Background

Refugee background children/young people may have an incorrect birthdate on their visa paperwork, which becomes the basis for all the official documentation in the country of settlement. Similarly, children seeking asylum may have an incorrect birthdate on their immigration paperwork. This issue is not uncommon and may have significant effects on school placement, developmental assessment (including formal assessments such as cognitive assessment) and access to welfare, services and case management/support.

Families may be reluctant to raise this as an issue, and sometimes this is because they are worried about the implications for their migration claim/visa/citizenship. It often emerges as an issue some years after settlement. 

The reasons for an incorrect birthdate are often complex:

• The true birthdate may be unknown
• The birthdate may have been recorded incorrectly on migration paperwork (which may be completed by someone outside the family)
• Calendar discrepancies can lead to differences in recorded dates (e.g. the  Ethiopian calendar, or  Farsi calendar - also see  converter)
• Calendars may have previously not been available (e.g. in Afghanistan)
• Birthdates occasionally may been changed to due to family circumstances/conditions in country of origin (e.g. to obtain more rations for 'older' children)
• Any child with a birthdate of 1/1/(year) is almost certainly younger. The 1st of January was previously often assigned as a birthdate when the actual birthdate was unknown. Over the last few years, the 31st December has generally been used instead.

Assessment

• Use clear terminology e.g. 'paperwork birthdate' and 'stated birthdate'
• Document any existing paperwork - this paperwork is sometimes available, although may require translation. Some countries may issue 'retrospective' birth certificates (e.g. Sudan) - where paperwork is completed when the child is older (often evident in the photo) - this should be noted clearly in any summary
• Assess the family narrative, including:
  • Family report of stated birthdate
    
  • Time between marriage/start relationship and birth, birth order and ages of siblings
  • Contextual migration events, world events
    
  • School entry and expected starting age for location, years of schooling
  • Our experience has been that the narrative history of age assessment often reveals extensive prior trauma (often undisclosed) - it is important to allow enough time for assessment
• Assess the physical development narrative - pubertal growth spurt, adrenarche, menarche, family pubertal history (e.g. maternal menarche), dental eruption
• Assess the child's developmental milestones and current development/level of function. Toilet training (relatively consistent at 2-3 years in different groups), sentences (remarkably consistent before 3 years across language groups)
• Assess education history, current function and peer relationships age at which the child started school, number of years at school, years since the child left school, assess the age of friends (i.e. level of peer relationships)
• Assess child's growth and pubertal stage including height, weight, percentiles, and also check measures against median percentiles for paperwork and stated age, assess family growth patterns
• Assess the child's pattern of dental eruption - see infant/child eruption/exfoliation (Australian Dental Association) and dental eruption chart (Qld health)
• Obtain reports from other relevant sources - teachers, case workers - on maturity, problem solving, level of function, self identity
• A bone age x-ray is sometimes helpful, but does not define the child's age. They are generally used in the the specialist setting
  • Bone age x-rays provide an estimate of bone age compared to chronological age
  • The Greulich and Pyle (GP) method is used most commonly (evaluating a single frontal x-ray of the left wrist)¹ however it is essential to note:
    • The GP method is intended to assess skeletal age knowing the chronological age (not the reverse)_¹
    • The GP method is based on data from white American children from the 1930's; and considerable racial variation is found^2-4
    • The GP method is not precise, the margin of error is typically a 3-4 year range throughout childhood/adolescence¹
    • Skeletal maturity is affected by additional factors such as constitutional delay in maturation, and malnutrition 
  • Bone age x-rays are most useful in a child who is clearly many years older or younger than their paperwork birthdate.

Documentation

• It is not possible to determine age, only to assess age
• In our experience, it is helpful to write a letter clearly documenting the paperwork age, the stated age, and any supporting information (as above). This is often useful for schools while the family organise to change the birthdate through formal channels. Please see  example letter about birth date issues
• Incorrect dates of birth can be formally changed using  Form 424C under the Freedom of Information Act, through the Department of Home Affairs
• Age discrepancies can have consequences for citizenship and other official paperwork many years down the track. 

Resources

• Benson J and Williams J.  Age determination in refugee children. Australian Family Physician 2008; 37(10):821-24
• Sypek SA, Benson J, Spanner KA and Williams JL. A holistic approach to age estimation in refugee children. J Paediatr Child Health 2016; 52(6): 614-20
• Assessment of age of refugees. Letter from RACP, APEG, ANZSPR, RANZCR to Minister Chris Bowen, August 2011
• Inquiry into the treatment of individuals suspected of people smuggling offences who say they are children. Australian Human Rights Commission discussion paper. December 2011
• Assessing age for asylum applicants - United Kingdom Home Office (2011, updated 2019) - note this uses a social work based model, we suggest a comprehensive medical and developmental assessment offers additional information. 
  

References

• References

_{Immigrant health clinic resources. Initial version: Georgie Paxton. Revisions: Georgie Paxton, Daniel Engelman August 2013, reviewed May 2016, May 2019, Feb 2020. Contact: georgia.paxton@rch.org.au}