Department of Homeland Security

Office of Inspector General 

Age Determination Practices for Unaccompanied 


Alien Children in ICE Custody 


OIG-10-12 November 2009 
Office of Inspector General 

U.S. Department of Homeland Security 

Washington, DC 20528 

 November 10, 2009 

Preface 

The Department of Homeland Security (DHS) Office of Inspector General (OIG) was 

established by the Homeland Security Act of 2002 (Public Law 107-296) by amendment 

to the Inspector General Act of 1978. This is one of a series of audit, inspection, and 

special reports prepared as part of our oversight responsibilities to promote economy, 

efficiency, and effectiveness within the department. 

This report addresses Immigration and Customs Enforcement’s practices for determining 

the age of individuals in its custody, focusing on the use of dental or skeletal radiographs. 

It is based on interviews with employees and officials of relevant agencies and 

institutions, direct observations, and a review of applicable documents. 

The recommendations herein have been developed to the best knowledge available to our 

office, and have been discussed in draft with those responsible for implementation. We 

trust this report will result in more effective, efficient, and economical operations. We 

express our appreciation to all of those who contributed to the preparation of this report. 

Richard L. Skinner 


Inspector General 

Table of Contents/Abbreviations 

Executive Summary.............................................................................................................1
 

Background..........................................................................................................................2
 

Results of Review ................................................................................................................7
 

ICE Needs to Record and Track Age Determination Data............................................7 


ICE Recognizes Limits of Radiography for Age Determinations ...............................10 


Management Comments and OIG Analysis ................................................................20 


Appendices 

Appendix A: Purpose, Scope, and Methodology.......................................................22 


Appendix B: Management Comments to the Draft Report.......................................23 


Appendix C: Major Contributors to This Report ......................................................25 


Appendix D: Report Distribution ..............................................................................26 


Abbreviations 

A-file Alien File 

CBP United States Customs and Border Protection 

DHS Department of Homeland Security 

DIHS Division of Immigration Health Services 

DRO Office of Detention and Removal Operations 

ENFORCE Enforcement Case Tracking System 

FY fiscal year 

HHS Department of Health and Human Services 

ICE United States Immigration and Customs Enforcement 

INS Immigration and Naturalization Service 

JFRMU Juvenile and Family Residential Management Unit 

ORR Office of Refugee Resettlement 

PHS United States Public Health Service 

TAR Treatment Authorization Request 

TVPRA Trafficking Victims Protection and Reauthorization Act of 2008 
 

OIG
 

Department of Homeland Security 

Office of Inspector General 

Executive Summary 

The Department of Homeland Security Immigration and Customs 

Enforcement enforces United States immigration law by 

apprehending, detaining, and deporting individuals who are not 

authorized to remain in the country. Children are sometimes among 

those encountered, and the Department of Homeland Security must 

ensure that they are not detained with unrelated adults. 

To separate unaccompanied children from detained adults, the 

Department of Homeland Security attempts to establish the date of 

birth of anyone it cannot readily identify as an adult or child. 

Immigration officials collect information on possible juveniles to 

ascertain their correct ages. Information may include professional 

opinions based on dental or skeletal radiographs. However, the use 

of radiographs to determine chronological age—age from a 

person’s date of birth—has been criticized by some in the medical 

and advocacy communities as unreliable. 

We reviewed Immigration and Customs Enforcement’s approach to 

age determinations at the request of the House Appropriations 

Committee. In House Report 110-862, the committee said that the 

department had “not ceased its reliance on bone and dental 

forensics for child age determinations, as directed” in a previous 

report. In its request, the committee asked us to report on any 

cases in which Immigration and Customs Enforcement used bone 

and dental forensics in 2008 or 2009. 

Immigration and Customs Enforcement does not track age 

determination data; therefore, we were unable to identify all cases 

where it used radiographs for age determinations. Based on 

interviews with officials, and our review of selected files and 

guidance, we concluded that Immigration and Customs Enforcement 

recognizes the limits of radiographs and strives to obtain additional 

information when making age determinations. We are making 

recommendations to track age determination data better, update 

guidance for field offices, and ensure that radiographic exam results 

include all required information and are properly documented. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

Page 1 
Background 

The Department of Homeland Security’s (DHS) Immigration and 

Customs Enforcement (ICE) enforces United States immigration 

law by apprehending, detaining, and deporting individuals who are 

not authorized to remain in the country. Children apprehended by 

ICE require different treatment than adult detainees. 

Unaccompanied alien children—individuals less than 18 years of 

age who are unlawfully in the United States without a parent or 

other legal guardian—must be transferred to the Department of 

Health and Human Services (HHS), Office of Refugee 

Resettlement’s (ORR) custody to await deportation or transfer to a 

legal guardian in the United States.1 

To separate unaccompanied children from adults, ICE attempts to 

establish the date of birth for any apprehended person not readily 

identifiable as an adult or child. ICE uses various forms of 

information for age determination purposes, including interview 

statements and documentation such as birth certificates. When 

ICE has difficulty determining whether an individual is a child or 

an adult, it may also obtain a professional medical opinion based 

on dental or skeletal radiographs, commonly referred to as x-rays, 

to help make a determination. ICE’s use of radiographs, however, 

has been criticized by some in the medical and advocacy 

communities as unreliable. 

