The largest segment of missing children are runaways and children who are told to leave home. Pediatricians play a role in helping reduce long-term health risks for those who consider running away or have already done it.
Every year, as many as 1 in 20 U.S. children and adolescents run away from home. When an adolescent leaves the home, it does not occur in a vacuum – it often occurs in the setting of a long history of trauma, family conflict, abuse and/or mental illness.
In a clinical report, the American Academy of Pediatrics (AAP) provides guidance for pediatricians and health care professionals to help identify young people at risk of running away, and to work with families to improve these children’s physical, emotional and social needs.
The report “Runaway Youth: Caring for the Nation’s Largest Segment of Missing Children,” published in the February 2020 issue of
Pediatrics is the first update to AAP recommendations since 2004. More than three decades of research has shown that runaways or “thrownaways” – children and adolescents who are asked to leave home – are at high risk for additional trauma, victimization and violence, and have unique health care needs.
"Many of these children wind up homeless and face daunting circumstances, including sexual exploitation and abuse,” said Thresia B. Gambon, MD, MPH, MBA, FAAP, coauthor of the report, which was written by the AAP Committee on Psychosocial Aspects of Child and Family Health and the AAP Council on Community Pediatrics. “The long-term health impact of these scenarios can be devastating. It is our goal to support children, keep them safe and in a stable environment.”
Several groups that are already marginalized are at particularly high risk of running away or becoming homeless, including children in protective custody, children with a history of abuse and children who identify as LGBTQ. About 20% to 40% of teenagers who are homeless identify as LGBTQ, compared with 4% to 10% of their non-homeless peers. LGBTQ youth report higher rates of survival sex, substance use and victimization, research has shown.
The clinical report discusses how technology and social media influence the experiences of runaway youth. Though there are some risks associated with social media use, technology is also credited with offering opportunities for intervention, such as research into connecting with the difficult-to-reach populations of homeless youth who are risk for commercial sexual exploitation.
AAP recommends that clinicians:
Conduct a thorough, confidential social history including questions regarding their daily environment and activities, including home, school and friends, with all adolescents.
Ask if teens have sources of support, and if they can identify an adult that they can confide in.
Support and maintain awareness of local and national resources for runaways and share them with youth and families.
If an adolescent is believed to be at risk for running away or has run away before, discuss a safety plan for the future, including options for safe housing and access to sexual health services and mental health care.
Recognize and provide support for specific populations at high risk for running away or being asked to leave home, including abuse and neglect victims, youth in protective custody, children who identify as LGBTQ, and children with mental health or substance use disorders.
“All children need to feel safe and reassured in their homes and know where to find help if they need it,” said Janna R. Gewirtz O’Brien, MD, FAAP, coauthor of the report. “The pediatrician can offer a voice of compassion and support, foster positive relationships among families that are struggling, and connect children and families to community resources.”
Additional Information from HealthyChildren.org: