Migrant children are caught in the vice-grip of a tortured political moment in the United States. This commentary is intended to elevate the precarious state of migrant children in the U.S. and contribute to a broader, long-overdue pediatric focus on children in detention.1 Specifically, this commentary is directed at protecting unaccompanied migrant children, defined as migrants less than 18 years of age who are detained without a parent or legal guardian. While most migrant children who enter U.S. detention are apprehended with their parents as part of a family unit, the focus of this discussion on unaccompanied children (UCs) reflects their special vulnerabilities and requirements for custodial care.

Almost always, UC’s enter detention soon after crossing the border, voluntarily giving themselves up to agents of the U.S. Border Patrol (BP), a component agency of Customs and Border Protection (CBP) in the Department of Homeland Security. Standards for the care of children in BP custody were first established after years of litigation by the 1997 Flores Settlement Agreement (FSA), which required that children be provided with “safe and sanitary” custodial conditions.3 However, in late 2018 and early 2019 overcrowding and the deaths of three children in BP custody led to new litigation. A settlement was reached in July 2022 which required new and much enhanced custodial standards, including the designation of Juvenile Priority Facilities (JPFs) in each of the 9 Southwest border sectors. These JPFs must provide essential child-focused supplies and services, including strengthened medical care. (See Table 1). The enhanced FSA also requires that BP deploy contracted “caregivers” to help provide direct care for young UCs and child-friendly activities and support. It also established an external, court-appointed Juvenile Care Monitor (Co-author PHW has served as the Juvenile Care Monitor since its establishment in July 2022) for a 16-month period to assess compliance with the FSA. This appointment was recently extended for at least an additional 6 months.