After facing intense pressure from the American Academy of Pediatrics and many other healthcare organizations, faith leaders, business leaders and the public to stop the practice of forcibly separating immigrant children from their parents at the southern border, President Donald Trump last week issued an executive order that seeks to end his administration's harmful policy.
Unfortunately, his vow to maintain the "zero tolerance" policy will put more children in detention facilities, an environment that is no place for a child, even if they are accompanied by their families. And it fails to address the families who have already been separated.
In April, I traveled to the U.S.-Mexico border in Texas along with other AAP colleagues to witness firsthand how these children are being affected. What I saw at a shelter for unaccompanied children broke my heart. While the staff at the facilities I visited were conscientious, and there were beds, toys, a playground and diaper changes, the children were not animated or engaged. Several were crying for their parents.
Yet the image that remains seared in my mind is that of a little girl about 18 months old screaming and pounding her fists on the floor. She was inconsolable. We knew what the problem was: She didn't have her mother. And none of us could fix that.
Since the zero-tolerance border security policy took effect in April, more than 2,300 children have been separated from their parents. These families and unaccompanied children are seeking safe haven in our country and need our help and support. Broad-scale expansion of family detention only exacerbates the suffering.
Conditions in U.S. detention facilities, which include sleeping on cement floors, open toilets, constant light exposure, insufficient food and water, lack of bathing facilities and cold temperatures, can be traumatizing for anyone. However, they can be devastating for a child.
Even short periods of detention can cause physical and psychological trauma and have long-term mental health risks. Children who have been detained show signs of physical and emotional stress, including developmental delays, poor psychological adjustment, anxiety, depression, risk of substance abuse and other behavioral problems. The emotional strain the children in these facilities are under produces a condition called "toxic stress" that inhibits brain development and keeps them from developing emotional bonds as well as language, social and gross motor skills.
Children have many needs that are not readily apparent. Bones are being formed, nervous systems are being developed and brain architecture is being built—with simple circuits and skills providing scaffolding for more advanced circuits and skills over time. Unlike adults, children lack the reserves required to endure acute stress and are more susceptible to illness, psychological trauma and infectious disease.
These children suffer not just acutely, but potentially, over their lifetimes, because trauma and early adversity leave tracks in the developing brain that can affect the immune system, heart, behavioral health—even the expression of genes. Science tells us that these adverse experiences can even be passed on to future generations through changes in the DNA of these children.
Immigrant children fleeing violence and persecution face a formidable list of challenges, including poverty, food-insecurity, language barriers and history of trauma.
Pediatricians recognize these dangers and are intervening so that these adverse experiences do not become these children's destiny and trauma does not dictate their life story. We want to ensure that these scared and vulnerable children are treated with compassion and not exposed to conditions that may further harm them.
Immigrant children are still children. They need to be protected, not prosecuted. Most of these families are not a risk to society. Instead of being held in detention they should be released as a family to the community, while their immigration cases proceed.
It's in our national interest that leaders and professionals from across healthcare work together to ensure that all children—including immigrant, border and migrant children—grow up physically and developmentally healthy.
