Table 1.

Investigations and screening to consider at an initial assessment of newcomer children and youth: Comprehensive checklists and follow-up recommendations are available from

Laboratory investigations
  • CBC

  • Hemoglobin electrophoresis

  • G6PD screening (and subsequent quantitative level if screening result is positive) for patients from Africa, Asia, or the Mediterranean

  • TSH

  • Serum B12 level

  • Iron studies

  • Lead testing

  • Infectious disease testing*:

    • -Hepatitis A IgG

    • -Hepatitis B surface antigen and hepatitis B surface antibody

    • -Syphilis testing (VDRL or RPR test) in those ≥ 15 y of age or in younger children in cases of suspected congenital syphilis or suspected sexual activity or assault

    • -VZV IgG in those ≥ 13 y of age

    • -Stool ova and parasite testing (2 samples)

    • -TB testing (Mantoux skin test)

    • -Malaria smears (RDT) if febrile and from an endemic area up to 12 mo

    • -HIV serology for those from an endemic area (ie, sub-Saharan Africa, Central Asia, and the Caribbean) ≥ 15 y of age; those with an infected or deceased parent or sibling; if there is suspected sexual abuse or a history of blood product transfusion; or if the patient is not accompanied by the birth mother

    • -Hepatitis C serology if from an endemic area (ie, North Africa, Asia, the Middle East, and Europe)

    • -Strongyloides and schistosomiasis serology testing if from an endemic area (ie, Africa and Southeast Asia)

  • Consider creatinine and vitamin D levels and LFTs

Screening and focused physical examination
  • Mental health and psychosocial screening (see text for clarification)

  • Vision (includes age-appropriate visual impairment screening and assessing for strabismus and red reflex)

  • Hearing (otoacoustic emission testing)

  • Dental (includes inspection for caries and gum disease)

  • Growth (height, weight, head circumference for infants)

  • Assessment of dysmorphic features, infectious signs (eg, hepatomegaly, rashes, etc) and hallmarks of micronutrient deficiencies

  • CBC—complete blood count, CCIRH—Canadian Collaboration for Immigrant and Refugee Health, CDC—Centres for Disease Control and Prevention, G6PD—glucose-6-phosphate dehydrogenase, IgG—immunoglobulin G, IME—Immigration Medical Examination, LFT—liver function test, RDT—rapid diagnostic test, RPR—rapid plasma reagin, TB—tuberculosis, TSH—thyroid-stimulating hormone, VDRL—Venereal Disease Research Laboratory, VZV—varicella-zoster virus.

  • * Note that the IME includes a limited number of public health investigations such as TB testing. However, aside from results not being available to primary care providers in Canada, current recommendations advise repeat testing in case patients have converted or were malnourished before and thus did not mount a response.

  • Endemic regions are based on prevalence cutoffs detailed in the CCIRH guidelines; such regions might change over time.21

  • Data in this table are complementary to the CCIRH guidelines by Pottie et al.20,21 Another similar checklist is also available on the CDC website.22