One of the hottest topics debated in the 2020 presidential race so far has been immigration reform. There has been widespread outrage centered on the separation of families and the horrible conditions and long stays in detention centers along our southern borders. Detainees hope they’ll be released as soon as possible, but for the children being held, getting out isn’t the end of the ordeal. Trauma from a child’s experience in detention can increase the risk for psychological and physical health issues throughout not only the rest of the child-detainee’s life but also the lives of their future children. In this article, I discuss how certain conditions in migrant detention centers can lead to health problems, and I provide a medical perspective from Hopkins pediatrician Tania Maria Caballero.

Detention Conditions Harm Health

Far from a comprehensive list, the following are three examples of how practices and conditions in migrant detention centers can cause mental and physical health problems.

Separation: Being separated from one’s family at a young age can have seriously deleterious health effects. Children respond to stressful and traumatic situations in a variety of ways. They have different responses and coping mechanisms based on age and previous experience. Despite the heterogeneity in responses, the single biggest buffer against later mental health issues is having a stable and nurturing adult present. From studies of children in Russian orphanages1, we know that even short-term isolation from such an adult can cause anxiety, post-traumatic stress disorder (PTSD) and depression in children, which can persist into adulthood. Even after reunification with parents or family, the child might experience reattachment issues. Additional long-term effects include increased risk of developing a substance use disorder, heart disease, attention deficit/hyperactivity disorder (ADHD) and developmental delays.

Touch Deprivation: In migrant detention centers, detainees are not allowed to touch each other, nor are guards allowed to touch them. This rule exists to minimize risk of abuse, but may have unintended adverse effects on child development. As social animals, humans have evolved to need physical contact with other humans. As such, touch is extremely important for how we deal with stress as well as how we bond and grow2. Not allowing guards, parents or other children to comfort a child in distress is detrimental to the mental health of the upset child and equally frustrating for the person who wants to provide relief via physical touch.

Sleep Disruption: In many migrant detention facilities, bright lights are kept on 24 hours a day. This results in insomnia and disrupted sleep cycles, in addition to increasing the risk of some types of cancer and depression later in life. Disrupted sleep can have negative consequences for cognitive development, mood regulation, attention and behavior3. Beyond this, disrupted sleep cycles can increase insulin resistance and, correspondingly, increase the risk of developing diabetes.

Again, this list is by no means exhaustive. Other potential health issues include malnutrition4,5, increased infection rates from overcrowding5,6 and self-harm/suicide7,8.

Trauma Affects Future Generations

From previous studies, we know that trauma can have psychological and physiological effects that carry over into subsequent generations. For example, the offspring of Holocaust survivors have increased chances of developing PTSD, mood disorders, anxiety disorders and substance use disorders. Children of Rwandan genocide victims have increased rates of PTSD. The grandchildren of Dutch famine survivors have an increased risk of developing obesity9. For all of these studies, other environmental factors, or genetics alone, cannot explain the increased rate of the disorders.

So, how are traumatic events encoded and passed on? The current consensus is that stressful or traumatic situations result in changes in one’s epigenetics. This does not refer to a change in DNA sequence itself but rather to heritable changes that occur in DNA packing that affect gene expression. The more tightly DNA is packed, the less protein that the gene encodes will be produced. For example, a Holocaust survivor experienced prolonged periods of extreme stress and corresponding increases in the production of receptors that sense the stress hormone cortisol. During that time, the DNA encoding those receptors was marked with molecular tags that kept it loosely packed, so that the cell could make many copies of the receptor to respond to the huge amounts of stress hormone being produced. When the Holocaust ended, these tags didn’t go away entirely, so the survivor still had a great deal of cortisol receptors, and a corresponding increase in sensitivity to stress hormone. When the survivor had children, those children inherited the same molecular tags from their parent, causing them to also have increased sensitivity to cortisol10. In this way, epigenetic changes can encode traumatic experiences and can pass the effects along to future generations.

Will this be the case with the detained immigrant children? If so, how can we help this community cope with the lifelong aftereffects of their trauma? To gain insights on these issues and more, I spoke with Hopkins pediatrician Tania Maria Caballero.

How to Mitigate the Effects of Trauma

Caballero is a general pediatrician who grew up in Baltimore, and after completing most of her higher education outside of Maryland, she came back to do a research fellowship at the Johns Hopkins Bloomberg School of Public Health. As her father is from Argentina, Caballero identifies as Latina and has always been interested in Latinx immigrants to the United States. Caballero works at Johns Hopkins Bayview Medical Center at Centro SOL (Center for Salud/Health & Opportunities for Latinos), an organization that conducts research focused on Latinx health, provides clinical care for the Latinx community, and advocates for policies to improve health and opportunities for Latinxs. Her research focuses mostly on supporting families with U.S.-born children and undocumented parents.

