'Zero Tolerance' Immigration Policy Poses Health Risks for Children
Separation from parents can lead to PTSD, depression, anxiety, and physical health problems.
By Fran Kritz
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June 21, 2019
News of families being separated under the Trump administration’s “zero tolerance” immigration policy has raised concerns among medical and mental health experts about the long-term psychological and physical toll on children.
On Wednesday, President Trump signed an executive order halting future separation. But an estimated 2,300 migrant children have already been taken from their parents, with no current plan for how, when, or even whether these families will be reunited.
Experts say that even the children who will be reunited with their parents are at risk for short- and long-term mental and physical health problems because of the trauma of separation.
“We know that family separation causes irreparable harm to children,” said Colleen Kraft, MD, the president of the American Academy of Pediatrics (AAP), in a statement this week. “This type of highly stressful experience can disrupt the building of children's brain architecture. Prolonged exposure to serious stress — known as toxic stress — can lead to lifelong health consequences.”
Physical Effects of Toxic Stress
Deborah Gross, RN, a doctor of nursing science and a professor of psychiatric and mental health nursing at the Johns Hopkins School of Nursing in Baltimore, says that whenever there is fear or stress, there is a release of stress hormones.
“We know that constant secretion of the stress hormone cortisol will have a real damaging effect at a cellular level, and that change is what can have impacts on mental and physical health,” says Dr. Gross.
“Soothing, especially by a parent, creates other hormonal responses that reduce the levels of stress hormones and bring them into equilibrium,” she says. “Toxic stress is when that stress response is chronic because the child is not soothed and comforted.”
The Centers for Disease Control and Prevention (CDC) lists toxic stress as one of several adverse childhood experiences (ACEs) that can lead to physical and mental health conditions.
The in Washington, DC, shared previously published studies on Wednesday that point to the long-term impacts of stress on children.
In a statement, the NAS said, “Decades of research have demonstrated that the parent-child relationship and the family environment are at the foundation of children’s well-being and healthy development.”
According to the NAS studies:
- Parents’ impact on their children’s well-being may never be greater than during the earliest years of life, when a child’s brain is developing rapidly and when nearly all of her or his experiences are shaped by parents and the family environment.
- Young children who are separated from their primary caregivers may potentially suffer mental health disorders and other adverse outcomes over the course of their lives.
- Child development involves complex interactions among genetic, biological, psychological, and social processes. Any disruption hinders healthy development and increases the risk for future disorders.
- Most mental, emotional, and behavioral disorders have their roots in childhood and adolescence.
Gross says that even a brief separation from a parent — being left for a few hours with a babysitter, for example — can cause stress in a child. In a supportive environment, in which the child is soothed in a familiar space or with a familiar toy, for example, the child calms down.
“But these separations from parents are happening in the context of having just crossed the border, a stressful and frightening situation, and the children have also been exposed to their parent’s stress,” says Gross. “It’s not just one moment in time, it’s how the moment occurs in light of the cascade of stress and without the parent there to soothe them and make them feel safe.”
She adds that studies have shown that even babies can experience deep sadness and grief. “There is an immediate and long-lasting impact on the brain when it is overwhelmed by stress hormones and without the ability to make sense of what is happening to them.”
Short- and Long-Term Consequences
The concern is both for short- and long-term consequences. Gross says that she expects many to most of the children to regress in some ways, even once they're reunited with parents. Symptoms may include difficulty sleeping, wetting themselves even if they were previously toilet trained, and becoming clingy.
“Given the way the separation occurred, post-traumatic stress disorder (PTSD) is certainly something to be concerned about,” says Sarah Vinson, MD, an assistant professor in psychiatry and pediatrics at Morehouse School of Medicine in Atlanta and a member of the American Psychiatric Association (APA) communications committee.
“Compounding what has happened is that the trauma occurred at the hands of people many of the children knew their parents were coming to for help,” says Dr. Vinson. “That power dynamic can make it hard to trust someone in authority who says they are there to help them out of fear they may be harmed again.”
Julie Linton, MD, an assistant professor of pediatrics at the Maya Angelou Center for Health Equity at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, says that it is not healthy for children to experience an acute stress or fight-or-flight response for a long period of time.
“In addition to the short-term changes, the stress can cause changes in behavior, anxiety, difficulty forming relationships with others, and difficulty with learning and development,” she says. Research has linked stressful experiences to the later onset of conditions such as diabetes and heart disease.
What Comes Next?
Health experts say that ending the administration’s separation policy was a critical step toward the well-being of migrant children and families. But detention, even with parents, brings its own mental and physical health concerns.
“Detention is also profoundly harmful and is not a solution for separation of children from their parents at the U.S. border,” says Dr. Linton.
The AAP issued a policy statement on detaining children in March, coauthored by Linton, saying that “the Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings.”
Linton says studies of families in detention have not shown that any amount of time spent in detention is safe. The consequences of being confined to a specific space, often overcrowded and without familiar toys or other items, can result in depression, anxiety, and PTSD.
She says that in the past detention centers have had open toilets which can lead to infection, children sleeping on cement floors, constant light that can prevent good sleep, shortages of food and water, and no provisions for bathing.
“These conditions are traumatic for children and adults,” says Linton, adding that the AAP feels very strongly that all children upon release into the community need access to mental healthcare, as well as education and legal representation.
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