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On June 20, President Trump issued an executive order rolling back the separations of undocumented immigrant families at the southern border in favor of family detention. However, despite claims that more than 500 children have been reunited with their families since the order was issued, thousands remain detained separately or in foster care, and reestablishing communication between children and their parents has proven very difficult in some cases.
For the children – some only a few months old – the consequences extend far past a question of asylum or citizenship, as physicians and researchers across disciplines have noted that the cumulative childhood trauma and chronic stress associated with these separations can cause potentially irreparable lifelong harm and put their mental health and physical development in jeopardy.
“There’s no clear plan of what to do with these children, and because there’s no way for them to know what’s coming next or when – or if – they’ll see their parents again, they are stuck in a state of constant anxiety,” said Steven Berkowitz, MD, director of the Penn Center for Youth and Family Trauma Response and Recovery and an associate professor of Clinical Psychiatry. “That chronic ‘not knowing’ can take on a life of its own and can be extremely damaging. The longer it goes on, the longer these kids’ stress response systems are elevated, and without intervention, there is a potential for permanent dysregulation.”
Whether a child is abruptly and indefinitely separated from a parent due to divorce, incarceration, military deployment, or immigration/deportation, uncertainty is at the core of the problem, and its effects linger long after the initial separation. From the moment these families are split – often in confusing, chaotic circumstances that make it unclear how long they will be apart – and in the weeks that follow, the children’s anxiety continually mounts and can breed fear for the future and a sense of helplessness and insecurity.
“The science is pretty irrefutable at this point that chronic stress due to traumatic events is damaging to children at any stage of their development,” said David Rubin, MD, MSCE, director of PolicyLab and Population Health Innovation at Children's Hospital of Philadelphia (CHOP) and a professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. “This is especially true for infants still in an attachment stage, but even school-age children and teenagers who can’t fully process complex, stressful emotions without support are at risk of poor outcomes.”
According to Harvard University’s Center on the Developing Child, the sympathetic-adrenomedullary system and the hypothalamicpituitary-adrenocortical system, which produce adrenaline and cortisol respectively, are chiefly responsible for helping the body cope with stress. However, if these systems kick into overdrive due to an adverse childhood experience like a forced separation from their primary caregiver, the sustained cortisol release can cause chronic stress and “alter the function of a number of neural systems, suppress the immune response, and even change the architecture of the regions in the brain that are essential for learning and memory,” all of which can be damaging to a child’s cognitive, social, and motor development, as well as their sense of self.
“The younger the child, the more likely there will be negative outcomes,” Berkowitz said. “We might see depression, anxiety, post-traumatic stress disorder (PTSD), hypervigilance, agitation and aggressive behavior, nightmares, or difficulties concentrating and learning – among other poor health outcomes,” such as increased risk for substance abuse, heart disease, or diabetes. Self-harm and suicide attempts have also been reported already.
While these long-term issues can’t necessarily be prevented after the separation has occurred – “That’s the difficulty of talking about trauma; you can’t know if a child will develop PTSD or other disorders until they do,” Berkowitz said – there are ways to improve outcomes, even short of immediate reunification. Critical to this is employing childcare workers who can develop appropriate, supportive relationships with the detained children. But while the facilities reportedly require employees to be licensed and to attend childcare training, a license doesn’t guarantee an empathetic caregiver, especially when they aren’t able or prepared to comfort distraught children outside of offering toys.
Multiple reports have noted that even if detainment facilities don’t officially prohibit touching or hugging, staff members across facilities believe they are not allowed to physically calm or comfort children. However, a lack of touch and physicality, particularly in childhood, can be catastrophic for development. The physical effects of positive touch, even in short intervals, demonstrate how central it is to emotional, physical, and cognitive development at any age, and particularly during infancy and into childhood. The Atlantic’s assessment of research by Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, notes that positive touch not only lowers levels of cortisol, but it enhances the natural antidepressant serotonin. By preventing employees from offering physical comfort and refusing to allow kids to soothe each other, “a lack of affectionate touch...can be harmful, regardless of whether those withholding the affection are relatives, caregivers, or other professional staff.”
Berkowitz echoes this, explaining that without caregivers who are responsive, sensitive, and able to personalize their comfort methods for a child’s needs, a child left to “cry it out” will remain in a state of fear and elevated anxiety. Still, “you cannot replace parental attachments, no matter how ‘nice’ the facilities are or how ‘professional’ the employees are; the best case scenario is to transfer them to the care of somebody they already know – ideally, their parents, of course, but also an aunt or uncle.”
The traumatic experience of being separated from a parent, plus the potential triggers associated with the reported conditions of some detainment facilities, are only the latest of what could be a long list that these children have experienced – domestic violence, gang intimidation, and extreme poverty at home, as well as hazardous conditions along the long, difficult journey to the U.S. Berkowitz notes that this history of compounding, cumulative trauma “primes these kids to negatively respond to the devastating separation from their parents.”
Both Rubin and Berkowitz agree with Colleen Kraft, MD, FAAP, president of the American Academy of Pediatrics, the practice of separating children from their parents amounts to child abuse – Rubin responded, “Absolutely,” and for Berkowitz, “It’s not even a question.” For Rubin, there’s also no escaping the bitter irony that this is all occurring only months after Congress adopted the Family First Prevention Services Act, which seeks to provide trauma-informed support services that keep families in crisis together and stabilize children.
While some might be able to overcome these experiences on their own or with supportive psychiatric treatment, he insists “the best possible treatment is reunification.” The quicker the separations are ended, communication is restored between family members, parents and children are reunited (preferably outside of detention centers), and access to mental health resources is provided, the more likely these children will be able to cope with their circumstances, successfully adjust as they mature, and overcome the trauma.