Intended for healthcare professionals

Education And Debate

Street children in Latin America

BMJ 1998; 316 doi: (Published 23 May 1998) Cite this as: BMJ 1998;316:1596
  1. Thomas J Scanlon, research fellowa (cich{at},
  2. Andrew Tomkins, professor of international child healtha,
  3. Margaret A Lynch, reader in community paediatricsb,
  4. Francesca Scanlon, clinical assistantc
  1. a Centre for International Child Health, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London Medical School, London WC1N 1EH
  2. b Newcomen Centre, UMDS, Guys Hospital, London
  3. c Department of Child and Family Psychiatry, Horsham and Crawley Healthcare Trust, Horsham, West Sussex
  1. Correspondence to: Dr T Scanlon

    Millions of children throughout the world live on the street. These children are among the most deprived; they usually have no access to health care or education and some of them have been victims of violence even before taking to the street. Street children are seen by many as worthless, and many countries have used violent and punitive measures to remove them. Recently new approaches have been introduced that aim to restore these children to their families and societies. Initial evaluation suggests that these schemes can be successful. This article discusses the phenomenon of street children in Latin America and seeks to provide some answers to commonly asked questions.

    Summary points

    The definition of street children varies, although much research distinguishes two groups: home based, who usually return home at night, and street based, who remain on the street and have no family support

    Little accurate information exists about the numbers of street children

    Street children are more prone to several physical problems, although most research has focused on adverse effects of sexual activity and drug misuse

    Support programmes have succeeded in returning children to their homes

    Despite legislative changes, a vocal street children's movement, and adoption of advocacy strategies many street children continue to suffer violence and human rights abuses

    Much of society and the media remain to be convinced of the worth of street children


    Much of the information on street children is unpublished, and most of the published information is not in peer reviewed journals. We decided to use both published and unpublished work for this review. We performed conventional searches using Medline, Geobase, PsychLlT, and CINALH. Additional information was obtained from the resource centre at the Institute of Child Health in London, the International Child Resource Unit in San Francisco, and the Henry Durrant Institute in Geneva. We also accessed numerous web sites with information on street children and posted requests for information to a street children forum (“Streetkid-L” Our contacts with non-governmental organisations and academic institutions in South America helped to secure further information. This article concentrates on South America, which is where most research has been conducted and where two of us have some field experience.

    What do we mean by street children?

    The term “street children” was first used by Henry Mayhew in 1851 when writing London Labour and the London Poor, although it came into general use only after the United Nations year of the child in 1979.1 Before this street children were referred to as homeless, abandoned, or runaways. Most definitions of street children concentrate on just two characteristics: presence on the street and contact with the family. The most commonly used definition comes from Unicef and distinguishes two groups (box).2

    Definition of street children adapted from Unicef 1986

    Children on the street: “Home based” children who spend much of the day on the street but have some family support and usually return home at night

    Children of the street: “Street based” children who spend most days and nights on the street and are functionally without family support

    Some social scientists have constructed more revealing typologies and systems 3 4 which consider other dimensions of street life such as street territories, social organisation, economic activities, and integration with street culture. Others have sought to define street children in terms of human rights.5 The Unicef definition was developed with Latin America in mind, where studies suggest that 80% to 90% of street children have some contact with their family. 2 3 678It may be inappropriate for some countries such as India, where often whole families remain on the street.9

    How many street children are there?

    Most estimates of the number of street children fail to give a definition of street children or details of the method of counting. Nevertheless published estimates, which are essentially informed guesses, are quoted and requoted by different authors until they become accepted as fact. In 1986 the United Nations Department of International Economic and Social Affairs estimated that there were 30–170 million street children worldwide. The large range illustrates how difficult it is to count street children accurately.

    Surveys of street children in Latin America 3 7 8 suggest that their ages range from 8 to 17 years, with the average age on entering the street being 9 years. Girls form just 10-15% of street children, probably because of alternative strategies open to them such as mothering younger siblings, domestic employment, and prostitution. The few authors who have considered race suggest that in Latin America at least, black and mixed race children may be over-represented among street children.

    Why are there street children?

