Skip to main content

Advertisement

Log in

Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Age assessment of migrants is crucial, particularly for unaccompanied foreign minors, a population facing legal, social, and humanitarian challenges. Despite existing guidelines, there is no unified protocol in Europe for age assessment.

The Forensic Anthropology Society of Europe (FASE) conducted a comprehensive questionnaire to understand age estimation practices in Europe. The questionnaire had sections focusing on the professional background of respondents, annual assessment numbers, requesting parties and reasons, types of examinations conducted (e.g., physical, radiological), followed protocols, age estimation methods, and questions on how age estimates are reported.

The questionnaire's findings reveal extensive engagement of the forensic community in age assessment in the living, emphasizing multidisciplinary approaches. However, there seems to be an incomplete appreciation of AGFAD guidelines. Commonalities exist in examination methodologies and imaging tests. However, discrepancies emerged among respondents regarding sexual maturity assessment and reporting assessment results. Given the increasing importance of age assessment, especially for migrant child protection, the study stresses the need for a unified protocol across European countries. This can only be achieved if EU Member States wholeheartedly embrace the fundamental principles outlined in EU Directives and conduct medical age assessments aligned with recognized standards such as the AGFAD guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. United Nations Children’s Fund (2022) Refugee and migrant response in Europe. Humanitarian Situation Report No. 42. Available online: https://www.unicef.org/documents/ecaro-humanitarian-situation-report-no-42-refugee-and-migrant-crisis-january-december (Accessed on April 27, 2022)

  2. UNHCR (2020) Refugee and migrant children in europe – accompanied, unaccompanied and separated. Factsheet, Jan-Dec 2020. Available online: https://data2.unhcr.org/en/documents/download/87693 (Accessed on April 27, 2022)

  3. Eurostat (2021) Asylum applicants by type of applicant, citizenship, age and sex – annual aggregated data. Available online: http://appsso.eurostat.ec.europa.eu/nui/show.do?wai=true&dataset=migr_asyappctza (Accessed on April 27, 2022)

  4. Schmeling A, Reisinger W, Geserick G, Olze A (2006) Age estimation of unaccompanied minors. Part I. Gen Considerations Forensic Sci Int 159:61–64

    Article  Google Scholar 

  5. United Nations Children’s Fund (2020) A statistical profile of birth registration in Africa. UNICEF, New York

    Google Scholar 

  6. United Nations Children’s Fund (2017) A snapshot of civil registration in sub-Saharan Africa. UNICEF, New York

    Google Scholar 

  7. United Nations Children’s Fund (2021) A statistical profile of birth registration in Asia and the Pacific. UNICEF, New York

    Google Scholar 

  8. European Migration Network (2018) Approaches to unaccompanied minors following status determination in the EU plus Norway. synthesis report for the EMN study. Available online: https://emn.ie/files/p_201808090907072018_emn_sythesis_unaccompanied_minors_09.08.2018.pdf (Accessed on April 27, 2022)

  9. Bokhari F (2008) Falling through the gaps: safeguarding children trafficked into the UK. Child Soc 22:201–211

    Article  Google Scholar 

  10. Aynsley-Green AI, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RMM (2012) Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. Br Med Bull 102(1):17–42

    Article  CAS  PubMed  Google Scholar 

  11. Smith T, Brownlees L (2011) Age assessment practices. A literature review & annotated bibiliography. UNICEF, New York

  12. EU-Directive (2013a) 2013/32/EU (26.06.2013). https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013L0032&from=LT (Accessed on 27.12.2023)

  13. EU-Directive (2013b) 2013/59/EURATOM (05.12.2013). https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013L0059&from=EN (Accessed on 27.12.2023)

  14. EU-Directive (2016) 2016/800 (11.05.2016). https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32016L0800&from=EN (Accessed on 27.12.2023)

  15. Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzcher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460

    Article  CAS  PubMed  Google Scholar 

  16. Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, Lynnerup N, Cattaneo C (2009) The problem of aging human remains and living individuals: a review. Forensic Sci Int 193:1–13

