Immigration Problems Source of Toxic Stress for Children

Michael Vlessides

April 29, 2019

For children whose families have been the target of immigration policies, toxic stress is a real and present danger that has long-lasting and harmful effects on their emotional and physical well-being.

"I believe every child born into our world should have the opportunity to reach his or her full potential," said Julie Linton, MD, from the Wake Forest School of Medicine in Winston-Salem, North Carolina. However, in the United States, "the policies that we have right now are actually threatening that notion rather than supporting it."

Although most pediatricians are well versed in the effects of toxic stress on development, they might not realize that immigration policies can be a source of such stress, said Linton, who was one of several physicians who addressed the impact of immigration policies on child health at the Pediatric Academic Societies 2019 Meeting in Baltimore.

"Toxic stress places children at risk of negative health impacts in the short term, where it can manifest itself as a host of physical symptoms, including such changes in body function as eating, sleeping, and toileting," she told Medscape Medical News.

The mental-health struggles for these children include depression and anxiety. And children who are victims of toxic stress also startle easily, can be withdrawn, and can experience negative changes in learning or working memory, she explained.

Children who have faced prolonged exposure to serious stress are at risk for things like heart disease, diabetes, depression, and post-traumatic stress disorder.

In addition, "children who have faced prolonged exposure to serious stress are at risk for things like heart disease, diabetes, depression, and post-traumatic stress disorder," Linton reported.

"Obviously, family separation is the most visible and palpable manifestation of toxic stress," said Linton. These children have fled a country where they have already experienced trauma, likely faced a journey that involved trauma, are processed at the border in conditions that are not safe for children, "and then, on top of all that, they have a parent taken away."

"I got to see these little guys in one of the Office of Refugee Settlement tender-age shelters," said Colleen Kraft, MD, immediate past president of the American Academy of Pediatrics (AAP). "And the children in these shelters were as young as 18 months."

"You could just see the stress from the despair," Kraft told Medscape Medical News. "What these children needed was their parents, and we couldn't give that to them."

"For the first time, I saw the effects of this policy on their little brains," she explained.

But even immigrant families not separated can be affected by toxic stress. Parents and their children are often housed in prison-like situations at detention centers. "Even if they're together, you're taking away the parents' authority, as well as the natural role of the parent as a buffer to stress," she said.

And just the threat of family separation can be an issue. "Threatened deportation of a parent in a mixed-status family also constitutes toxic stress," Linton added.

What these children needed was their parents, and we couldn't give that to them.

Data are beginning to emerge that show that restrictive immigration enforcement is itself a key factor in the promotion of negative health outcomes in children. "There have been a couple of studies looking at birth outcomes, either after immigration raids or with increasingly restrictive policies," she reported. "These studies have found things like increased risk of preterm birth and low-birth-weight babies."

"Again, this shows the impact of these policies on the health and well-being of the affected families," said Linton. And that can persist well into adolescence and adulthood, affecting a child's "ability to learn, develop, and grow normally, and to ultimately reach his or her potential to contribute to our society."

The AAP has not taken the situation lightly. In 2012, the academy published a statement on childhood adversity and toxic stress, reaffirmed in 2016, suggesting that many adult diseases are developmental disorders that begin early in life (Pediatrics. 2012;129:e232-e246). The report also suggests that "persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood."

The academy used the statement as a call to action, asking pediatricians "to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health."

Then, in 2017, the AAP released a far-reaching policy statement on the protection of immigrant children (Pediatrics. 2017;139:e20170483), which declared that "no child should ever live in fear. When children are scared, it can impact their health and development. Indeed, fear and stress, particularly prolonged exposure to serious stress — known as toxic stress — can harm the developing brain and negatively impact short- and long-term health."

Kraft expressed pride in the work the academy has done with respect to protecting immigrant children. The AAP has contributed to a change in the conversation, from "What do we do with these illegals?" to "What about the children," she said.

How Pediatricians Can Help

Opportunities begin in the clinic but certainly don't end there, said Linton. At an individual level, physicians can help families access the many resources and benefits available. They can also help create safe environments for families.

"We should help families understand that while they're with us, we're solely concerned with their health, not their immigration status," she explained.

"These people need to be in a situation where clinicians understand what's gone on with them," Kraft added. "Then we need to work with both the parents and child to build a relationship based on trust."

More broadly, Linton urged her colleagues to consider taking action against government policies that have an impact on the health of these patients.

"These policies affect the potential of the children and youth I care for to contribute to our society," she explained. "As such, I'm going to advocate for policies that actually support their health rather than impede it."

"As physicians, we have the opportunity to amplify evidence-based messages that support health," she added. "Even if you're not the person testifying on Capitol Hill, you can be a person who shares the stories of immigrant families in a way that supports the development of safer, more equitable policies."

Linton and Kraft have disclosed no relevant financial relationships.

Pediatric Academic Societies (PAS) 2019 Meeting. Presented April 29, 2019.

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