For detained migrant children, the longer the trauma the greater the impact

As a pediatric intensive care doctor, I have stood next to countless family members remembering the death of their loved ones with hand and footprints marked in the same proud ink that captures the hand and footprints of healthy children. I have recently held the tiny hands and feet of one of my own family member’s children gently but firmly to etch their imprints into white concrete molds that memorialize the innocence of life both born and lost too soon. 

In recent testimony before Congress, Yazmin Juarez recounted her own story of the death of her daughter after being held in detention and the “piece of paper with Mariee’s handprints” memorializing her death on Mother’s Day. Her testimony reminds us of the other children whose lives have been lost in custody and of the ongoing experiences of trauma and suffering for immigrant children and their families. We must stop ongoing trauma at the border and create a plan to address recovery. To do so, we need a strong commitment to funding and resources that can interrupt the current cycle of revictimization.

Juarez’ testimony occurs in the context of a lawsuit alleging failure to prevent the death of her daughter. It comes simultaneously with calls from 18 states for relief for “failure of the federal government to meet it’s legal requirement to hold children in ‘safe and sanitary’ condition.” Both of these actions reflect a desire for accountability on the part of government for the experiences endured by individuals seeking refuge in this country. 

The recently passed Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act did not include provisions for addressing the physical or mental health needs of children outside of maintaining minimum facility staffing ratios.  

In the context of a projected ongoing shortage of mental health professionals in the coming years, recovery plans must incorporate attention to and sufficient funding sources for adequate mental health resources to address the impacts of revictimization and complex trauma in this vulnerable population. 

Trauma is perhaps greatest felt by the loss of life occurring for detained children. But, there remain additional sources of trauma as well.  Drawings from children held in detention centers depict their experiences. These images, showing children drawing themselves in cages, are powerful reminders of their intense emotional distress. 

A recent article noted the Smithsonian’s potential interest in these drawings, reflecting a time in history that will be remembered for its profound impact. And, concerns remain that ongoing immigration raids will create an enduring sense of crisis among the immigrant and border population.  

Ongoing trauma related to continued time in detention even when not separated from families, family separation, and a culture of fear in the immigrant community revictimizes individuals who have already experienced trauma in their attempt to seek refuge from the original conditions that brought them to this country. This can create complex trauma that cuts against known best practices to avoid retraumatization in a trauma-informed approach to addressing the needs of detained children. Amidst calls to address the myriad needs of children at the border needs to be a strong demand to address the impacts of revictimization. 

Accountability is important to ensure the kind of change over time that will avoid repeating or perpetuating similar experiences in the future. But, what our children need now is continued focus on ceasing the practices that create ongoing trauma, adequate attention to their current physical and mental health needs, and a comprehensive plan for mental health recovery.  

The American Academy of Pediatrics has repeatedly documented best practices for addressing health needs of immigrant, migrant, and border children, highlighting the importance trauma-informed approaches to their care. Responding to complex trauma will require access to individuals who are skilled in completing comprehensive assessments and trained to implement effective interventions. These include promoting attachment of children and comprehensive family services to facilitate ongoing coping and recovery. 

When a child dies, we create memory boxes as a space to hold onto something — often all a family feels they have left of their child. We think of the process as both honoring the child’s life and opening up a space for remembrance and recovery for the family, to begin the process of healing from the trauma of loss.  

Children are fundamentally resilient, and, with the right resources, can place their experiences into some sort of their own memory boxes. Experiences will likely never be forgotten. And, the longer the trauma endures the greater the impact will be. But, with appropriate and timely intervention we can limit impact and facilitate recovery. 

Erin Paquette, MD, JD, MBe is a pediatric critical care doctor, lawyer and ethicist. Paquette is an assistant professor of pediatrics at Northwestern University’s Feinberg School of Medicine, adjunct professor at NU’s Pritzker School of Law, and pediatric critical care scientist development scholar. She is a public voices fellow with The OpEd Project.