Legal Guidance on Unaccompanied Alien Children 

Since 1997, ICE and its precursor, the Immigration and 

Naturalization Service (INS), have been bound by the Flores 

Settlement Agreement. This agreement between the Department of 

Justice and a coalition of immigrants’ rights groups established 

guidance on the treatment of minors in the custody of immigration 

officials. It also recognizes the particular vulnerability of minors 

and states that immigration officials will hold minors separate from 

unrelated adults. The agreement stipulated 3 to 5 days for the 

transfer of juveniles to a licensed juvenile shelter. 

While the INS maintained its own program for housing juvenile 

aliens, the Homeland Security Act of 2002 transferred 

responsibility for housing unaccompanied alien children from the 

INS to HHS ORR. ORR places unaccompanied alien children in 

juvenile facilities and foster care homes for the duration of their 

1 Homeland Security Act of 2002 (Public Law 107-296) November 25, 2002. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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immigration proceedings, or until they can be reunited with 

appropriate guardians in the United States. 

Because unaccompanied children must be placed in separate 

facilities from adult detainees, an incorrect age determination may 

result in violating the Flores Settlement Agreement. While no 

statute or regulation describes an exact procedure for establishing 

an individual’s age, the Flores Settlement Agreement instructs that 

if a “reasonable person” would conclude that an alien detained by 

immigration officials is an adult, despite his or her claim to be a 

minor, the individual shall be treated as an adult. The Flores 

Settlement Agreement also provides that immigration officials may 

require an alien to submit to a medical or dental examination 

conducted by a medical professional, or to other appropriate 

procedures, to verify his or her age. 

In December 2008, Congress provided direction for developing 

age determination procedures in the William Wilberforce 

Trafficking Victims Protection and Reauthorization Act of 2008 

(Public Law 110-457), also known as the TVPRA. Effective 

March 23, 2009, the TVPRA required HHS to develop procedures 

for making a “prompt determination of the age of an alien” in 

consultation with DHS. According to the TVPRA, both DHS and 

HHS must use these procedures. While it did not specify which 

methods to use in the age determination process, the TVPRA 

established a minimum requirement that the government’s 

procedures take into account multiple forms of evidence, including 

the nonexclusive use of radiographs for age determinations.2 

Apprehension and Detention of Unaccompanied Alien Children 

ICE’s Office of Detention and Removal Operations (DRO) is 

responsible for managing immigration cases for juveniles and 

adults. At the headquarters level, DRO’s Juvenile and Family 

Residential Management Unit (JFRMU) manages policy for alien 

juveniles and families, and provides related oversight and support 

for ICE’s field offices. 

At the field level, ICE agents and officers encounter 

unaccompanied alien children in various ways. Unaccompanied 

alien children may be encountered and detained by ICE agents and 

officers participating on fugitive operations teams, or through 

enforcement actions undertaken by ICE’s Office of Investigations. 

2 William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 (Public Law 110-457) 

December 23, 2008. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Unaccompanied alien children are also encountered and detained 

by local police departments, which notify the local ICE office. 

ICE field offices also reach out to local detention facilities through 

the Criminal Alien Program, which aims to identify and deport 

incarcerated criminal aliens after completion of their sentence. 

After apprehending an alien, ICE agents and officers collect and 

document available biographical information before placing 

juveniles and adults in appropriate facilities. 

U.S. Customs and Border Protection (CBP) also apprehends 

unaccompanied alien children. Like their counterparts at ICE, 

CBP agents and officers typically bear responsibility for 

conducting initial interviews with the individual and gathering 

basic biographical information to determine whether an individual 

is a juvenile or adult. ICE assumes responsibility for effecting all 

deportations from the United States and maintains an Alien File 

(A-file) to document pertinent biographical and legal information 

on each alien it detains. 

Age Determinations 

The need to verify a detained individual’s age can arise at any 

point between his or her apprehension to release from custody. 

Figure 1 identifies three typical scenarios during an alien’s 

apprehension and detention when age-related information is 

gathered and age determinations are made. 

In figure 1, the first scenario occurs at point A when DHS initially 

apprehends an alien. DHS officers and agents make placement 

decisions based on whether an alien entering DHS custody is a 

juvenile or an adult. In some cases, however, it may not be readily 

apparent whether an individual is a juvenile or an adult. In these 

instances, the apprehending officer typically takes additional 

measures to determine an individual’s age, guided by the 

“reasonable person” standard articulated in the Flores Settlement 

Agreement, along with specific agency guidance. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Figure 1. Age Determinations in DHS and HHS Custody 

Source: Interviews with field staff 

Under the second scenario, at point B in figure 1, officers make a 

more explicit age determination when an individual already 

detained in an adult detention facility claims to be a juvenile. In 

this case, facility personnel separate the individual from the 

detained adult population until ICE can acquire additional 

information to ascertain the individual’s date of birth. 

Point C in figure 1 depicts the third scenario, in which an 

individual in a juvenile shelter is suspected of being an adult, either 

because of his or her own statements or through research by shelter 

staff. In these cases, the shelter’s staff is responsible for verifying 

the individual’s age. ICE accepts individuals who are determined 

to be adults into one of its adult detention facilities, provided the 

shelter staff supply documentation of the alien’s age; juveniles 

remain in the shelter. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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The Role of Radiographs in Age Determinations 

Without clear evidence indicating whether a person is either an 

adult or juvenile, ICE agents and officers may obtain the results 

from a dental and skeletal radiograph to assist with an age 

determination. A medical professional examines skeletal or tooth 

development as depicted on a radiograph and estimates the 

individual’s chronological age, or age from date of birth. In the 

case of dental radiographs, dentists usually make assessments 

based on the development of an individual’s third molars, or 

wisdom teeth, in both the upper and lower jaws. For skeletal 

radiographs, the examiner makes an age estimation based on bone 

development in the hand and wrist area. 

