Trump Signs Order to Stop Separating Immigrant Families

Marcia Frellick

June 20, 2018

President Trump signed an executive order today to end the separation of families at the US border.

To date, more than 2300 children have been separated from their parents in a "zero tolerance" policy that applies to immigrants who enter the United States illegally.

A 2-year-old Honduran asylum seeker cries as her mother is searched and detained near the US– Mexico border on June 12 in McAllen, Texas.

Prosecutions will proceed, but with families remaining intact while in custody.

The American Medical Association (AMA), the American Psychiatric Association (APA), the American Academy of Nursing, (AAN), the American Academy of Pediatrics (AAP), and the American College of Physicians (ACP) are among the organizations that called on Trump to end the separations immediately.

Physicians have detailed the physical and psychologic effects that detention and separation from their families can have on children.

Pediatrician Julie Linton, MD, cochair of the AAP immigrant health special interest group, told Medscape Medical News that, in 2016, she was inside the largest processing center, in McAllen, Texas, which has frequently been shown in recent news reports.

"I get chills when I see that facility, and I was in there for 3 hours as a physician," Linton said. "I can't imagine what it's like for a little child to be in there with or without a parent. It's chain-link fencing that looks like very large cages that extend from the floor to the ceiling. The lights are kept on 24/7, which is totally disorienting. There are naps on the floor."

For some of these children who have been exposed to traumatizing circumstances there will be lifelong effects, she explained.

Any plan that includes the detention of children should not be acceptable, even if children are with their parents, Linton said.

Unsafe for Children

"There's no safe amount of time for a child to be separated from a parent," Linton explained. "There's no safe time for a child to be in detention, and the myth that whatever doesn't kill you makes you stronger is not true when we're talking about developing brains."

Kim Schrier, MD, a pediatrician and democratic congressional candidate from Washington's 8th congressional district, told Medscape Medical News that these separations have meant that children have not had the comfort and guidance they need to condition their brains to cope with the ultimate stressful environment.

Children default to a "fight or flight" mentality, when the brain focuses only on survival, Schrier explained. When the brain does not have the chance to develop coping mechanisms, fight or flight can become the norm.

"These are children fleeing violence in their own countries," she pointed out. They survive a dangerous journey "only to be torn from their parents in a foreign country where they don't speak the language, if they're even verbal yet."

Even if the separation policy ends immediately, children can suffer long-term effects, said Sarah Vinson, MD, a member of the APA council on communications.

"Children are trying to figure out how the world works, who they are in the world, and how things operate," she told Medscape Medical News. "For them to have such a traumatic experience — where they are separated from their caretakers — it has an effect on their self-concept, how they relate to other people, and on their mental health.

We know that children who have experienced traumatic events are at increased risk for depression, post-traumatic stress disorder, anxiety, and substance abuse disorders. Childhood trauma has implications for adults in the physical and mental health space as well."

Linton, Schrier, and Vinson have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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