    Article  CAS  PubMed  Google Scholar 

  17. Schmeling A, Rudolf E (2022) Medical age assessment in living individuals. In: Madea B (ed) Handbook of Forensic Medicine, 2nd edn. Wiley, Chirchester, pp 1027–1053

    Chapter  Google Scholar 

  18. Schmeling A (2019) Forensic age assessment. Revista Española de Med Legal 45(4):163–169

    Article  Google Scholar 

  19. Schmeling A, Kreitner KF, Heindel W, Vieth V (2019) Imaging methods used for forensic age assessment in juveniles and young adults. Radiol U2pdate 19(01):63–75. https://doi.org/10.1055/a-0795-1838

    Article  Google Scholar 

  20. Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G (2016) Forensic age estimation: methods, certainty, and the law. Dtsch Arztebl Int 113:44–50. https://doi.org/10.3238/arztebl.2016.0044

    Article  PubMed  PubMed Central  Google Scholar 

  21. European Asylum Support Office (2018) EASO practical guide on age assessment. Second edition. EASO Practical Guides Series. Available online: https://www.easo.europa.eu/sites/default/files/easo-practical-guide-on-age-assesment-v3-2018.pdf (Accessed on April 27, 2022)

  22. United Nations Children’s Fund (2013) Age assessments: a technical note. Available online: https://www.refworld.org/docid/5130659f2.html (Accessed on April 27, 2022)

  23. European Asylum Support Office (2014) EASO age assessment practice in Europe. Publications Office. Available online: https://data.europa.eu/doi/https://doi.org/10.2847/28339 (Accessed on December 27, 2023)

  24. De Tobel J, Ottow C, Widek T, Klasinc I, Mörnstad H, Thevissen PW, Verstraete KL (2020) Dental and skeletal imaging in forensic age estimation: disparities in current approaches and the continuing search for optimization. Semin Muscoskelet Radiol 24(5):510–522

    Article  Google Scholar 

  25. Obertová Z, Cattaneo C (2018) Child trafficking and the European migration crisis: the role of forensic practitioners. Forensic Sci Int 282:46–59

    Article  PubMed  Google Scholar 

  26. Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Adama M (2019) Décision n° 2018–768 QPC du mars 2019. Conseil Constitutionnel. Commentaire. Available online: https://www.conseil-constitutionnel.fr/sites/default/files/as/root/bank_mm/decisions/2018768qpc/2018768qpc_ccc.pdf

  28. WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age:methods and development. World Health Organization, Geneva

    Google Scholar 

  29. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL (2000) CDC growth charts: United States. Adv Data 8(314):1–27

    Google Scholar 

  30. Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of hand and wrist. Stanford University Press, California

    Book  Google Scholar 

  31. Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5–8

    Article  PubMed  Google Scholar 

  32. Tanner JM, Healy MJR, Goldstein H, Cameron N (2001) Assessment of skeletal maturity and prediction of adult height (TW3 method). WB Saunders, London

    Google Scholar 

  33. Bouchard M, Sempé M (2001) <<Maturos 4.0>> CD: Un nouvel outil d’évaluation de la maturation squelettique. Biométrie Humaine et Anthropologie 19(1–2):9–12

  34. Gök Ş, Erölçer N, Özen C (1985) Age determination in forensic medicine, 2nd edn. Turkish Republic Ministry of Justice, Council of Forensic Medicine Press, İstanbul

    Google Scholar 

  35. Todd TW, D’Errico J (1928) The clavicular epiphyses. Am J Anat 41:25–50

    Article  Google Scholar 

  36. McKern TW, Stewart TD (1957) Skeletal age changes in young American males. Technical report EP-45. Quartermaster Research and Development Center, Environmental Protection Research Division, Natick, Massachussetts

    Google Scholar 

  37. Jit I, Kulkarni M (1976) Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64:773–782

    CAS  PubMed  Google Scholar 

  38. Owings PA, Suchey JM (1985) Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of males and females. American Journal of Biological Anthropology 68(4):457–466

    Article  Google Scholar 

  39. Ji L, Terazawa K, Tsukamoto T, Haga K (1994) Estimation of age from epiphyseal union degrees of the sternal end of the clavicle. Hokkaido Igaku Zasshi 69:104–111

