June 21, 2018

What health care experts are saying about child separations

Daily Briefing

    President Trump on Wednesday signed an executive order to rein in the separation of migrant children from their parents amid a growing chorus of concerns from health care professionals about the practice's short- and long-term health effects.

    Background

    In early May, the Trump administration began enforcing a policy of detaining and criminally prosecuting all individuals who have crossed the U.S.-Mexico border without proper authorization, according to the Kaiser Family Foundation. Because a court ruling known as the Flores settlement limits the number of days a child can be held in detention, children were removed from the detention centers and placed with HHS' Office of Refugee Resettlement while their parents awaited trial.

    According to AP, DHS data show more than 2,300 children were separated from their parents under the policy between May 5 and June 9. Trump's executive order would halt this practice by allowing children to remain with their families while they are detained—an approach that experts say may conflict with the Flores settlement. The House on Thursday is expected to take up immigration legislation that would address the issue.

    What are the health effects of child separations?

    Pediatricians, psychologists, and other health care experts say there is a solid body of research that shows separating young children from their parents can cause "toxic stress"—a condition that is commonly seen in children who have been placed in orphanages, survived a natural disaster, or lived in poverty or war-torn countries, PBS News reports.

    In an interview with Vox, Nadine Burke Harris—founder and CEO of Center for Youth Wellness, which researches the condition—explained how toxic stress is triggered in the human body. When an individual experiences a traumatic experience—such as a child being separated from their parent—the body releases stress hormones, commonly referred to as "fight-or-flight" hormones: adrenaline, cortisol, and norepinephrine. The reaction helps alert people to dangerous situations so they can respond and get to safety.

    According to Burke Harris, parents or a familiar, nurturing caregiver play a key role in turning off this biological stress response for children. She explained, "[W]hen parents hug or snuggle or give kisses to their children, it increases the release of oxytocin in the child's body." Oxytocin is a bonding hormone that "inhibits the activation of the stress response," Burke Harris said.

    But when the stress response is not suppressed and the individual is exposed to prolonged, abnormal levels of stress hormones, toxic stress occurs—and that can have both short- and long-term negative health consequences, Burke Harris said. Toxic stress "changes the structure and function of children’s developing brain, their developing immune system, their hormonal system, and even the way that DNA is read and transcribed," she said.

    Colleen Kraft, president of the American Academy of Pediatrics, similarly said in an appearance on "CBS This Morning" Monday that toxic stress can "disrupt the synapses and the neurological connections that are part of the developing brain."

    What are the short- and long-term effects of toxic stress?

    In the short term, children who experience toxic stress have an increased risk for autoimmune disease and infection, as well as problems related to digestion, growth, and sleep, Burke Harris said. Kraft said toxic stress could also cause developmental delays, such as slower speech and delayed motor skills. Some children may also have difficulty forming proper bonds and attachments with other people.

    In the long term, Burke Harris said, research has shown adults who experienced toxic stress in childhood are at an increased risk of Alzheimer's, cancer, diabetes, heart disease, stroke, and other conditions. According to Kraft, such adults also may be more susceptible to drug and alcohol misuse.

    For instance, research on Aboriginal children in Australia who were removed from their families showed the individuals were nearly twice as likely to be arrested or criminally charged in adulthood, twice as likely to have a gambling problem, and 60% more likely to misuse alcohol, the Washington Post reports.  

    In addition, Jack Shonkoff—who leads Harvard University's Center for the Developing Child and has spent decades researching the effects on stress in the brain, including for a 2012 study published in Pediatrics—said children who experience toxic stress are more likely to have behavioral or mental health problems and drop out of school.

    According to Burke Harris, the long-term effects are most pronounced when toxic stress is experienced in the first five years of life. "[W]hat we see is that the exposures that happen in early childhood, through the first five years, tend to have an outsize impact on kids' health and development, compared to impact that happens later, because of this change in neuroplasticity" that happens as children age, she said.

    Prominent provider groups, experts weigh in

    Prior to the announcement of Trump's executive order on Wednesday, provider groups representing hundreds of thousands of U.S. doctors issued statements against separating children from their parents, the Washington Post reports.

     The American Psychiatric Association in a letter to Trump administration officials said, "Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

    American Public Health Association called the practice "inhumane." The group said, "Decades of public health research has shown that family structure, stability and environment are key social determinants of a child’s and the communities' health."

    The American Medical Association in a letter also called on the Trump administration to end the practice. The letter stated, "It is well known that childhood trauma and adverse childhood experiences created by inhumane treatment often create negative health impacts that can last an individual's entire lifespan."

    In addition, the National Academies of Sciences, Engineering and Medicine, 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."

    The American College of Physicians in a release following Trump's executive order continued to raise concerns, saying it does not offer a "permanent end to the policy of separating children from their parents at the border." ACP said, "The children who were taken from their families are more likely to experience increased mental health impacts like depression, an increased likelihood of engaging in risky behavior such as smoking and alcohol abuse and drug use, and increased likelihood to develop preventable illnesses like heart disease, cancer, or stroke" (Wan, Washington Post, 6/18; Benavidez, STAT News, 6/19; CBS News, 6/20; Santhanam, PBS Newshour, 6/18; Lind, Vox, 6/20; Politico, 6/20; Kelleher, Fortune, 6/16; Burke/Mendoza, Associated Press, 6/20; Spagat, Associated Press, 5/8; Kaiser Family Foundation, 6/20; Stanglin, USA Today, 6/20; Gonzales, NPR, 6/20).

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