    Several related economic, social, and political factors have been linked with the phenomenon of street children. Land reform, population growth, drought, rural to urban migration, economic recession, unemployment, poverty, and violence have all been implicated. Brazil, which is thought to have the highest numbers of street children in Latin America, has one of the most unequal distributions of wealth in the world: the top 20% of the population receive 26 times the income of the bottom 20%, and half the population survive on 14% of the national income. Street children have been described as victims of “economic violence.”10

    Much published research focuses on family breakdown. Compared with home based children, street based children are less likely to come from a home headed by their father and less likely to have access to running water or toilet facilities; their parents are more likely to be unemployed, illiterate, less cooperative, and less mutually caring with higher levels of violence.11121314 Nevertheless, most children from poor and dysfunctional families remain at home. Research on street children's families could offer further potential to solve the problem, particularly if it focuses on what keeps children at home in difficult circumstances.

    What problems do street children encounter?

    Physical health

    Little information exists on the general physical health of street children (table 11).15 Trauma and certain infections are more common among children who are street based than among those based at home. In terms of nutrition, however, street children fare no worse than other children from similar backgrounds. Indeed astute begging and stealing might actually enhance the nutritional status of street children.3

    Table 1

    Health of street children in Belo Horizonte, Brazil 199115

    View this table:
    Table 2

    Sexual practices of street children in Belo Horizonte, Brazil17

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    Several studies have confirmed that around 80% of street children use drugs regularly. 15 16 Traditionally this has been glue, which is readily available and a cheap way of coping with hunger, fear, loneliness, and despondency.6 Indeed communal drug use may be an important factor for integrating children into street life.4 The use of crack cocaine is reported to have increased dramatically among street children, although accurate figures are as yet unavailable.

    Sexual health

    Street children are sexually active early in life (table 2). To obtain money, food, clothing, and shelter they may engage in “survival sex” with adults. Within their peer group sex is used for pleasure and comfort as well as to exert power and establish dominance, sometimes in ritualised gang rape. Sex under the influence of drugs, anal sex, and same sex encounters are common. Teenage pregnancy is almost universal among street girls, and over 25% of them report one or more abortions, procured illegally, usually with over the counter abortifacients. 6 11 15 18

    An outreach programme in Honduras reported that 85% of sexually active street children had been treated for a sexually transmitted disease.14 HIV infection has been reported in 6% of street children, syphilis in 3%, and hepatitis B surface antigen in 2%. 15 18

    Mental health

    Measurement of psychiatric and psychological morbidity in street children is fraught with practical problems. Tests often rely on fine motor skills and a vocabulary street children have not had the opportunity to develop; most have not been educated past the second year of primary school. 6 19

    There are also issues of interpretation. One small study of street children in Columbia recorded intelligence and neurological functioning below the national average.3 The author argued, however, that given street children's low socioeconomic status, high rates of illiteracy, multiple siblings, and non-intact families the results were better than might have been expected and that the degree of self management required on the streets might enhance cognitive development.

    Objective testing of self esteem is difficult to find. Street children make derogatory comments about themselves,6 although such comments may be made to satisfy researchers or to enhance their earning potential from begging.3 One study compared the views of adult helpers with those of street children.20 Helpers characterised street children as lacking self esteem, will power, and the discipline to achieve unrealistic aspirations. By contrast the street children aspired to a diverse choice of careers and often had some experience in their chosen field. Half of them were optimistic about the future, and virtually all were determined to leave the streets.

    Social circumstances

    Most street based children do not gradually move from home to street but establish themselves on the street early on.3 Most do intermittent, casual work such as hawking goods, cleaning and guarding cars, market work, begging, stealing, and prostitution. 3 6 19 Some form gangs with hierarchical structures loosely based on the family. More of them, however, form “near groups,” which are less stable with more diffusely defined roles and territories and consequently more adaptable to the problems street life brings.4

    A Honduran outreach programme found that half of street children had been arrested and 40% imprisoned.11 São Paolo court figures show that the number of arrests of street children is increasing. However, despite the popular assumption that street children are all thieves, scant evidence exists about illegal activities. Mainstream health and social services are often regarded with suspicion, mainly because so called welfare has historically been associated with punishment. 6 21 Health services are rarely geared to the needs of street children. They are often run at times and places that make them inaccessible. Furthermore, street children will tolerate adverse physical symptoms for long periods. 6 22


    Victim of the massacre of street children, Rio de Janeiro

    Marginalisation and extermination

    In Latin America many people in the judiciary, the police, the media, business, and society at large believe that street children are a group of irredeemable delinquents who represent a moral threat to a civilised society—a threat that must be exorcised.23 The most frightening manifestation of this view is the emergence of “death squads”: self proclaimed vigilantes, many of whom are involved with security firms and the police and seek to solve the problem by elimination.24

    In Brazil, a pioneering study set up by the National Movement of Street Children25 recorded 457 murders of street children between March and August 1989. The state juvenile court recently reported that an average of three street children are killed every day in the state of Rio de Janeiro. On 23 July 1993 a vigilante group openly fired on a group of 50 street children sleeping in the Candelaria district of Rio de Janeiro. Seven children and one adult were killed and many others injured. Of the eight defendants originally accused, just two have been imprisoned; a further two have been tried and released.26 Amnesty International has estimated that 90% of the killings of children in Brazil go unpunished.27

    What can be done to help street children?


