Bastioned by the AAP’s statement1 in support of school reopenings amidst the ongoing COVID-19 pandemic, school governing bodies everywhere have established a spectrum of different masking requirements for students. Some may argue that masking could be disruptive to learning and development, particularly in young children. However, the caveat in the AAP’s statement must not be forgotten: that the school reopenings are to be driven by science and safety. Arrangements for social distancing at school are frequently changing, with some schools having greater capacity than others to space out students, and some school districts electing to continue the school year entirely online. Parents and guardians are often constrained by work or other life circumstances, including lack of financial or technological resources, giving them little choice but to send their children back to in-person education. Consistent masking practices for as many children as possible at school will greatly help to mitigate the associated risk of students and staff contracting and spreading COVID-19. Pediatricians are uniquely poised to advocate for this low-cost, minimally invasive intervention that may save countless lives of all ages.
Without clear scientific guidance indicating that children do not contribute significantly to the spread of the pandemic, we are left to answer the question of how to proceed this academic year.
Texas is returning to normalcy as restrictions are being eased from the COVID-19 pandemic. Children are still out of school and it remains to be seen when they will return to the classroom environment. The combination of idle time, travel restrictions, and social distancing practices present a significant challenge to parents with restless children at home – as well as an excellent opportunity to promote reading. Pediatricians should use each well-child visit right now to encourage parents to take time to read with their children.
The Council on Early Childhood found approximately two-thirds of children in the United States fail to develop reading proficiency by third grade.1 Reading proficiency by third grade is an important predictor of high school graduation rates, as those who cannot read by that mark are four times more likely to later drop out of high school.1-2 Early reading deficiencies can lead to a lifetime of economic consequences. The Program for International Assessment of Adult Competencies (PIAAC), in a 2016 survey, suggested roughly 1 in 5 U.S. adults do not have basic literary proficiency.3 Low levels of adult literacy and educational level are associated with less economic opportunity, poor health outcomes, and social dependency.1,4
The promotion of reading skills can start in infancy. Parents can read aloud to infants to encourage language development and model reading behavior.1 As infants age, they begin to mimic their parents by turning the pages of books. With picture books toddlers can make inferences from the images before they can read the words on the page. Gradually and with training they may begin to recognize letters and eventually words. Ideally, pediatricians would like our patients to be familiar with the alphabet and recognize their name prior to starting kindergarten. For older children and teenagers, quarantine can be an opportunity to expand their literary horizons. By reading popular novels, classic literature, or books from high school reading lists, students can improve their literacy.
Many resources are available to help parents promote reading. Reach Out and Read Texas has a partnership with many pediatric clinics to provide children with a book at each visit from 6 months to 5 years; their website (see link below) also includes expected reading milestones by age. The Dallas Public Library has Tumble books available for children grades K-12 (see link below) online and additional books are available with a library card (free with proof of residence). Google Play Books has free children’s books available online which are playable on iOS devices.
Donovan Berens, MD
Works Referenced:
High PC, Klass P, Council on Early Childhood. Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. Pediatrics. 2014 August; vol 134 (2): 404-409
Hernandez D. Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation. Annie E. Casey Foundation. 2011 April. https://files.eric.ed.gov/fulltext/ED518818.pdf Date accessed 5/01/2020
Mamedova S, Pawlowski E. Adult Literacy in the United States. National Center for Education Statistics Data Point, U.S. Department of Education. 2019 July. https://nces.ed.gov/pubs2019/2019179.pdf. Date accessed: 5/02/2020
It was a little over a year ago when I first heard about the child separations happening at the U.S.-Mexico border. I had recently had my own son and it gave me a visceral feeling of horror imagining someone taking him away from me, not knowing where he was going, when I would see him again, or who would take care of him. I read a story of a 4-month-old taken from his mother as I held my own infant of a similar age. I imagined what kind of fear would drive me to make a dangerous journey with a newborn and beg for safety in a foreign country. Children continue to be separated from their parents and caregivers. They are kept in conditions unfit for anyone, and especially damaging for children. We need to speak out against the treatment of migrant children that is occurring and demand more humane solutions.
