Pediatricians speak out: Detention is not the answer to family separation

Over a span of two weeks, AAP President Colleen A. Kraft, M.D., M.B.A., FAAP, and other pediatrician experts were featured in more than 60 national and regional news outlets covering the crisis at the border. They had a consistent message: Family separation causes irreparable harm to child health, and detention is no place for a child.

Amid advocacy and outcry from pediatricians, advocates and the public, President Donald Trump issued an executive order in June that sought to end the administration’s policy of separating children and parents at the border.

The Academy agreed the practice must end immediately but was emphatic that family detention is not the solution. The order also failed to address the more than 2,300 children who had been separated from their parents under the policy.

“Continuing to maintain the ‘zero tolerance’ policy will put more children in detention facilities, an environment the AAP states is no place for a child, even if they are accompanied by their families,” Dr. Kraft said in a press statement.

In 2017, the Academy issued a policy statement stating that immigrant children seeking safe haven in the United States should never be placed in detention facilities. Detention of Immigrant Children, http://bit.ly/2zufzee, outlines the harmful effects that any amount of detention has on children’s health as well as the dangerous conditions of the facilities.

This policy statement will continue to guide the Academy’s stance on any policy or proposal that impacts immigrant children and families.

Harms of detention

Per the Academy’s policy statement, there is no evidence that any amount of time in detention is “safe” for children. In fact, even short periods of detention can cause psychological trauma and long-term mental health risks for children.

Studies of detained immigrants have shown that children and parents may suffer negative physical and emotional symptoms from detention, including anxiety, depression and post-traumatic stress disorder.

Even after children are released from detention, post-traumatic stress symptoms can be long-term, negatively impacting their emotional, mental and physical health into adulthood.

In addition to the health consequences associated with detention, the conditions in the detention facilities themselves can be traumatizing. Some of these conditions include open toilets, forcing children to sleep on cement floors, constant light exposure, insufficient food and water, no bathing facilities, and extremely cold temperatures.

“No child should ever have to endure these conditions,” Dr. Kraft said in a press statement.

AAP advocacy

As discussions among federal leaders and in the media shifted from family separation to detention, the Academy was out in front, outlining its position on detention and its damaging impact on children’s health.

In the days following President Trump’s executive order, Dr. Kraft and Danielle Dooley, M.D., M.Phil., FAAP, testified before Congress twice, addressing the child health harms of both family separation and detention.

Several members of Congress cited the Academy’s policy when stating their own opposition to the practices.

AAP chapters also have played a critical role in opposing separation and detention policies, as have individual members who have been published in their local newspapers.

In addition, Dr. Kraft recently visited the U.S. southern border with UNICEF USA President and CEO Caryl Stern, witnessing the continuing issues facing immigrant children and families and engaging with the media. Dr. Kraft explained to members of the media and others how detention is not the answer to the forced separation of children and parents.

Through its advocacy, the AAP continues to emphasize that alternatives to detention exist, and children fare best in community settings, under the care of parents who love them. The Academy urges that children and families should have access to legal counsel throughout the immigration pathway and that community-based case management can increase the likelihood of compliance with government requirements.

The AAP is further calling on the federal government to appoint an independent medical monitoring council to ensure that the children receive optimal medical and mental health care while in government custody.

Judicial, legislative actions

In late June, a U.S. district court in California ordered the federal government to end family separation and to reunite immigrant parents with the children who had been separated. The nationwide preliminary injunction requires that children younger than 5 be reunited with their parents within 14 days and older children be reunited within 30 days.

The order does not stop criminal prosecution of parents at the border, and it does not prohibit the administration from expanding family detention.

Following the order, AAP joined UNICEF USA in issuing a press release supporting the decision, offering assistance in reunifying families, but also opposing detention.

“These families deserve clarity and compassion. As pediatricians, we know children fare best under the direct care of parents who love them, in a community setting — not a detention center,” Dr. Kraft said in the news release.

In addition, the Department of Health and Human Services recently announced the creation of an unaccompanied children reunification task force that will be overseen by the assistant secretary for preparedness and response. The AAP is in contact with the agency about the reunification plans and the health and well-being of children while in federal government custody.

On the legislative front, the U.S. House of Representatives failed to pass the Border Security and Immigration Reform Act by a vote of 121-301. The AAP-opposed legislation did not address the family separation policy and would have increased the use of immigrant detention. At press time, it remained unclear whether Congress would consider another immigration bill, even legislation narrowly focused on family separation.

As federal leaders consider any future immigration policies, the Academy will continue to serve as the leading voice for children’s health, analyzing each proposal informed by AAP policy.

Similarly, as plans develop surrounding the reunification of children and parents, the AAP will be at the forefront, speaking out to promote and support the health and well-being of immigrant children and families.