Age assessment practices: a literature review & annotated ... - Unicef

and Goldberg from the „Droit et Ethique de la Sante‟ state that numerous experts agree that
it is impossible to conclude chronological age from bone age (Eizenberger 2003).
Dental age assessments are known to be carried out in Europe in Sweden, Portugal,
Poland, Italy, Germany, France, Finland, Czech Republic, Belgium, Austria and the USA
(European Migration Network, 2010). Dental examinations and x-rays are also frequently
used by the Immigration and Naturalisation Service (INS) in the USA as method of age
assessment, with reports of one dentist examining 1,500 young people in New York City
alone. There is significant concern about the reliance on this process among activists,
advocates and medical experts, who have criticised the federal government‟s reliance on
age testing and emphasized the inaccuracy of this form of assessment;
“A fundamental concept is being ignored in the current INS approach to „age testing‟:
chronological age, dental age and skeletal (bone) age are not necessarily the same in a
given individual. In fact, deviation among these three „ages‟ is common and well
appreciated in paediatric medical and dental practice. Discrepancies among these ages can
amount to as much as five years; this is substantial when one is considering a span as short
as the first two decades of life.” (Ferraro, INS Public Comment in Physicians for Human
Rights et al, 2003:131)
Despite the limitations and concerns associated with both dental and bone x-ray age
assessment, the UK Home Office has indicated a significant shift in policy, moving from
guidance which stated that „under no circumstances should a caseworker suggest that an
applicant should have x-rays for this purpose‟ (Einzenberger, 2003:37) to an indication that it
intends to make much greater use of dental development x-rays where there is a reasonable
doubt about the claimed age. In a consultation document, the Home Office states (but does
not reference the sources of the claims) that „there does appear to have been more recent
research that indicates x-ray analysis (of the teeth and collar and wrist bones) can be a
more reliable means of determining age than was once thought. That is certainly the belief
of some EU Member States, who regularly use the techniques for immigration purposes‟
(Home Office, 2007 in Crawley, 2007:35). In response, the former Children‟s Commissioner
for England, a qualified paediatric endocrinologist, has been considerably outspoken in
raising his concerns about the use of dental or skeletal x-rays to determination chronological
age, describing them as inaccurate, unethical and potentially unlawful. 4
In addition to criticism already noted, the European Society for Paediatric Endocrinology has
stated that „dental and skeletal maturity cannot be used for the assessment of chronological
age in children,‟ and recommends that assessments are made by interviewers who know
the language and country of origin of a child; 5
4 See letter dated 06/08/09 to Save the Children Brussels, re Brussels conference on separated children in EU
policy
5 Letter dated 10/11/2007 to Professor Sir Albert Aynsley-Green, the Children’s Commissioner for England re
The inappropriate use of ‘medical examinations’ to assess the age of children seeking asylum in European
countries
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