Impact of Toxic Stress on Migrant Children Devastating, Enduring

Deborah Brauser

July 10, 2018

As the US government scrambles to meet today’s court-ordered deadline to reunite the youngest migrant children with their families, scientists continue to underscore the long- and short-term impact of "toxic stress" on young minds and bodies.

Almost 3 weeks after President Trump's order to stop separating migrant children from their parents, and 2 weeks after a court order was issued to reunite the families, the American Civil Liberties Union (ACLU) reports that it is "likely that less than half" of the children aged 4 or under will be reunited by today's court-mandated deadline. Questions also remain as to whether the July 26 deadline for reunification of all children forcibly removed from their families will be met.

"These kids have already suffered so much because of this policy, and every extra day apart just adds to that pain," Lee Gelernt, deputy director of the ACLU's Immigrants' Rights Project, said in a press release.

Lanre Falusi, MD, president of the Washington, DC, chapter of the American Academy of Pediatrics (AAP), agrees. However, in a recent press telebriefing, she noted that even if reunited at a facility, "these are basically jails with physical conditions that are not meant for children. No child should be kept in detention."

Evidence-based research backing these statements continues to mount, showing devastating physical and mental effects to children exposed to toxic stress at a young age. Studies have identified at least five measurable areas that can show lasting impairment from toxic stress. These include the following:

  • Ongoing mental health and behavioral problems, including anxiety, depression, suicidal ideation, poor judgement, and substance use/abuse

  • Lower language, literacy, and math skills

  • Smaller amygdala on MRI in teens after childhood stress

  • Problems in brain development, especially for parts in charge of emotion, because of lack of loving touch

  • Increased risk for cancer, diabetes, and cardiovascular disease

A long listing of studies on toxic stress and children are currently available on the AAP website. In addition, a study published online July 9 in Pediatrics shows that effects from adverse childhood experiences reverberate through generations.

"Government-Sanctioned Child Abuse"

During the briefing, Falusi was joined by Nathalie Bernabe Quion, MD, pediatrician at Children's National Health System in Washington, DC, to discuss long-term health effects of detaining immigrant children.

They also shared their experiences of going inside immigrant detention centers, and they discussed their participation, along with that of current AAP President Colleen Kraft, MD, in a short film documenting all of this called Trauma at the Border.

"It's certainly a relief that the harmful policy of separating children and families who are seeking refuge is ending. But locking children up even with their families in these detention facilities has long-lasting effects on their brains and on their bodies," said Falusi.

In the film, Kraft notes that if the brain is disrupted by toxic stress, "you will see children who will not do well in school. They will drop out of school. They relieve their pain by smoking, drinking alcohol, doing drugs. We see gross motor delays, and we see children who look like they may be on the autism spectrum.

"There was a feeling of desperation and profound sadness that we knew how to help them and that it wasn't happening," she said.

"Our government sanctioned this behavior, which really amounted to government-sanctioned child abuse."

"Shattering" Images

Quion went with Kraft to a facility in McAllen, Texas, in April. Although it was before the policy was in place to transport children away from their parents, they were upset with what they saw there — especially in a so-called "toddler and infant room."

"That was the most shattering image that I have and that I carry to this day. As a mother and a pediatrician, I know that children need their parents. When they cry for their parents or someone to take care of them and there's no one, that's heartbreaking," she said during the media briefing.

She said that although attendants were present, her group was told that according to policy, the children should not be touched or picked up.

"This is troubling because, especially in young children, touch and physical connection with their caregivers is very important for the brain to grow," said Quion. "An adolescent whose brain is still growing should not be in detention, whether that's with family or by themselves."

She also told of seeing a crying 3-year-old in a courtyard who was upset "and having a meltdown, which we were told she'd been having every day and which wasn't surprising to us." It was because of these actions that the little girl had become labeled as "problematic" and was taken out to the courtyard every day and left to cry alone on a park bench while an attendant stood nearby.

"We know as pediatricians that when dealing with children of this age, this is going to happen — they're going to act up. In their inability to express their emotions verbally, this is what they do: they cry, they throw temper tantrums. This is not a behavior disorder, as the attendant giving us the tour was trying to say it was," said Quion.

