
Children and families benefit greatly from the advocacy that doctors can provide, for example, supporting access to education and appropriate housing, signposting to services, and facilitating access to health services and preventive programmes (Box 3).
Box 3. Tips for GPs when consulting with refugee and asylum-seeking young people
Use the whole-practice approach to ensure accurate registration of new patients and guidance on navigating health care. Train reception staff to offer a private room for complex queries (for example, using the safeguarding room).
Always offer an interpreter if English is not a person’s first language.
Take time to build rapport and establish trust before asking sensitive questions; explain principle of confidentiality.
Use a structured trauma-informed or strengths-based consultation tool (ABCDEF: https://v0-next-js-consulting-guide.vercel.app).
Provide longer GP appointments for initial consultations or when using an interpreter.
Be aware of child migrant health guidance.6–8
Reflect on your own values, beliefs, and the potential biases, and how these may influence your clinical interactions.
Refer to organisations and agencies that can address the social determinants of health, for example, housing and financial support, access to education, and support with the asylum process.
Use social prescribing to help people to settle into a community and engage in social and wellbeing activities.
Consider the impact of religious requirements such as medication amendment for Ramadan and the impact of fasting on medical conditions. Signpost to the British Islamic Medical Association (BIMA) for advice.
Check gender preference for translated consultations.
Discuss facilitating the consultation with the young person by use of preferred appointment times to fit with school and digital modalities.
Consider the risk of digital exclusion when conducting remote consultations or using devices to facilitate care. Families may not have appropriate devices or access to the internet, and the level of familiarity or education may pose barriers. Tackle digital barriers with supply of IT kit and training by reaching out to charities such as the Good Things Foundation.
The authors have co-written a tool that may be bookmarked to assist clinicians consulting with young people and displaced people. This may be useful to prompt clinicians who infrequently consult with migrant young people. It is offered as an aide mémoire, to guide a structured consultation and reduce significant omissions. Understanding the context of the person’s journey facilitates comprehending what the person’s needs are now and plan for the future. Feedback on the use of this tool to enable consultations is welcomed; see https://v0-next-js-consulting-guide.vercel.app.
Notes
Provenance
Freely submitted; externally peer reviewed.
Competing interests
Liz Hare has had prior voluntary roles as a member of the Royal College of General Practitioners Adolescent Health Group Special Interest Group and as a case reviewer for the National Confidential Enquiry into Patient Outcome and Death. The other authors have declared no competing interests.
- Received May 9, 2025.
- Revision received June 11, 2025.
- Accepted September 25, 2025.
- © British Journal of General Practice 2025
