AAP renews call for an end to family separation at the border

The Academy is renewing its call for an end to family separation at the southern border following a new report showing thousands more children were separated than previously reported.

“Children didn’t ask to be born in a country where they had to flee because of violence and fear,” said AAP Immediate Past President Colleen A. Kraft, M.D., M.B.A., FAAP. “We need to treat children with compassion and respect. This means not separating them from their parents. This means not keeping them in detention. This means having pediatric guidance and medical professionals to care for them when they are in United States custody.”

Under a June 2018 court order, government officials identified 2,737 children in the care of the Office of Refugee Resettlement (ORR). However, a new report from the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) shows there was a spike in family separations a year earlier, prior to authorities announcing a zero-tolerance policy for illegal border crossings and publicly acknowledging these prosecutions would result in family separations.

“HHS officials estimate thousands of other children were separated, referred to HHS for care and released from HHS care prior to the June court order,” Ann Maxwell, OIG assistant inspector general for evaluation and inspections, said Thursday.

However, she said HHS does not have an exact count because it lacks a formal tracking system.

The news was not surprising to Dr. Kraft, who visited the border in April 2018 after hearing from local pediatricians that children were being separated from their parents.

She saw firsthand the toll of children living in shelters and not knowing when they’d see their parents again. Those experiences can cause toxic stress, which damages developing brains and leads to both short- and long-term health impacts, she said. In recent months, two children died while in U.S. Customs and Border Protection custody. The AAP has called for pediatric medical experts to have access to the facilities and repeatedly offered its assistance.

“Children have unique medical and mental health needs and care under the guidance of a pediatric professional is important,” Dr. Kraft said. “First and foremost, their security needs — being with a parent or a loving, trusted adult — is foundational to their physical and mental health.”

Since the June 2018 court order, at least 118 additional children have been separated from their parents at the border, but data on the reasons for the separations are limited. HHS officials say they have improved their system for tracking these children, but Maxwell was cautious in her assessment.

“At this point, it is not yet clear whether these changes will be sufficient to ensure accurate data about separated children,” she said.

Dr. Kraft called for the children to be reunited with their parents and offered trauma-informed care. Families seeking asylum should be able to stay in a community-based setting instead of detention, she said.

The OIG plans to release additional reports this year on efforts to reunify families, ORR facilities’ screening of employees, security, responses to incidents in which children have been harmed, and its ability to meet children’s health needs.