Although unhealthy conditions in immigrant detention centers have been getting a lot of press very recently, Caballero says it’s not a new issue. However, the situation has become particularly urgent now that unnecessary child deaths have occurred. She urges people to “think about any point in your life when you were startled, anxious or saw something scary, and a trusted adult stepped in and made you feel calm, secure and safe. Think about if that didn’t happen. That moment. These children experience that every day. Even a short amount (of detention) can affect a child’s entire life trajectory.” Further, we should remember that these immigrants are “our community members and schoolmates. This affects all of us. They have so much resilience and potential, and it would be so horrible to not have them as members of our community. They’re so valuable.”

Caballero agrees that some detained migrant children will have long-lasting health problems, some of which could, based on previous studies, span generations. However, she remains somewhat hopeful. “Families by virtue of getting here are very resilient,” she says. “They can withstand tough conditions and flourish. Many families from Latin America have traditional family and community values that will help buffer the effects of trauma over time.” In other words, continue advocating for better policies and detention center conditions (examples: no family separation, more community release, better health care access), but in the meantime, we can help the community thrive by mitigating the negative health effects of their detention. Below, I briefly address pediatrician-recommended changes in migrant center policies, the care of released immigrant children and what you can do to help.

Detention Center Conditions and Policies: How detained children are processed at the U.S. border is complex, and according to Caballero, training is often inadequate. However, experts who understand how to appropriately screen and assess immigrant children for health issues already exist. Putting the right teams of people together to process the families coming in could vastly strengthen the safety of the whole operation. In addition, in 2017, the American Academy of Pediatrics put together a list of recommendations11 to improve the health of immigrant children and families during the immigration process. Access the recommendations here.

Post-Release Medical Care: The mental health issues caused by detention can take time to detect in released children. According to Caballero, kids may have a “honeymoon” period after their release, during which they are relieved to be reunited with family and excited about a new environment, and they appear to be settled. Over time, however, symptoms of anxiety and depression can start to appear. These symptoms can be exacerbated by the stress of discrimination, difficulties in school, adjusting to a new household structure and sometimes life in poverty. It is often difficult for clinicians to catch these symptoms because there is a trust barriert takes time to build trust in any doctor-patient relationship, but this may be even more difficult for children and families who, in the past, have felt intimidated, threatened, or let down by authority figures. In addition, undocumented immigrants have variable access to health insurance and extremely limited access to medical care, which poses another barrier.

How You Can Help: In addition to advocating for the policy changes recommended by the American Academy of Pediatrics, you can help by supporting the Latinx immigrant community in Baltimore. Centro SOL, the Hopkins-based outreach organization for which Caballero works, is looking for volunteers! As a volunteer, you can help with community and youth outreach, child supervision and health education, as well as wellness activities for adults such as dance and yoga. For many of these volunteer positions, no Spanish proficiency is required. Sign up here!

References

  1. Merz, E.C., and McCall, R.B. (2010). Behavior problems in children adopted from psychosocially depriving institutions. Journal of Abnormal Child Psychology, 38(4), 459–
  2. Ardiel, E.L., and Rankin, C.H. (2010). The importance of touch in development. Paediatrics & Child Health, 15(3), 153–
  3. Nunes, M.L., and Bruni, O. (2015). Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. Jornal de Pediatria, 91(6), S26–
  4. Bhutta, Z.A., Berkley, J.A., Bandsma, R.H., Kerac, M., Trehan, I., and Briend, A. (2017). Severe childhood malnutrition. Nature Reviews Disease Primers, 3, 17067.
  5. Ibrahim, M.K., Zambruni, M., Melby, C.L., and Melby, P.C. (2017). Impact of childhood malnutrition on host defense and infection. Clinical Microbiology Reviews, 30(4), 919–
  6. Okarska-Napierała, M., Wasilewska, A., and Kuchar, E. (2017). Urinary tract infection in children: Diagnosis, treatment, imaging—comparison of current guidelines. Journal of Pediatric Urology, 13(6), 567–
  7. Brown, R.C., and Plener, P.L. (2017). Non-suicidal self-injury in adolescence. Current Psychiatry Reports, 19(3), 20.
  8. Sousa, G.S.D., Santos, M.S.P.D., Silva, A.T.P.D., Perrelli, J.G.A., and Sougey, E.B. (2017). Suicide in childhood: a literature review. Ciência & Sauˊde Coletiva, 22(9), 3099–
  9. Galler, J., and Rabinowitz, D.G. (2014). The intergenerational effects of early adversity. Progress in Molecular Biology and Translational Science (Vol. 128, 177–198). Academic Press.
  10. Yehuda, R., Daskalakis, N. P., Lehrner, A., Desarnaud, F., Bader, H.N., Makotkine, I., and Meaney, M.J. (2014). Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. American Journal of Psychiatry, 171(8), 872–
  11. Linton, J.M., Griffin, M., and Shapiro, A.J. (2017). Detention of immigrant children. Pediatrics, 139(5), e20170483.

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