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The family separation crisis is a health crisis

Health risks come with separating kids from their parents.

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

There is no more important story in the country right now than the thousands of parents and children being separated from each other at the border as they attempt to enter the United States.

The debate over the crisis has spun off into many tangents: whether there is any federal law requiring family separation (there isn’t), about America’s rules for asylum seekers, and whether Congress will do anything about it as the House prepares to take up immigration legislation this week.

But as much as the family separation crisis is a story about immigration policy and our country’s values, it is also a health crisis.

Dr. Colleen Kraft, president of the American Academy of Pediatrics, visited a shelter housing unaccompanied minors ages 12 and younger in April. She described walking into a toddler room where, instead of finding a group of rambunctious kids, she found quiet ones and, in the middle of the floor, a little girl crying uncontrollably.

I asked Kraft to explain the health risks that come with separating kids from their parents.

”Every bit of their health is predicated on a foundational relationship with a caring adult,” she said. Their parents, in other words.

When they are separated from their parents, kids’ stress hormones start working overtime. They are constantly on red alert. Over time, Kraft said, that “causes disruption in the way the neural synapses connect with each other, in their brain architecture.”

That can lead to developmental delay. Children develop speech slower, their motor skills don’t come along as quickly as they should, and they start to have difficulty creating proper attachments to other human beings.

The presence of a social worker isn’t enough to mitigate those effects, Kraft said, and the younger the child is and the longer they are in this kind of situation, the more difficult it is to reverse it. These experiences can have lifelong consequences too: They affect a child’s ability to learn, their susceptibility to drug and alcohol abuse, and could even potentially make them more at risk of heart disease or cancer when they become adults.

”The foundational piece of their health and development is the relationship with their parents,” Kraft said. “When you take that away, you take away the basic tenets of pediatric health.”

This isn’t just traumatic for the children either. Take the story of a Honduran woman whose child was ripped away from her by federal immigration officials quite literally while she was breastfeeding, according to her lawyer.

There is an actual physical effect of that separation, on top of the psychological damage. To understand it, you need to understand what’s called the oxytocin effect. As Vox’s Julia Belluz explained:

Breasts full of milk can be painful. Latching can also be painful, especially in the early days and months after the baby’s birth. But when a baby suckles a mom’s breasts, the mother’s brain’s posterior lobe secretes oxytocin, and some of that pain is relieved with the release of milk.

There are other risks associated with splitting a mom from her baby at this vulnerable time. “A woman’s breasts are continuously making milk,” [Alison] Stuebe, [a professor of obstetrics and gynecology at University of North Carolina School of Medicine]. said, “ and if that milk is not removed, her breasts become swollen and painful. She can develop mastitis, and mastitis can evolve into a breast abscess that may require surgical drainage.”

This highly refined and intricate system of hormones during breastfeeding is essential to keeping moms and babies healthy, and “it explains why the mother and baby should be kept together and why they should have skin-to-skin contact,” the WHO explained.

It also helps explain why the story of the Honduran migrant is so inhumane.

We’re also seeing what appears to be a shocking violation of medical ethics under the Trump administration’s policies.

Children who are detained at the border often talk with social workers or doctors or clinical psychologists — which makes sense given the traumatic experience they are going through.

But, as Vox’s Ella Nilsen meticulously detailed, the information that they provide to the professionals caring for them can then be used against them in immigration court proceedings. The children’s care is overseen by HHS — specifically the Office for Refugee Resettlement (ORR) — but the information the agency’s representatives collect can be shared with the Department of Homeland Security and federal immigration authorities.

Immigration lawyers told Nilsen that the Obama administration would also sometimes share information between the two agencies, but typically, minors were reunited with their families. Under Trump, however, the policy “is increasingly used to detain or deport undocumented minors.”

If you’re shocked that information obtained by medical professionals could then be used against their patients, you aren’t alone. This is an unusual legal question, considering these patients might be in the United States illegally, but nevertheless, some of the experts Nilsen consulted seemed to believe this was an egregious ethical violation.

The law may not be clear on whether ORR is allowed to share confidential social worker or psychologist records with DHS, but one medical expert Vox spoke to said the medical ethics surrounding the practice are certainly questionable.

“There is privileged communication between a health care provider and a client,” said Erica Monasterio, a clinical professor of nursing at the University of California San Francisco. “When you breach confidentiality outside of those situations, you’ve clearly communicated to the patient, you’ve really breached trust. And health care relationships are really based on trust.”

Monasterio says that in her job as a medical professional, she has never seen any law that says an immigrant’s legal status has any impact on their right to medical confidentiality.

“Sometimes [providers] don’t well understand their responsibilities,” she said. “That doesn’t make it right, and it doesn’t make it ethical, and it seems to me to be a flagrant breach of confidentiality.”

So the health risks in the family separation crisis are multi-faceted. Children are being subjected to trauma that could affect them for years, there is sometimes physical consequences to separating parents from their young children, and the medical rights of the children being detained may also have been violated.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.