    For years many governments sought to discipline street children by imprisoning them. In the 1960s the emphasis changed from a correctional approach to one of offering help. However institutions and their staff remained the same and so called “assistance” and repression became intertwined.21

    In the late 1980s the combination of the United Nations Convention on the Rights of the Child, greater democracy, and pressure from non-governmental organisations led some governments to introduce more enlightened legislation. In 1990 a new article based on the United Nations convention became law in Brazil. This new article details rights to free movement and free education up until the age of 8 years. Each municipality is required to set up a guardianship council composed of five elected professionals, including non-formal educators, who are responsible for handling the cases of children at risk or who have broken the law. These councils have access to a range of community and educational initiatives and represent children before the police, judiciary, education, and health bodies. Anyone can ask the council to intercede on a child's behalf. However, eight years after the adoption of the new article the Brazilian state of Para, which has 144 municipalities, has just 22 guardianship councils (L Nobre Lamarao, personal communication).

    Non-governmental organisations

    For many years non-governmental organisations argued that with sufficient support street children could be “rehabilitated.” The approach that has been most copied is the Bosconia project which aims at creating a new person through work and teaching values. Four stages (box) are facilitated by volunteer counsellors, educators, and medical and nursing assistants.

    Four stages of the Bosconia project

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    Some rehabilitation programmes have been criticised for “batch processing,” being paternalistic, and emphasising children's passivity. 2 28 Furthermore, they fail to engage more established street children, and in the 1980s many non-governmental organisations set up outreach programmes. Outreach programmes are sometimes entirely street based, providing food and medical support and, more rarely, educational, psychological, and legal support.6 Others represent the first stage of a more individualised rehabilitative programme which aims to integrate the child back into the family. 10 19 One such programme in Puebla, Mexico, estimates that 67% of children contacted will have left the street by one year and of those who are placed with their own or a substitute family, 94% will remain with the family after one year. 18 28 This process, however, requires ongoing support for many years, and the cost of returning a child home is estimated at £460. This may seem very little, but it represents a considerable challenge to fundraisers. The success of this programme contradicts the views that the family dynamics of street children are beyond repair and that street children fare better than their siblings who remain at home.3

    Other non-governmental initiatives are aimed at preventing children from going on to the street and involve building housing, sewerage systems, community centres, and nurseries and introducing work skills into schools' curriculums.29


    Street children: a sad reflection of an amoral society

    Street children

    One of the more positive developments in recent years has been the contribution of street children themselves. Established in 1984, the Brazilian National Movement of Street Children24 played a large part in securing new legislation. Currently there are 75 local groups, with a total membership of 3000 voluntary educators working in about 400 projects. Media coverage of the organisation gives Brazilian society an opportunity to see street children in a positive light, articulating their concerns and proposals.

    What is the way forward?

    There is no one answer but there are some clear messages. There are many reasons for street children being on the street, most of which are outside the control of children or their families. Epidemiological and health data on street children are scant and more quality research is needed which is informed by street children and their legitimate representatives.

    Various interventions are required, although returning children to their families seems to be a viable and appropriate option. The move towards advocacy and social mobilisation is welcome, particularly if it is led by street children. This process needs to be monitored, however, to ensure that street children are not manipulated for the ends of others who may have a personal political agenda and that it is not at the expense of successful non-governmental interventions.

    The question remains why in a country like Brazil which now has highly progressive children's rights legislation and a strong movement for street children, there continues to be a tide of violence and human rights abuses against children, with apparent impunity for the aggressors. The public and the media still need convincing of the worth of street children and the contribution they can make to resolving the situation. The more street children are afforded the chance to speak out for themselves, the more people will come to realise that street children are not in fact a moral threat to society, but rather a sad reflection of an amoral society.


    The references and further information are available from the Centre for International Child Health (


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