Using radiographs of a person’s bones or teeth, however, cannot 

produce a specific age due to a range of factors affecting an 

individual’s growth. These include normal biological variation, as 

well as cultural and ethnic differences. The timing of puberty, diet, 

genetics, health, and geography can also affect tooth and bone 

development. We spoke with a pediatric physician who said that 

abuse and torture can affect bone growth as well. 

Historically, the use of radiographs for age determinations has 

drawn upon research dating back to the 1930s and 1940s on bone 

growth in juveniles. Early studies, however, involved ethnically 

homogenous populations. Used in the context of immigration, 

where agencies encounter a variety of ethnicities, such limited 

studies do not adequately represent the individuals whose ages 

must be verified. More recent work, cited by some medical 

professionals we spoke with, has begun to account for ethnic 

variations in bone and tooth development. 

Although the Flores Settlement Agreement permits “medical or 

dental” examinations, some advocacy groups have opposed the use 

of dental and skeletal radiographs as part of an age determination, 

arguing that the results are not reliable and could lead to 

individuals being inappropriately assigned to adult facilities or 

juvenile shelters. Reports released by the House Appropriations 

Committee express similar concerns. 

Alternative Approaches to Age Determination 

In an earlier report, the House Appropriations Committee 

suggested that ICE employ “holistic age-determination 

methodologies” when assessing the age of those in its custody. 

The TVPRA, however, does not require the adoption of such an 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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approach; nor does instruction released in March 2009 by HHS 

define or elaborate on what constitutes a holistic approach to age 

determinations. As part of our review, however, we attempted to 

discover what such an approach might consist of and what efforts 

ICE made in response to the committee’s direction. 

We could not identify a single, authoritative definition of what 

might constitute a holistic approach to age determination. Medical 

professionals we spoke with, including representatives of medical 

centers and universities as well as immigrants’ rights advocates, 

were not aware of a specific holistic approach to age 

determinations. Several individuals in the medical community 

noted that psychological testing of individuals to determine exact 

age would be difficult. Some appeared to favor measuring 

biological factors over psychological testing, as the latter is more 

difficult to do and is even less predictable. 

ICE indicated that it had studied the matter as well. Responding to 

congressional concerns, ICE stated that little information is 

available on a single, authoritative holistic method and it did not 

find people properly credentialed to perform such assessments. 

ICE further stated that despite extensive research, it did not find a 

standard or precise process or technique for conducting holistic age 

determinations. 

Results of Review 

ICE Needs to Record and Track Age Determination Data 

Due to limitations in the data maintained by ICE regarding age 

determinations, we were unable to ascertain how often ICE had used 

radiographs to determine an individual’s age. ICE does not collect 

information on the number of radiographs taken to help make an age 

determination, or on the number of times a determination had been 

reversed. The only information ICE could provide on age determinations 

was the number of times its field offices formally requested to use 

radiographs for age determination purposes. Headquarters officials we 

spoke with at ICE said that the agency plans to update its information 

systems to collect more data on age determinations. Such a step can help 

ICE monitor and evaluate its use of radiographs in better assessing age. 

ICE Does Not Track Radiographic Examinations 

ICE was unable to provide data showing the number of individuals 

who underwent a radiographic examination from the beginning of 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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FY 2008 to April 2009. However, JFRMU officials said that this 

number is historically low. We also spoke with field office 

juvenile coordinators—DRO field personnel who oversee juvenile 

cases within a particular geographic area— who provided 

estimates of how many radiographs were taken in a given year for 

age determination purposes. Many juvenile coordinators indicated 

that radiographs were rare, commenting that they had not been 

aware of any radiographs performed in the past 2 years. A few 

indicated that a dental radiograph might occur as often as 2 to 5 

times per month in their geographic area of responsibility. 

The Division of Immigration Health Services (DIHS) provided us 

with the number of requests for a radiograph for an age 

determination. Field personnel submit Treatment Authorization 

Requests (TARs) to DIHS for health and medical services for 

detained aliens, including radiographs for age determinations. 

Information provided by DIHS showed that 258 radiograph 

requests were received from the beginning of FY 2008 to April 14, 

2009. These requests covered 248 individuals, including 178 

individuals in FY 2008 and 70 individuals through April of 

FY 2009. The remaining 10 TARs were either duplicates or 

requests for a second exam. 

We were unable to rely on TAR figures to determine the exact 

number of radiographic exams performed for age determinations 

for two reasons. First, when field personnel submit a TAR for a 

radiograph, there is no assurance that a radiograph is actually 

taken. Of 89 alien files that we reviewed for individuals who were 

the subject of the TARs previously described, 40 files did not 

contain evidence of a radiograph.3 Field office juvenile 

coordinators cited examples of exam that were requested but not 

carried out because they were able to verify age by other means, 

such as a birth certificate. 

