Crisis at the border: Long-term health risks of family separation

By Mary Ellen Cagnassola, for MDLinx
Published July 3, 2018

Key Takeaways

Medical experts say family separations at the US border will have long-term health consequences for the children, their parents, and those who work to help them. Consequently, the implications go beyond their mental health.

The Trump administration’s policy of detaining migrants at the border and separating them from their children sparked controversy and public outcry across the United States. Members of the medical community echoed citizens’ demands for an end to what many in the pediatric psychiatry and infectious disease fields called a health crisis in progress.

Even with the president’s June 20 executive order to reunite the separated families, lasting damage has already been inflicted, according to child and adolescent psychiatrist Lisa Amaya-Jackson, MD, MPH. She also mentioned that the reunification process poses additional trauma that will likely have future implications for both the children and their caretakers.

“Professionals like myself who work with children’s mental health needs are having extreme distress over what’s happening, because we all know that a relationship to a loving parent or caregiver is absolutely critical to a child’s sense of self and their ability to thrive,” said Dr. Amaya-Jackson, who also acts as the associate director of the UCLA-Duke National Center for Child Traumatic Stress. “These children have been clinging to their parents in what have most likely been harrowing conditions [before crossing the border]. When they are separated, that’s one of the most stress-inducing experiences a child can have.”

She added that studies of children who experience natural disaster, war, and abuse in institutions demonstrate that the negative impact of separation is potentially lifelong. While reuniting these children with their parents is of critical importance, Dr. Amaya-Jackson and the National Child Traumatic Stress Network (NCTSN) also recognize that the process will need some guidance.

According to the Centers for Disease Control and Prevention, children who have endured the separation process are more likely to adopt health-risk behaviors, are at greater risk of developing chronic diseases, disabilities, and social problems, and are susceptible to early death.1

Dr. Amaya-Jackson noted that Post-Traumatic Stress Disorder is one of the most common implications of separation. Symptoms include aggression, withdrawal, irritability, opposition, avoidant behavior, sleep disruption, physiological hyperarousal, substance abuse, and depression. Social stigmas often result from the manifestation of these symptoms in school and in public.

Peter Wenger, MD, a pediatric infectious disease specialist with St. Peter’s University Hospital in New Brunswick, NJ, and JFK Medical Center in Edison, NJ, added that while the psychosocial implications will have the most pronounced and long-term impact on the families at the center of President Trump’s zero-tolerance policy, there are also epidemiological concerns associated with detaining children together in a foreign environment.

The children being housed at various centers across the country are vulnerable to spreading and contracting respiratory illnesses such as whooping cough, influenza, CMV, hepatitis A, and vaccine-preventable diseases such as measles and rubella, said Dr. Wenger.

“You need a certain population density to spread these particular diseases, and in facilities such as these, you would certainly find that,” he explained. “If you pull a kid away from their parent, then how do you know what they’re eating? What are their hygiene habits? Are they going to be put with a group of children, who, because they’re so young, don’t have the best hygiene practices? They’re at a much higher risk [of contracting infectious diseases]. While young kids may have a strong immune system, they’re not experienced.”

Dr. Wenger added that traumatic stressors also factor into a child’s ability to fight off infections, as they weaken the immune system. Overall, the circumstances at hand are an invitation for a potential outbreak, he explained—and the migrant children will be the ones who suffer the most damage. Contracting one or more infectious diseases can impair or delay a child’s development, creating potentially lasting cognitive consequences and stunted growth.

Dr. Wenger emphasized that—depending on the illness—almost all infectious diseases can potentially affect a child’s cognitive abilities as well as their physical development.

But the consequences don’t end with the children and their primary caregivers, according to Dr. Amaya-Jackson. Since the onset of the separations, child service workers, pediatric psychiatrists, psychologists, and anyone who works to help displaced and refugee children have been overwhelmed—with few resources to provide enough care or comfort.

“We had one group working with adolescents who were tasked with caring for these much younger children,” Dr. Amaya-Jackson said. “They are not sure what to do, and they, in turn, are developing secondary post-traumatic stress. Hearing these kids crying and crying, and there’s nothing they can do to soothe them because what they want, and what they’re pining for, is their families. It’s important to recognize that these effects are happening to the very professionals who are trying to take care of these children.”

The National Center for Child Traumatic Stress and the NCTSN, a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded and Congressionally mandated resource created to raise the standard of care for traumatized children and families, offer a plethora of resources for medical providers, child services workers, mental health professionals, survivors of trauma, and the general public. Medical professionals and practitioners who are on the frontlines or who are looking to help remedy separation-related health crises with their services can access the best treatments and practices for trauma-informed care, as well as a host of data on family and childhood trauma.

NCTSN Learning Center will offer a free webinar on July 10 that focuses on helping providers, caregivers, and others understand and recognize the effects of traumatic separation in immigrant children of different ages. The course also provides guidance on understanding their prior trauma experiences and practical suggestions for supporting immigrant children who have been separated from parents and siblings. To enroll and learn more, click here.

Reference:

1. Fortson B, et al. Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf. Accessed July 2, 2018.

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