    CAS  PubMed  Google Scholar 

  40. Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116–1122

    Article  CAS  PubMed  Google Scholar 

  41. Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124:321–325

    Article  PubMed  Google Scholar 

  42. Gilsanz V, Ratib O (2005) Hand bone age: a digital atlas of skeletal maturity. Springer, Berlin

    Google Scholar 

  43. Scheuer L, Black SM (2000) Developmental juvenile osteology. Academic Press, San Diego, CA

    Google Scholar 

  44. Schaefer MC, Black SM (2005) Comparison of ages of epiphyseal union in north American and Bosnian skeletal material. J Forensic Sci 50(4):777–784

    Article  PubMed  Google Scholar 

  45. Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119:142–145

    Article  PubMed  Google Scholar 

  46. Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124:149–154

    Article  PubMed  Google Scholar 

  47. Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10:163–169

    Article  PubMed  Google Scholar 

  48. Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45(2):411–421

    Google Scholar 

  49. Mincer HH, Harris EF, Berryman HE (1993) The A.B.F.O. Study of third molar development and its use as an estimator of chronological age. J Forensic Sci 38(2):379–390

    Article  CAS  PubMed  Google Scholar 

  50. Willems G, Van Olmen A, Spiessens B, Carels C (2001) Dental age estimation in Belgian children: Demirjian’s technique revisited. J Forensic Sci 46(4):893–895

    Article  CAS  PubMed  Google Scholar 

  51. Cameriere R, De Angelis D, Ferrante L, Scarpino F, Cingolani M (2007) Age estimation in children by measurement of open apices in teeth: a European formula. Int J Legal Med 121(6):449–453

    Article  PubMed  Google Scholar 

  52. Cameriere R, Ferrante L, De Angelis D, Scarpino F, Galli F (2008) The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects. Int J Legal Med 22(6):493–497

    Article  Google Scholar 

  53. Moorrees C, Fanning E, Hunt E (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42(6):1490–1502

    Article  CAS  PubMed  Google Scholar 

  54. Liversidge HM (2008) Timing of human mandibular third molar formation. Ann Hum Biol 35(3):294–321

    Article  CAS  PubMed  Google Scholar 

  55. Ubelaker DH (1978) Human skeletal remains: excavation, analysis, interpretation. Aldine Publishing Co., Inc, Chicago

    Google Scholar 

  56. Orhan K, Ozer L, Orhan AI, Dogan S, Paksoy CS (2007) Radiographic evaluation of third molar development in relation to chronological age among Turkish children and youth. Forensic Sci Int 165(1):46–51

    Article  CAS  PubMed  Google Scholar 

  57. Ruhstaller P (2006) Zahnärztliche Altersdiagnostik durch röntgenologische Evaluation der Entwicklingsstadien des unteren Wishetiszahnes: Auswertung von 1260 Orthopantomogrammen von Jugendlichen und jungen Erwachsenen. Med Diss, Zürich

  58. Kahl B, Schwarze CW (1988) Updating of the dentition tables of I. Schour and M. Massler of 1941. Fortschr Kieferorthop 49:432–443

    Article  CAS  PubMed  Google Scholar 

  59. Gunst K, Mesotten K, Carbonez A, Willems G (2003) Third molar root development in relation to chronological age: a large sample sized retrospective study. Forensic Sci Int 136:52–57

    Article  CAS  PubMed  Google Scholar 

  60. Olze A, van Niekerk P, Ishikawa T, Zhu BL (2007) Comparative study on the effect of ethnicity on wisdom tooth eruption. Int J Legal Med 121:445–448

    Article  CAS  PubMed  Google Scholar 

  61. UNHCR (2021) Global trends. Forced displacement in 2020. Available online: https://www.unhcr.org/60b638e37/unhcr-global-trends-2020 (Accessed on April 27, 2022)

  62. Cummaudo M, De Angelis D, Magli F, Minà G, Merelli V, Cattaneo C (2021) Age estimation in the living: a scoping review of population data for skeletal and dental methods. Forensic Sci Int 320(2):110689