Second, while ICE officials said that field personnel are supposed 

to request radiographs for age determinations through DIHS, this 

does not always occur. DIHS officials agreed that requests might 

not be submitted in all cases and noted that access to TARWeb, the 

information system through which TARs are submitted, is limited. 

While most juvenile coordinators we spoke with were aware of 

either the TAR process or the need to request approval, several 

field office juvenile coordinators were unaware of the TAR 

3

 The 89 files were drawn from archives at the National Records Center based on the age-related 

information within each file. The sample is not representative and cannot be generalized to the detained 

population as a whole. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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process and indicated that notice of a radiographic exam being 

scheduled is not forwarded beyond their field office. 

ICE Does Not Track Age Determinations That Were Reversed 

ICE could not account for the number of instances an age 

determination had been reversed, either correcting an instance in 

which an adult had been classified as a child or a child had been 

classified as an adult, or the number of times an age determination 

has been appealed. 

Field office juvenile coordinators provided informal estimates on 

how many reversals they generally see in a given year. Of the 21 

juvenile coordinators we interviewed, 12 indicated that they were 

familiar with instances in which a juvenile had been placed in an 

adult facility or an adult in a juvenile shelter. The frequency with 

which such inappropriate placements are identified ranged by field 

office, from twice over three years to about three times per week, 

according to the officers. Other officers we interviewed were not 

sure of the number or told us that they were unaware of any 

instances when this occurred. 

ICE Has Initiated Efforts to Increase Collection of Age 

Determination Data 

ICE officials informed us that they plan to address limitations in 

the agency’s ability to collect age determination data. Specifically, 

JFRMU is pursuing modifications to ICE’s primary administrative 

case management system, the Enforcement Case Tracking System 

(ENFORCE), to help the agency track age determinations better in 

the future. Among the fields, it requested an entry to account for 

whether ICE field personnel requested a radiographic exam. 

JFRMU understands that these fields will be incorporated in an 

updated version of ENFORCE, due in December 2009. 

Conclusion 

ICE reporting and management activities could benefit from the 

ability to track and assess information pertaining to age 

determinations centrally, including (1) the frequency of dental or 

skeletal radiographs, (2) instances in which an initial age 

determination and placement by DHS has been reversed, and 

(3) information used to support the reversal. This type of 

information will help ICE identify how often radiographs are used 

in the field, as well as gauge their contribution to the age 

determination process. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Recommendation 

We recommend that the Assistant Secretary for U.S. Immigrations 

and Customs Enforcement: 

Recommendation #1: Continue to enhance JFRMU’s ability to 

collect and analyze data on the use of radiographs for age 

determinations. At a minimum, enhancements should provide 

JFRMU with the ability to track (1) the number of radiographs 

taken for age determinations, (2) date and results of the exam, and 

(3) age determinations and placement decisions that were later 

reversed. 

ICE Recognizes Limits of Radiography for Age Determinations 

The House Appropriations Committee expressed concern that ICE was 

relying on radiographs for age determinations for aliens in its custody, and 

questioned the reliability of radiographic evidence that ICE uses when 

determining whether an individual is an adult or juvenile. Advocacy 

groups have made similar assertions and expressed concern that children 

or adults may be placed in inappropriate facilities. 

Medical professionals we spoke with expressed skepticism that a 

radiographic exam could be used to discover specifically whether an 

individual has attained 18 years of age. However, they did generally agree 

that radiographic exams could provide a usable age range. 

ICE recognizes the limits of radiographs as a precise indicator of age and 

in 2004 issued guidance on age determinations for custody decisions. This 

guidance, which is still in use, directed officers not to base age 

determinations solely on radiographs, but to consider the totality of 

available evidence. ICE’s guidance cautions field offices about the 

variability of results from radiographic exams when used for age 

determinations. This guidance also notes many of the same factors 

affecting radiographic exam reliability that medical practitioners brought 

to our attention, including normal biological variations, nutrition, race, 

ethnicity, geographic location, socioeconomic status, and variations in 

interpreting radiographic exam results. 

Evidence Used in Age Determination Cases 

ICE’s 2004 guidance identifies a range of information sources that 

field officers may use to determine whether an individual is an 

adult or a juvenile, including results from radiographic exams. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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According to ICE’s guidance, sources of information that can help 

establish whether an individual is a juvenile or adult include the 

following: 

•	 Statements made by the alien, or by another individual with 

personal knowledge of the alien’s age, 

•	 Information or records from federal, state, local, or foreign 

government agencies, 

•	 Documentation that can credibly establish date of birth, 

•	 Results of dental or wrist bone radiographs conducted by an 

expert, and 

•	 Assessments of the alien’s physical appearance and behavior. 

To assess the types of evidence that ICE uses in addition to 

radiographs for age determination purposes, we reviewed a sample 

of 89 A-files for which a radiograph had been requested. Of the 89 

A-files that we reviewed, 49, or 55%, included evidence that a 

radiograph had been performed. Based on our file review and 

interviews with field staff, we conclude that ICE acquires multiple 

forms of available evidence, including radiographs, to help 

establish an alien’s age in borderline cases. 

Initial Evidence Used to Determination Age 

During an apprehension, the arresting officer determines whether 

the individual is a juvenile or adult based on statements made in an 

interview, the alien’s physical appearance, and any documents the 

alien might be carrying. Information acquired during interviews is 

recorded on ICE’s form I-213, Record of Deportable/Inadmissible 

Alien. This information often plays a significant role when 

assessing whether someone is an adult or child. Juvenile 

coordinators we spoke with commented that appearance is a factor 

in an officer’s determination; however, we noted minimal 

documented evidence that appearance was used as a factor during 

our file review. 

