Pediatricians Knew About Family Separation Long Before the Public Did—and They Were Worried

Colleen Kraft repeatedly warned the government that migrant children were in danger during her year as president of the American Academy of Pediatrics. Her worst fears were realized when two children died in government custody at the end of her term.
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A family of three from Honduras crosses the border wall on the beach in Tijuana, Mexico, before surrendering to Border Patrol on the other side on December 13th, 2018.

A family of three from Honduras crosses the border wall on the beach in Tijuana, Mexico, before surrendering to Border Patrol on the other side on December 13th, 2018.

In the early months of 2018, a disturbing rumor traveled from the southern border of the United States into the office of Dr. Colleen Kraft: Pediatricians in the Southwest were reporting that they had begun to encounter migrant children whom the government had separated from their parents.

The reports began to reach Kraft soon after she began her one-year term as president of the American Academy of Pediatrics, one of the country's foremost professional organizations of doctors dedicated to children's health, in January of 2018. As individual reports gathered in her office, Kraft became one of the first people in the country to understand that the government was separating migrant children from their families. The Trump administration would not admit to the practice until June, when then-Attorney General Jeff Sessions announced the administration's "zero-tolerance" police. Just this week, an internal government report revealed that potentially thousands more children were separated from their parents before that announcement was made.

Kraft says it was hard to comprehend the initial reports. "You don't want to believe that your country is doing something so awful," she says. "So my first thought was that we need to see what's happening. If we need to be advocates for these kids, we need to know what's going on on the ground, and then be able to speak from that position."

In April, Kraft planned a fact-finding trip to the border in southern Texas. There, she managed to tour one of the "tender age" facilities for young children managed by the Office of Refugee Resettlement. When Kraft walked first into the "toddler room" of the facility, she noticed cribs and toys. The room seemed comfortable—even homey. But Kraft immediately felt a deep sense of unease. The room, full of 15 toddlers, was dead silent.

"You know how toddlers normally are: They're rambunctious and noisy and playing," she says. "But these kids were quiet. They were just eerily quiet, except for one little girl who began sobbing in the middle of the room and was not consolable."

The staff at the facility, who Kraft believes were caring people, told her that they were not allowed to pick up or otherwise physically comfort any of the children. Kraft watched as they tried to offer the young girl a book or a toy, but they could not calm her down.

As a pediatrician, Kraft knew that, even if the staff could hold the girl, there was really nothing they could do to console her. The problem was simple: The girl needed a parent. All the kids in the room needed their parents.

Because of her expertise in children's health, the scene affected Kraft beyond its immediate tragedy. Kraft knew that all the children in the facility were likely experiencing "toxic stress," a medical condition in which sustained periods of anxiety begin to damage children's developing brains. As she thought of the crying girl, Kraft worried that the pain the child was experiencing that day could affect her for the rest of her life.

After leaving Texas, Kraft and the AAP doubled down on their campaign to urge the government to end the separation of children. Throughout 2018, the AAP continued to warn the government that the detention of children, even with their parents, for any amount of time, was dolorous to children's long-term development and dangerous for their immediate health. Kraft says that the letters and reports the AAP sent the government seemed to fall on deaf ears, until, in December, Kraft's worst fears were realized: Two children died in Customs and Border Patrol custody.

After the second child died in government custody the day before Christmas, CBP Commissioner Kevin McAleenan finally called Kraft to ask for help. The government shutdown had already begun, and McAleenan's agents were reporting that a record number of children and families continued to arrive on the southern border. Together, Kraft and McAleenan worked out a plan for his staff to coordinate with the AAP's disaster preparedness experts.

Pacific Standard spoke to Kraft in early January, after she had finished her one-year term as AAP president. She continues to serve on the organization's executive committee.

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When you began your term as president of the AAP in January of 2018, did you have any idea that the health and well-being of migrant children would become such a central issue for your organization (and indeed the country) during your tenure?

I had no idea that this was going to become the issue of my time here. Two things really brought it out into the spotlight: First of all, the Department of Homeland Security's policy of separating parents and children at the border. We know that separating parents and children is bad for children's brains. We know it causes toxic stress and is particularly damaging for a child's brain. So we we spoke out on that piece of it, and it actually resulted in President [Donald] Trump rescinding that policy. So they aren't separating parents and kids at the border [anymore].

But the second thing that's happened is the increasing number of migrant children who are coming to the border. When you look at the people coming to the border now, about half are children.

Colleen Kraft.

