At the 2018 AMA Annual Meeting in Chicago the House of Delegates adopted policy opposing the practice of separating migrating children from their caregivers in the absence of immediate physical or emotional threats to the child’s well-being.
Two experts—James Pawleski, director of state advocacy at the American Academy of Pediatrics, and Marisa Chumil, national social work director at the Young Center for Immigrant Children’s Rights at the University of Chicago—recently participated in an AMA grand rounds event that outlined the potential health impact on minors who have been separated from their families at the U.S. border.
Here are four things physicians need to know if a child who has been affected by this policy comes to your practice for care.
Three sources of trauma
“There are many different forms of trauma and the fact that we are working with a population that has survived trauma can impact us as service providers,” said Chumil. “We really want to engage in trauma-informed ways, elicit trauma-informed approaches and have an organization that supports trauma-informed care.”
Physicians should view the care of these children through lens of the triple trauma paradigm. That paradigm includes:
- Pre-migration: This is when many children are forced to leave their home countries.
- During migration: This includes what children have to do to survive all the risks they are facing and the survival skills they need.
- Post-migration: This is when a child is apprehended by border patrol who might be armed.
“The detention can be another form of trauma,” said Chumil. “Their journey has been interrupted when they are placed in a detention center.”
Understand the experience
While it is no secret that the immigrant children population is growing in the U.S., said Pawleski, the experience colors their health.
“Pediatricians are on the front line of caring for these children so their ability to know how their experience affects their health is important to this process,” he said. “Immigration itself has significant social, economic and health consequences in these children, families and communities.”
The related health effects of immigration can also have long-term developmental, health and well-being effects on these children too. Understanding a child’s experience is extremely important for physicians who are caring for these kids.
“It is an important priority to understand the entire experience and be prepared to care for the growing population of immigrant children in the country,” said Pawleski.
While immigrant kids are experiencing trauma throughout the different stages of their journey, physicians should also remember to celebrate their resiliency.
“They are more than their trauma stories. It is their story and it is our privilege to hear it in a way that they feel comfortable sharing it with us,” said Chumil. “They do have a lot of protective factors and they’ve built a lot of defense mechanisms and survival skills.”
“It is really just helping them mold those into adaptive forms in their new environments, helping them feel empowered and being an active participant in their trajectory so they can get to the point that they can recover from their trauma,” she added.
Think beyond fences
Even families who did not endure child-separation but live in the U.S. illegally have been affected. Parents are less likely to bring their children for care, with pediatricians in Texas, Pennsylvania and Florida seeing a 60–80 percent drop-off in their patient loads.
“Our pediatricians are seeing the chilling effects on children and families living in communities,” said Pawleski.
When children do present to health care facilities, physicians noticed kids are exhibiting:
- Nightmares and sleep disorders.
- No sense of future.
- Damaged self-concept.
- Communication disorders.
- Adjustment disorders.
Parents and families are also experiencing fear and stress over deportation threat and are reluctant to access medical care.