    Article  PubMed  Google Scholar 

  63. Schmeling A (2018) Die aktuelle medizinethische Debatte über forensische Altersdiagnostik bei unbegleiteten minderjährigen Flüchtlingen. https://www.dgrm.de/fileadmin/PDF/AG_FAD/masterarbeit_schmeling.pdf (Accessed on December 27, 2023)

  64. United States Nuclear Regulatory Commission (2017) Biological effects of radiation. Available online: https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html (Accessed on April 27, 2022)

  65. Okkalides D, Fotakis M (1994) Patient effective dose resulting from radiographic examinations. Br J Radiol 67:564–572

    Article  CAS  PubMed  Google Scholar 

  66. Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263. https://doi.org/10.1148/radiol.2481071451

    Article  PubMed  Google Scholar 

  67. Jurik AG, Jensen LC, Hansen J (1996) Radiation dose by spiral CT and conventional tomography of the sternoclavicular joints and the manubrium sterni. Skelet Radiol 25:467–470

    Article  CAS  Google Scholar 

  68. Gassenmaier S, Schaefer JF, Nikolaou K, Esser M, Tsiflikas I (2020) Forensic age estimation in living adolescents with CT imaging of the clavicular – impact of low-dose scanning on readers’ confidence. Eur Radiol 30(12):6645–6652. https://doi.org/10.1007/s00330-020-020-07079-y

    Article  PubMed  PubMed Central  Google Scholar 

  69. Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J, Bajoanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129:187–193. https://doi.org/10.1007/s00414-014-1067-0

    Article  PubMed  Google Scholar 

  70. Hermetet C, Saint-Martin P, Gambier A, Ribier L, Sautenet B, Rérolle C (2018) Forensic age estimation using computed tomography of the medial clavicular epiphysis: a systematic review. Int J Legal Med 132(5):1415–1425. https://doi.org/10.1007/s00414-018-1847-z

    Article  PubMed  Google Scholar 

  71. Tozakidou M, Meister RL, Well L, Petersen KU, Schindera S, Jopp-van Well E, Püschel K, Herrmann J (2021) CT of the medial clavicular epiphysis for forensic age estimation: hands up? Int J Legal Med 135(4):1581–1587. https://doi.org/10.1007/s00414-021-02516-z

    Article  PubMed  PubMed Central  Google Scholar 

  72. Boldsen JL, Milner GR, Koningsberg LW, Wood JW (2002) Transition analysis: a new method for estimating age from skeletons. In: Hoppa RD, Vaupel JW (eds) Paleodemography age distributions from skeletal samples. Cambridge University Press, Cambridge, pp 73–106

    Chapter  Google Scholar 

  73. Thevissen PW, Fieuws S, Willems G (2010) Human dental age estimation using third molar developmental stages: does a Bayesian approach outperform regression models to discriminate between juveniles and adults? Int J Legal Med 124:35–42

    Article  CAS  PubMed  Google Scholar 

  74. Tanner JM, Whitehouse RH, Marshall WA, Healy MJR, Goldstein H (1975) Assessment of skeletal maturity and prediction of adult height (TW2 method). Academic Press, London

    Google Scholar 

  75. Thiemann HH, Nitz I (1991) Röntgenatlas der normalen Hand im Kindersalter. Thieme, Leipzig

    Google Scholar 

  76. Roche AF, Chumlea WMC, Thissen D (1988) Assessing the skeletal maturity of the hand-wrist: FELS method, CC Thomas, Springfield, IL

Download references

Acknowledgements

This work was possible thanks to the community of FASE and also of GIAOF (Gruppo Italiano Antropologia e Odontologia Forense) of whom we would like to thank all members.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marco Cummaudo and Robin Peckitt. The first draft of the manuscript was written by Marco Cummaudo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marco Cummaudo.

Ethics declarations

Consent to participate

All participants have provided their consent to participate to the study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cummaudo, M., Obertova, Z., Lynnerup, N. et al. Age assessment in unaccompanied minors: assessing uniformity of protocols across Europe. Int J Legal Med 138, 983–995 (2024). https://doi.org/10.1007/s00414-024-03157-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-024-03157-8

Keywords

Navigation