Colleen Kraft.

In April of 2018, you visited a tender age shelter in Texas. Could you explain what it was like to see the children there?

We felt pretty helpless. The staff had told us about a set of three-year-old twins who had been there since the night before, and they were just crying for their mommy. And they were quiet. One of them had a little toy truck, one of them had a little doll, and they just looked at us and didn't say a word. They were playing very quietly. They were very, very subdued, and you knew that the stress had become somewhat of a despair, and you felt helpless to do anything because you knew they needed their parents. That was the problem, and we couldn't fix it.

Besides toxic stress, what other sorts of health concerns do you have when it comes to child detention?

What we know about the detention centers is that they are cold. That the lights are on 24/7. That there are open toilets. [McAleenan] has actually been quoted as saying that these centers were built for adult males; they weren't built for children.

As you learned more about family separation and the detention of children, what were some of the things most present in your mind?

The thing that was outraging everybody besides the separation was really the conditions of the detention centers. You know, the cage-like things and the Mylar blankets and stuff. But I think that what really stuck with me was that toddler room [in the tender age shelter] and seeing these kid who were just despairing. Knowing that, during the long journeys that they'd had from Central America to the United States, the only buffer for them to get them through that journey was a loving parent, a loving adult. And then to take that away from these kids was really awful.

How would you describe the AAP's political advocacy on behalf of migrant children?

We knew that we really had to take hold of this narrative from the child's point of view. I had to speak from the point of view of the child, and the developing brain of the child, and the fact that the children didn't do anything wrong. So why are we punishing them?

This is such political topic. I really try to keep the conversation on the kids. This is what children need. We're pediatricians; we are experts in child health, and that's what we can speak about. I can't speak about a global solution to this, but I'm much more focused on solutions than I am on trying to point fingers.

Do you ever get accused of being partisan?

Absolutely. We hear it all the time. But again, as you speak out for children, you will sometimes appear partisan. So when we speak out on children and what they need in terms of health benefits or food, we're told, "You're a Democrat." And when we speak out on behalf of children on the fact that marijuana is dangerous to the developing brain and kids are being poisoned, then we're told, "Well, you side with Republicans."

Well, we don't side with either. Kids come from Republican, Democrat, and Independent families—and we side with children. We are very pro-child. And we will take the tack that is science- and evidence-based to speak on behalf of children.

What sort of changes need to happen to ensure children arriving at the border stay safe and healthy?

We recommend pediatric standards, in the pre-hospital setting, which would include medical control. We would recommend developmentally appropriate pediatric health screening. And we would recommend training for non-medical or non-pediatric providers on basic standard care for children. That would be our first and foremost task.

Why do staff need to be trained specifically for children's health?

What's really important has to do with the differences between adults who are sick and kids who are sick. When we as adults get sick, we slow down, and we're not as active; we rest.

Children are so different. Some kids will slow down, but a lot of kids will keep on going. And if you don't know the difference between a mildly ill child and an evolving, severely ill child, you're going to miss it. You'll see kids running around and playing, but they have increased heart rates, increased respiratory rates, and early symptoms of shock. But those kids need emergency help even if they are active and playing and they don't look sick. So that training needs to happen on the field because I think a lot of kids were being missed because they just didn't look sick.

You went on record saying that the death of Jakelin Amei Rosmery Caal Maquin, the Guatemalan girl who died in CBP custody, was preventable. How could her death have been avoided?

The first thing is, if you had pediatric standards in the pre-hospital setting: How do you assess a child when they first come to the border? How do you recognize whether they're well or whether they're sick? Having a parent sign a statement saying their child is not sick when the parent speaks an indigenous language and the paper is in English—that's not the way to do it.

The other thing is the training for non-medical providers. When this child was being assessed, she might have been one of those kids who was running around playing but was actually starting to experience [emergency symptoms]. It might not have been picked up because you just did not have someone with the pediatric training to notice those symptoms.

Is there any way for children to be detained without it adversely affecting their health? What are the alternatives?

What we recommend instead of detention centers is family-based care coordination. Before [family separation], families who were apprehended were then released [with court dates]. They went to stay with relatives; they were staying in non-profit situations, but it was family-based, and it had the family together. They had contact with their immigration lawyer. They had contact with resources for medical care and trauma-informed mental-health care. And that's what we recommend, because the evidence shows that these families stay in touch with their immigration lawyers and they show up for their asylum hearings. And that's a much more humane way to care for a child.

This interview has been edited for length and clarity.

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