"Separating the child and giving her space could be helpful, but that's not enough. They need more support emotionally and mentally to work out the trauma that they're going through," she said. "These children need reassurance that they're going to be okay. And I can't say that that is happening now or is going to happen."

Falusi added that "it's important these children who are caught in the middle, through no fault of their own, get the support they need."

Lingering Health Effects

Common behaviors after experiencing these types of events include excessive crying, regression in development or "acting younger than they really are," poor socialization, and acting out. In the long term, these children may experience poor judgement, increased anxiety and depression, and even suicidal ideation, Quion noted.

"These are the types of things we see in kids who have toxic stress. And this is what the children are going to have if they are continuously separated — or even now that they've experienced this trauma. The conditions at these processing centers are definitely not acceptable for children," she said.

Quion added that even after they are released, these young detainees are likely to continue to have problems, including posttraumatic stress disorder and other mental health problems.

Asked during the briefing what the difference is between what these children are going through and what other children go through when parents leave them at daycare, with babysitters, etc, Falusi answered that it's a matter of choice.

"When I dropped my 3-year-old off at preschool, I chose to drop her off with people I know. And she knows that in the evening, either I or my husband will be picking her up. At the end of the day, I know she'll be there, and she knows I'll be there," said Falusi.

"I see that as a very different situation than being in a very stressful time seeking refuge in another country following international law and being told that my child is being taken away to, for example, get food and then not seeing her again," she said.

"On the other side, it's having her wonder who the strangers are that are surrounding her, not being sure she'll ever see me, and being placed with other children without the structure that a child that age needs, such as touch and loving support," said Falusi.

Quion added that "at the end of the day, I can comfort my child, but that's not going to happen with these children and a parent."

Falusi noted that family detention is also a stressful place for children. She said that many pediatricians have not been allowed to enter these facilities recently, but colleagues who went previously described cement floors, very cold temperatures, open toilets, and continuous light.

"Our brain needs light and darkness to understand when it's time to rest. All of that is so traumatizing to the bodies of adults and to children, particularly if they're still developing," she said. "It's good that there's now a ruling that families will be reunified, but, with the chaos of the separation, I'm curious to see how that will happen."

Brain Measurements

As reported by Medscape Medical News, a recent study published in Scientific Reports suggests that traumatic stress experienced by young children is visible on the brain years later, as measured by MRI scans.

Results showed that early childhood stress was associated with faster maturation of the prefrontal cortex and amygdala during adolescence. Current adolescent stress was associated with slower maturation of the hippocampus, parahippocampus, prefrontal cortex, and anterior cingulate.

"That is a very striking study," because of the very real evidence of brain changes in these children, Quion told Medscape Medical News.

"Despite the policy of reunification, because of the justice system being overwhelmed, we doubt that's going to happen soon enough. But the brain grows every day and makes connections to other parts of the brain. And as pediatricians, this is the crux of our concern," she said. "Even if this ends today, there are long-term effects on the brain and on ability to perform functions, whether cognitive or emotional, or to even make bonds with people."

What can clinicians do?

"I think a lot of it is enveloping these children with as much support as possible. We all worry about the effects of stress on the mind and body, but we do know that there are buffering systems that can mitigate that. It might not completely reverse it, but it's making sure the basics, like good nutrition, sleep, and exercise, are being taken care of," said Falusi.

It's also making sure they have access to mental health therapy, either one-on-one or group talk with peers, and ensuring that parents have access to the same type of services, she added.

Trauma-Informed Care Needed

In addition, Falusi and Quion emphasized during the briefing that these are not just "border town issues." Many of the children were transported to cities around the United States. With reunification questions still lingering, there's a strong probability that at least some will need to see local physicians.

"One of the most important things that we would like to get everyone aware of is trauma-informed care," said Quion.

Clinicians should also tell foster families to comfort these children by letting them know they are safe, to take care to not retraumatize them, and to ensure there is a structure put into place, Falusi said.

"This means all of us should come together to make sure we're communicating across sectors as families who take these children into their homes are seeking out community resources, mental health services, and more," she added.

Quion and Falusi noted that these recommendations are also important for other children who have experienced toxic stress from other situations.

Follow Deborah Brauser on Twitter: @MedscapeDeb. For more Medscape Psychiatry news, join us on Facebook and Twitter.


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