education

Mistreatment of Immigrant Children at the Southern Border

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

Acevedo, Nicole. “Why Are Migrant Children Dying in U.S. Custody?” NBCNews.com, NBCUniversal News Group, 30 May 2019, http://www.nbcnews.com/news/latino/why-are-migrant-children-dying-u-s-custody-n1010316.

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.

Raff, Jeremy. “What a Pediatrician Saw Inside a Border Patrol Warehouse.” The Atlantic, Atlantic Media Company, 4 July 2019, http://www.theatlantic.com/politics/archive/2019/07/border-patrols-oversight-sick-migrant-children/593224/.

Singer, Audrey. “Immigration: Alternatives to Detention (ATD) Programs.” Congressional Research Service, 2019, fas.org/sgp/crs/homesec/R45804.pdf.

Giving our patients a HEAD START!

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…)

Regulating the Quality and Availability of Our Children’s Pre-Kindergarten

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.

Stephanie Bousquet, MD

Sources:

Badger, E. (2014, June 23). That one time America almost got universal child care. Retrieved May 5, 2015, from http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/23/that-one-time-america-almost-got-universal-child-care/

Barnett, W. (2011). Effectiveness of Early Educational Intervention. Science, 975-978.

The Raising of America: Early Childhood and the Future of our Nation [Motion picture]. California Newseel with Vital Pictures.

Why A Strong Start Is Important

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.

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Mental Health and Our School System

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…)