Whether unaccompanied or as part of a family unit, when
children present for asylum, they are brought first through a Customs and
Border Protection facility where by law, they are not to be detained for more
than 72 hours (Linton et al., 2017). However, some children and families are being
held for much longer (Linton et al., 2017). There are small, unwashed and
underfed children taking care of younger, filthy toddlers without proper
sanitation available, like clean diapers (Raff, 2019). Studies have shown
negative physical and emotional symptoms among detained children under any
circumstance (Linton et al., 2017), then their source of resilience might be stolen
away- their caregivers. Even a short time in detention can have damaging
psychological effects (Linton et al., 2017). Interviewed parents have described
regressive behavior in their children after detention along with increased
aggression and self-injurious behavior (Linton et. al 2019). They might come
with parents or they may come with extended family members hoping to join their
parents already in the U.S. (Linton et al., 2017). In 2016, “Family Case
Management” was terminated, a short-lived program that was 99% effective in
having these families in court, even by ICE’s own statements (Singer, 2019).
The former program cost taxpayers about $38 a day, while the current system
costs hundreds per day (Singer, 2019).
Children are dying. They are dying. They are kept in ‘prison-like
conditions’ (Linton et al., 2017) and in the last year, at least 7 children
have died in immigration custody after almost a decade of no deaths (Acevedo,
2019). Dr. Dolly Lucio Sevier, a pediatrician who visited a Customs and Border
Protection facility in McAllen Texas, one of the facilities where immigrants
are not to be held for longer than 72 hours. She met a baby whose uncle was
forced to feed him for days from an unwashed bottle (Raff, 2019). She met a
teenage mom whose baby was wrapped in diapers and plastic because they refused
to give her clean clothes for her infant. This facility is known as the
hielera, or ice box (Raff, 2019). This mom was trying desperately to keep her
baby warm when she had nothing but concrete and mylar blankets (Raff, 2019).
Dr. Sevier saw unmistakable signs of mental trauma and illness. The children
had not been allowed access to soap, toothbrushes, clean clothes; and many had
been in the facility weeks. They smelled, were malnourished, dehydrated, and
most had at least a respiratory infection. The baby who had been drinking from
a dirty bottle was fevered and ill (Raff, 2019).
Exposure to the ‘prison-like’ conditions present in the
immigration facilities causes high levels of stress (Linton et al., 2017). It
has been well documented that toxic stress will have lasting effects on the
health of these children, even if they manage to somehow get past the mental
effects of their trauma. They will be at higher risk for heart disease, cancer,
diabetes, etc (Garner et al., 2015). Their present health and their future
health are being destroyed in one fell swoop. The recognition and reduction of
toxic stress in children should be a priority for all pediatricians (Garner et
al., 2015), and should be part of a routine evaluation for the care of
immigrant children (Linton et al., 2017).
The American Academy of Pediatrics issued a policy statement about the detention
of immigrant children. The policy outlines many concerns and recommendations
including that separating a parent or primary caregiver from their children
should never occur unless there is a concern for the safety of the child (Linton
et al., 2017). Practices in the CBP processing centers are inconsistent with
AAP recommendations for the care of children, and therefore children should not
be subjected to them. Community-based case management should be implemented for
the children and their families (Linton et al., 2017). Children should receive
timely and comprehensive medical care. “Treat
all immigrant children and families seeking safe haven who are taken into US
immigration custody with dignity and respect to protect their health and
well-being” (Linton et al., 2017).
It is easy to feel helpless and overwhelmed. I urge you to
not become complacent. Write your own opinion. Write your congressional
representatives. Donate to the Annunciation House, which helps to house some
immigrants. You can also give to RACIES (Refugee and Immigrant Center for
Education and legal Services) or to the Human Rights Initiative of North Texas,
both of which seek to help immigrants gain asylum and legal status, among other
services. I encourage my fellow physicians to look for immigrants among our
patients. Recognize the trauma they have been subjected to. Practice
trauma-informed care and do your best to refer to services that can help.