ICE officers also check government records for biographical 

information, which is a useful step when records on the detained 

individual exist and the information is accurate. However, juvenile 

coordinators said that in most cases, juveniles do not have existing 

records since it is their first time attempting to cross into and 

remain in the United States. 

In the absence of contradictions in age determination documentation 

and other related evidence, ICE holds adults in its detention facilities 

and transfers juveniles to juvenile shelters identified by HHS ORR. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Additional Evidence Used in Age Determination Cases 

Age is more difficult to determine in certain instances, specifically 

when an individual’s appearance does not closely reflect his or her 

actual age. Medical professionals we interviewed said that both 

adults’ and children’s physical appearance and behavior can vary 

widely based on several factors, including physical and emotional 

maturity, exposure to climate, work and life experiences, and 

trauma. A representative from HHS agreed with this assessment, 

noting that individuals’ appearance and behaviors can be subject to 

malnutrition, work experience, and trauma. 

In these cases, interview statements and appearance or behavior are 

not always sufficient. Juvenile coordinators told us of instances 

where detained aliens had initially provided inaccurate dates of 

birth to apprehending officers. Juvenile coordinators said that 

sometimes smugglers direct aliens to claim that they are older, or 

children will lie about their age so they can stay with adults with 

whom they were apprehended. 

When arresting officers question an alien’s claim as being an adult 

or juvenile, or an individual detained in an adult facility claims to 

be a juvenile, ICE officers must seek other forms of evidence to 

establish his or her actual date of birth. In these cases, additional 

information may include results from radiographic examinations; 

further interview statements from the alien or others; 

documentation from the alien’s family or home country consulate; 

other forms of input from the alien’s home country consulate; and, 

any combination of these or other credible sources. 

During our file review, we noted instances where a detained alien’s 

date of birth recorded after initial apprehension did not match their 

date of birth on a birth certificate or other formal document. In 

these cases, the apprehending officer obtained an incorrect date of 

birth for an alien, which may have contributed to their initial 

placement. 

Radiographs 

Most juvenile coordinators we interviewed said that radiographs 

are used as a last resort when ICE may question an alien’s claim of 

being a juvenile but cannot acquire other information to make an 

appropriate age determination. ICE officials explained that 

requested birth certificates may arrive late, and sometimes not at 

all. While some juvenile coordinators said that their field offices 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

Page 12 
do not use radiographic exams, others indicated that a radiographic 

exam is used when ICE must verify age in the absence of requested 

documentation or other credible information. 

One advantage of using radiographs is that they can be completed 

quickly. A comparison between the requested dates for 

radiographs and the actual examination, when such a comparison 

was possible, showed that for 42 of the 49 cases in our sample, the 

radiographs took place on average within 1 day of the request. In 

two of those cases, radiographs were conducted before the requests 

were submitted, suggesting that ICE officers may seek approval 

retroactively. This fast turnaround can be an important advantage 

given ICE’s time constraints and when other age-related 

information is not forthcoming. Officials in DRO and DHS’ 

Office for Civil Rights and Civil Liberties noted that the Flores 

Settlement Agreement time constraints create pressures on ICE to 

make age determinations as soon as possible. Juvenile 

coordinators indicated that radiographs can be done within a short 

timeframe. 

Information From Other Individuals 

ICE officers also make efforts to acquire information on an alien 

from others with whom the individual was apprehended. Some 

individuals have contact information for family in the United 

States. In these cases, ICE can attempt to contact relatives to seek 

confirmation of the individual’s age, as well as start to identify 

legal guardians. 

Documentation 

In practice, ICE officers indicated a preference for credible 

documentation to establish date of birth. Examples of these 

documents include birth certificates, identity cards, school and 

baptismal records, passports, and other travel documents. 

Officers attempt to obtain documentary evidence from the aliens, 

their families, or their home country consulate. Documentation 

attesting to the alien’s date of birth was included in 32 of the 49 Afiles with evidence of radiographs. 

Consular Involvement 

An ICE officer’s contact with consulates can be helpful in 

establishing an individual’s age. Consulates have some ability to 

provide or verify documentation and confirm information 

previously provided to ICE. They can also acquire and verify 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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information through their interviews with detained aliens. 

Consulates can also compare an alien’s biographical information to 

records in their data systems to verify information provided to ICE. 

Juvenile coordinators agreed that consulates tend to be very 

responsive to juvenile cases; however, their response times varied 

by case. Overall, juvenile coordinators said that ICE officers 

contact consulates regularly as they attempt to acquire additional 

information about a potential juvenile. Documented involvement 

by the alien’s home country consulate was included in 23 A-files 

that also had radiographs. 

Figure 2 shows the different combinations of information 

contained in the 49 A-files that also contained results from a 

radiograph. 

Figure 2. A-Files with Evidence of a Radiograph 

Source: A-file review and OIG Analysis 

ICE Needs to Provide Instructions to Field Offices for 

Implementing HHS Guidance 

The TVPRA provided DHS and HHS with direction for 

developing procedures for age determinations. In addition to 

charging HHS with the development of procedures for making age 

determinations in consultation with DHS, the TVPRA permits the 

nonexclusive use of radiographs for age determinations. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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In response to the TVPRA, HHS released program instruction on 

age determinations in March 2009. As of September 2009, this 

guidance had been signed by the acting director of ORR. Before 

releasing its own updated field guidance, however, ICE indicated 

that it is awaiting the release of HHS’ finalized policy on age 

determinations. 

