I thank Pulin et al. for their further contribution to this topic [1]. Their call for collective action, coordinated surveillance and multidisciplinary convergence is not only timely but represents the most constructive possible direction for a field that is still assembling its own evidence base. I would like to use this response to place children more explicitly at the centre of this discussion, both as biological subjects with specific vulnerabilities and as a demographic group whose exposure circumstances along Mediterranean migration routes deserve dedicated clinical, research and public attention.
The epidemiology of child migration across the Mediterranean is, in itself, a matter of urgency. UNHCR data consistently show that children and adolescents represent a significant proportion of arrivals on the Central Mediterranean route, with unaccompanied minors constituting a particularly vulnerable subgroup and, in some periods, accounting for up to a third of all sea arrivals [2].
These figures predate any toxicological consideration and already define a population exposed to the full range of risks associated with irregular maritime crossing: dehydration, hypothermia, traumatic injuries, infectious diseases and psychological trauma. The fuel toxicity now emerging adds a further, previously unrecognized layer to this already complex clinical picture [3].
Paediatric migrants at sea arrive in several different family configurations, and one specific group warrants separate consideration: unaccompanied minors [4]. These children, travelling without parents or legal guardians, face unique challenges at every stage of the medical encounter. They may be unable to provide an accurate exposure history. They may not disclose symptoms for fear of detention or deportation. They may be triaged as lower acuity than visibly symptomatic adults, particularly if their clinical presentation is subdued despite significant biochemical toxicity. Reception protocols that rely on self‐reported symptoms or adult‐mediated histories will systematically underperform in this population.
From an operational standpoint, this means that paediatric‐specific reception pathways need to explicitly incorporate fuel toxicity screening, not as an optional add‐on for clinically jaundiced children, but as a routine biochemical checkpoint for all paediatric arrivals at risk. The minimum biochemical dataset advocated (methemoglobin, fractionated bilirubin, liver enzymes) is feasible even in resource‐limited reception contexts and represents a low‐cost, high‐yield investment in early harm reduction compared to the risk of missing a haemolytic crisis or a liver injury.
Even if these outcomes are possible in the context of a single acute toxic exposure, the clinical recovery of all paediatric patients reported is, in this sense, reassuring. However, the absence of systematic follow‐up beyond the acute hospitalization, itself a reflection of the structural fragility of healthcare continuity for recently arrived migrants, means that subclinical chronic injury would simply not be detected. Children present differently, recover differently and carry different long‐term risks than adults exposed to the same compounds.
A call for collective action is therefore warranted. I would add that paediatric expertise must have an explicit and structured role within this effort, supported by dedicated surveillance protocols and a multicentre research agenda. Children crossing the Mediterranean are not small adults, and they deserve a dedicated framework of observation.
Author Contributions
Antonio Corsello: conceptualization, writing – original draft, funding acquisition.
Funding
This study did not receive any specific grant from funding agencies in the public, commercial or not‐for‐profit sectors.
Ethics Statement
The author has nothing to report.
Consent
The author has nothing to report.
Conflicts of Interest
The author declares no conflicts of interest.
Linked Articles
This article is linked to Corsello et al., Pititto et al. and Corsello et al. papers. To view these articles, visit https://doi.org/10.1111/apa.70550, https://doi.org/10.1111/apa.70575 and https://doi.org/10.1111/apa.70576.
Acknowledgements
The author has nothing to report.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.