Marie Varnet, MD
My son and I protesting the treatment of immigrant children in Dallas, Tx
Garner, Andrew S., et al.
“Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician:
Translating Developmental Science Into Lifelong Health.” Pediatrics,
American Academy of Pediatrics, 1 Jan. 2012,
pediatrics.aappublications.org/content/129/1/e224.short.
Linton, Julie M., et al.
“Detention of Immigrant Children.” Pediatrics, American Academy of
Pediatrics, 1 May 2017, pediatrics.aappublications.org/content/139/5/e20170483#xref-ref-10-1.
Head Start began in 1965 with the aim to provide children from low income families with skills to be ready for and to succeed in kindergarten and in life. It now serves nearly 1 million children from birth to age 5 years with comprehensive early learning services in classrooms, home-based programs and family child care partners. Pediatricians should promote Head Start in patient visits and through advocacy efforts at local, state and federal levels. (more…)
Texas House Bill 4 introduced this session seeks to regulate the quality of pre-kindergarten programs that eligible Texas children receive. The measure includes a provision to authorize state payment up to $1,500 per child to the schools to ensure the programs are effective. It requires that teachers be certified or have at least eight years of experience and that the student:teacher ratio be no more than 18:1. It also requires reporting of data to the state to regulate quality and track outcomes in these existing pre-kindergarten programs. Programs must also have a curriculum and a family engagement plan to maintain “high levels of family involvement and positive family attitudes toward education”. It does not expand enrollment, nor would it increase from the current half-day model.
Current opposition to the bill is reminiscent of 1971 and the failure to establish universal childcare for all American children. At that time, the Comprehensive Child Development Act had passed both houses of Congress. Before being signed into law, it was vetoed by President Nixon. Various repudiated the legislation as the “Sovietization” of American children. Opponents argued that the law took the rights of child-rearing away from parents and placed them with the government. They characterized the act as an attempt to indoctrinate American children, and further stated that children should stay at home with their mothers. This same argument is being revived today by some opponents of House Bill 4. Other opponents are rejecting this bill because they believe more could be done by expanding pre-kindergarten enrollment to allow every child to participate. Others withhold support claiming a lack of evidence to support early childhood education as effective.
With many more women fully employed now, childcare and early childhood education is a clear necessity for most families. High quality early educational programs have demonstrated substantial effects on social and cognitive outcomes for children. Some studies also show a reduction in crime and arrests of the participants in their later adult years. Two aspects which are crucial for a program to be effective are limitation of class size and the amount of individualized attention that each child receives. House Bill 4 lacks content to address those aspects, and it does not include a requirement to expand pre-kindergarten programs from half-day to full-day
As of May 7, 2015, House Bill 4 has been approved by both the House and Senate in Texas. When this bill is signed into law by Governor Abbot, we will have taken a step to help some Texas children reach their full potential. I encourage my colleagues to continue to advocate for all of our children. Universal early childhood education will benefit Texas families. Continue to raise awareness for this need by writing your state legislators to expand pre-kindergarten programs to give every Texas child the opportunity to benefit.
All children deserve a fair chance at a bright future, and the greatest window of opportunity to make a positive impact occurs during the years between birth and kindergarten. During this time, children develop very quickly, both physically and mentally.
It is a common sentiment in the pediatric community that our current health care system does not meet the needs of the 1 in 5 children in the United States with a diagnosable mental health disorder. There is a current bill in Congress that speaks to this very problem: The Mental Health in Schools Act of 2013. This bill would require a comprehensive school mental health program that would assist children in dealing with trauma and stress and would encourage community partnerships among education systems and mental health and substance use disorder services and other agencies. (more…)
Pediatric Advocacy 
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