HHS’ guidance contains the essential elements of ICE’s 2004 

policy in that DHS and HHS will use documentation, statements 

from the alien and other individuals, record checks, and bone or 

dental examinations as part of the age determination process. 

Compared with ICE’s 2004 guidance, however, HHS’ procedures 

limit the types of people who can provide statements on an alien’s 

age to the alien, the alien’s parents, and those encountered with the 

alien.4 The standard in ICE’s 2004 guidance is broader, directing 

officers to consider statements from those with a personal 

knowledge of the alien’s age that the ICE officer concludes can 

credibly attest to the age of the alien. 

Another significant difference is that HHS’ guidance does not 

include appearance or behavior as criteria for evaluating whether 

an individual is an adult or juvenile, but instead lists appearance as 

a challenge to the age determination process. It identifies 

additional challenges as diminished mental capacity, contradictory 

or fraudulent documents and statements, and unavailable 

documentation on date of birth. 

ICE’s 2004 guidance does comprehensively address the uses and 

limitations of radiography for making age determinations, 

something HHS’ program instruction excludes. HHS also includes 

a requirement on the use of radiographs as a last resort and only 

when other information listed in the guidance is not available. It 

also instructs those using radiographs to favor determining the 

alien to be a minor if the results are ambiguous. 

Figure 3 offers a basic comparison of elements of ICE’s 2004 

HHS’ 2009 policies. 

4

 HHS also allows sworn affidavits from parents or other relatives if the alien is already in HHS custody. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Figure 3. Information Used in Age Determinations 

Source: OIG Comparison of ICE DRO and HHS ORR policy documents 

While these policies are similar in most respects, it is important for 

ICE to release updated instructions to field officers that clarify 

ICE’s post-TVPRA approach to age determinations and conform to 

HHS’ guidance. In particular, field offices should receive 

instruction on the role that appearance and behavior play in 

considering whether an individual should be placed as an adult or 

juvenile, as well as the types of individuals who can provide 

information on a detained alien’s age. Procedures for handling 

individuals suffering from mental disabilities would aid field 

personnel when faced with such a scenario. ICE should also 

address the important role consulates can play for helping to 

establish the age of individuals in custody, when such a step would 

not adversely affect the alien. 

Conclusion 

Based on our review of specific documentation and interviews 

with relevant officials, we conclude that ICE officials maintain a 

keen awareness of the limitations of radiography and a preference 

for establishing age by other means. 

Legal requirements to place all unaccompanied juveniles in HHS 

custody make the timing of age determinations critical. ICE does 

not, however, immediately or simultaneously receive all the 

information mentioned. The A-files we reviewed did not 

document the decision process used by ICE to determine age, or 

the specific information and evidence that contributed to the age 

determination. In some files, officers included a “note to file” 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

Page 16 
marking the date an age determination was made, the result, and 

the information used to reach a decision. This is a commendable 

best practice by some field personnel that ICE should consider 

adopting on a more widespread basis. 

Recommendation 

We recommend that the Assistant Secretary for U.S. Immigrations 

and Customs Enforcement: 

Recommendation #2: Update and release guidance that clarifies 

how DRO field offices are to conduct age determinations 

following the TVPRA based on HHS’ guidance. ICE’s field 

guidance should be consistent with HHS’ procedures, address 

challenges, identify best practices for establishing age, and include 

requirements for documenting the age determination process. 

Radiographic Exam Results Need to Be Properly Documented 

ICE officers rely on the medical professionals who conduct 

radiographic exams to interpret exam results. ICE requires medical 

professionals who conduct radiographic exams to complete and 

return a two-page worksheet. The worksheet includes entries for 

information such as (1) whether the examined individual is 18 years 

or older; (2) the medical professional’s degree of certainty regarding 

the age determination, which should be in the form of a percentage; 

(3) an explanation of the medical professional’s conclusion; and 

(4) the research and materials that formed the basis for their 

conclusion. It requires a practitioner to indicate whether he or she is 

a physician, dentist, or forensic anthropologist. ICE also permits 

practitioners to generate their own report. 

ICE uses these worksheets and reports to help make and document 

its age and custody determinations. Therefore, it is important that 

worksheets (1) not oversimplify or overstate the results of a 

radiographic exam, (2) are based on up-to-date scientific research, 

and (3) identify underlying reference materials and any limitations 

of the materials or methods used. Age estimation reports that 

consistently provide ICE with such information can help ICE 

officers weigh the results of a radiographic exam alongside 

additional evidence. 

The quality and extent of documentation ICE receives on 

radiographic exam results varies. Most radiographic reports that 

we reviewed included a combination of data such as an average 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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age for individuals with equivalent tooth development as the 

subject, an age range or standard deviation, and a percentage 

probability on whether the individual had attained his or her 18th 

birthday. Specific medical professionals who provided multiple 

reports to ICE reported results in a consistent format; however, the 

providers differed among themselves on the types of data provided 

to ICE, and the presentation format. Some used ICE’s worksheet 

while others did not. Some providers furnished an age range while 

others included the average age of individuals with equivalent 

development and the probability that the individual had attained 18 

years of age. In several cases, the provider furnished minimal 

information other than the estimated age and the degree of 

certainty in that conclusion. 

Radiographic exam reports prepared by medical professionals also 

do not always include full reference information regarding the 

specific studies used as a basis for their age determination, which 

is a requirement in ICE’s 2004 guidance. In our sample of A-files, 

professionals who provided information cited three separate 

sources, but provided a full citation from only one case. In another 

instance, one dentist consistently cited a study based on white 

males and females, even though subjects of the age determinations 

appeared to be Hispanic. 

ICE needs to ensure the quality of its radiographic exam results by 

obtaining the citations for studies that physicians used to determine 

age. By receiving more complete information on the type of study 

used to make an age estimation, the underlying scientific data and 

methods that support its age determination can be based on more 

current research and reflect the appropriate ethnicity of the 

individual. 

ICE Needs to Prioritize Use of Providers with Specialized 

Experience 

ICE’s approach for selecting physicians to conduct radiographic 

exams for age determinations is inconsistent. ICE’s 2004 guidance 

requires field offices to consult with Public Health Service (PHS) 

staff when selecting a medical professional to conduct a 

radiographic exam. In practice, most juvenile coordinators we 

spoke to said that they schedule appointments for dental radiographs 

with the same dentists used by their predecessors. Field office 

juvenile coordinators did not know how professionals were initially 

selected and were unaware of any list of practices that ICE or PHS 

had released to the field. Some juvenile coordinators added that if 

they needed a dental radiograph, they chose providers based their 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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proximity to the office. Other coordinators said that they consulted 

a supervisor, headquarters, or PHS staff in their area to find a dentist 

to conduct an exam. Some juvenile coordinators we interviewed 

were not sure whether to seek providers with a specific certification, 

or what certification or specialty would be most useful. One 

suggested a pediatric dentist might be best; others said that a 

forensic dentist is preferable. 

Professional certifications in forensic dentistry are available to 

those who work in the field and who have completed a series of 

requirements, including examinations. Certifications beyond 

standard dental or medical degrees can provide assurance that the 

medical professionals asked to estimate an alien’s age based on 

radiographic exams have additional, specialized training. 

However, ICE has not identified credentials or certifications that it 

prefers for these purposes, or physicians with these certifications. 

ICE could start by ensuring that juvenile coordinators can identify 

and use professionals with the best qualifications to conduct forensic 

radiographs and provide age estimates. Equipping field offices with 

information on medical professionals who are specially trained and 

certified in forensic science can aid them in making appointments 

for radiographs. While using medical professionals with forensic 

science credentials might be difficult given location and availability, 

ICE would benefit by identifying and using these professionals 

wherever practical. Identifying professionals with such credentials 

provides a minimum level of certainty that those conducting exams 

are using the most current research and methods and are aware of 

limitations. It also guarantees that professionals have demonstrated 

their skill in forensic science through additional training, 

examination, and certification. With input from knowledgeable 

authorities, ICE should especially identify individuals who are 

routinely asked to provide age estimations based on radiographic 

exams; assess their degree of specialization in forensics, and direct 

field offices to use those who possess additional qualifications. 

Recommendation 

We recommend that the Assistant Secretary for U.S. Immigrations 

and Customs Enforcement: 

Recommendation #3: Release guidance on the selection of “bestqualified” practitioners to conduct radiographic exams and report 

results when practical. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Management Comments and OIG Analysis 

ICE provided comments to our draft report, concurring with all 

three recommendations. Below is a summary of ICE’s written 

response to our recommendations and our analysis of the response. 

A copy of ICE’s response, in its entirety, appears in Appendix B. 

Recommendation #1: Continue to enhance Juvenile and Family 

Residential Management Unit's (JFRMU) ability to collect and 

analyze data on the use of radiographs for age determinations. At a 

minimum, enhancements should provide JFRMU with the ability 

to track (1) the number of radiographs taken for age 

determinations, (2) date and results of the exam, and (3) age 

determinations and placement decisions that were later reversed. 

ICE Response: ICE concurred with our recommendation and said 

it will continue efforts to improve its ability to track data on age 

determinations. 

OIG Evaluation: This recommendation is resolved, but remains 

open pending confirmation that ICE can accurately account for the 

number of radiographs taken for age determinations over a given 

period as well as produce the number of instances an individual 

was mistakenly placed in either a juvenile or an adult facility. 

Such information can help ICE evaluate the efficacy of its age 

determination process and identify error rates when making 

placement decisions. 

Recommendation #2: Update and release guidance that clarifies 

how DRO field offices are to conduct age determinations 

following the TVPRA and release of HHS' guidance. The guidance 

they provide should be consistent with HHS' procedures, identify 

best practices for establishing age, and include requirements for 

documenting the age determination process. 

ICE Response: ICE concurred with our recommendation. 

However, it said that as of September 15, 2009 HHS has only 

issued field guidance based on a proposed draft policy. ICE said 

that it will disseminate updated field guidance after HHS has 

released a final policy. ICE added that in the interim it will 

continue to use its 2004 policy, which closely mirrors the draft 

HHS policy. ICE noted that HHS’ draft policy was based in part 

on DRO’s field guidance. 

OIG Evaluation: This recommendation is resolved, but remains 

open pending receipt of new field guidance for ICE field offices 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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that reflects age determination procedures released in final form by 

HHS. 

In addition, while ICE’s 2004 guidance shares many similarities 

with HHS’ 2009 procedures, as we report, both documents offer 

guidance not contained in the other. ICE can improve its field 

guidance by including, at minimum, elements of both policies such 

as challenges associated with age determinations, the limits of 

using radiographs, and how to handle ambiguous radiographic 

exam results. By incorporating these subjects into new field 

guidance ICE can enhance its existing field instructions and equip 

both new and more experienced field officers and agents with basic 

procedures for handling different types of cases. 

Recommendation #3: Release guidance on the selection of "best 

qualified" practitioners to conduct radiographic exams and report 

results when practical. 

ICE Response: ICE concurred with our recommendation and said 

that it will work with its Division of Immigration Health Services 

to develop such guidance. 

OIG Evaluation: This recommendation is resolved, but remains 

open pending receipt of such guidance. Making field officers 

aware of medical or dental professionals certified in forensics can 

facilitate acquisition of a more credible age estimation under tight 

time constraints. 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Appendix A 

Purpose, Scope, and Methodology 

In a House Report associated with the Consolidated Security, 

Disaster Assistance, and Continuing Appropriations Act, 2009 

(P.L. 110-329),5

 the House Appropriations Committee voiced 

concern that DHS had “not ceased its reliance on bone and dental 

forensics for child age determination, as directed” in a previous 

report. This previous report suggested that ICE use holistic agedetermination methodologies.6 The House Appropriations 

Committee also asked us to report on any cases in which bone and 

dental forensics were used in FY 2008 or 2009.7 

At the request of the House Committee on Appropriations, we 

reviewed ICE’s age determination practices for those in its 

custody, focusing on the use of dental and skeletal radiographs. 

Our objectives were to (1) identify the practices and procedures 

ICE used to determine the age of undocumented detainees held in 

ICE custody in fiscal 2008 and 2009; (2) determine whether ICE 

implemented age determination methodologies as identified in 

House Report 110-181, attached to P.L. 110-161; and 

(3) document any cases where ICE relied on bone and dental 

forensics for child age determinations in FY 2008 and 2009. 

We conducted field work at ICE headquarters in Washington, DC, 

and the National Records Center in Lees Summit, MO. We 

interviewed headquarters staff at ICE DRO, and field office 

juvenile coordinators at DRO offices nationwide via telephone. 

We also spoke to individuals working in the health care, academic, 

and advocacy communities across the United States on the use of 

radiographs for determining an individual’s age. 

We reviewed 89 A-files to assess how radiographs are used in age 

determinations, what other evidence ICE collects for this purpose, 

and how radiographic exams are presented to ICE. We reviewed 

and analyzed applicable laws, policy documents, records, and 

nongovernmental reports and journal articles relating to age 

determinations. 

We conducted our review between March and June 2009 under the 

authority of the Inspector General Act of 1978, as amended, and 

according to the Quality Standards for Inspections, issued by the 

Council of the Inspectors General on Integrity and Efficiency. 

5

 H.R. 110-862. 


6

 H.R. 110-181. 


7

 Pursuant to the House Appropriations Committee’s request, we focused on ICE’s practices for age
 

determinations exclusively, and did not examine CBP’s role in making age determinations for
 

unaccompanied alien children. 


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Appendix B 

Management Comments to the Draft Report 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 


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Appendix B 

Management Comments to the Draft Report 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 


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Appendix C 

Major Contributors to This Report 

Deborah Outten-Mills, Chief Inspector 

Andrew Schmidt, Inspector 

Howard Bobman, Inspector 

Shawntae Brown, Inspector 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 

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Appendix D 

Report Distribution 

Department of Homeland Security 

Secretary 

Deputy Secretary 

Chief of Staff for Operations 

Chief of Staff for Policy 

Deputy Chiefs of Staff 

General Counsel 

Executive Secretariat 

Director, GAO/OIG Liaison Office 

Officer for Civil Rights and Civil Liberties 

Assistant Secretary for Office of Policy 

Assistant Secretary for Office of Public Affairs 

Assistant Secretary for Office of Legislative Affairs 

Assistant Secretary for ICE 

ICE Liaisons 

Office of Management and Budget 

Chief, Homeland Security Branch 

DHS OIG Budget Examiner 

Congress 

Congressional Oversight and Appropriations Committees, as 

appropriate 

Age Determination Practices for Unaccompanied Alien Children in ICE Custody 


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ADDITIONAL INFORMATION AND COPIES 

To obtain additional copies of this report, please call the Office of Inspector General (OIG) at (202) 254-4100, 

fax your request to (202) 254-4305, or visit the OIG web site at www.dhs.gov/oig. 

OIG HOTLINE 

To report alleged fraud, waste, abuse or mismanagement, or any other kind of criminal or noncriminal 

misconduct relative to department programs or operations: 

• Call our Hotline at 1-800-323-8603; 

• Fax the complaint directly to us at (202) 254-4292; 

• Email us at DHSOIGHOTLINE@dhs.gov; or 

• Write to us at: 

DHS Office of Inspector General/MAIL STOP 2600, 

Attention: Office of Investigations - Hotline, 

245 Murray Drive, SW, Building 410, 

Washington, DC 20528. 

The OIG seeks to protect the identity of each writer and caller.