Clinicians at public hospitals in New York City who have started seeing children separated from their families at the border are concerned about the psychological impact of the separation as well as the practical challenge of treating children whose medical history is unknown.
At a news conference, officials announced that at least 12 such children had been seen at public hospitals, brought in by their new caretakers. Dr. Mitchell Katz, president and chief executive of NYC Health & Hospitals, described the children “being brought in by loving foster families struggling to take care of these children,” but aware that they have been traumatized by the separation. The announcement took place in the atrium of Bellevue, the oldest public hospital in America, founded in 1736 — a reminder that these institutions have a long history of providing front-line care to the marginalized, the dispossessed and struggling new arrivals.
Dr. Daran Kaufman, the director of pediatric emergency services at NYC Health & Hospitals/North Central Bronx, said that she had reached out to Dr. Katz because “all of us in our emergency department have been touched so deeply by this issue and the patients we’ve seen.” The foster parents who have brought the children in, she said, “have been very caring, but they’ve also felt quite unsure how to address the needs of these children.”
The children who come in with medical issues such as asthma are without adult family members who can provide medical history, Dr. Kaufman said. In some cases, doctors have asked for details of past illness and treatment from older siblings who may themselves not even be teenagers.
And then there are the children’s emotional needs, which are far more difficult to address. Dr. Jennifer Havens, the director and chief of service of the department of child and adolescent psychiatry at Bellevue Hospital Center, said that in the pediatric emergency room, doctors are accustomed to seeing adolescents who came to the United States without their parents, and have been placed by the government in the care of social service agencies. But now they have started seeing much younger children who were separated from their families at the border.
Dr. Ruth Gerson, director of the Bellevue Hospital Center Children’s Comprehensive Psychiatric Emergency Program, said that helping these children presents special difficulties. “Typically as child psychiatrists, we’re helping children deal with trauma, whatever it is, after it’s over and they’re in a safe and secure environment,” she said. “These kids are in the midst of ongoing trauma. They don’t know if their families are O.K., and we as therapists are also in a much harder position — we don’t know how to help, we don’t know the facts, it just makes trauma treatment so much more complicated.”
Young children who have suffered trauma may regress developmentally, she said, losing skills that they had mastered. Or they may have behavioral symptoms like severe tantrums or difficulty sleeping. “It’s important for people to remember that young children can experience pretty severe depression and suicidal thoughts, even preschool children,” she said, and caretakers should take any such statements from children seriously.
And children suffering from post-traumatic stress may describe their symptoms in terms that adults may misinterpret, she said.
“How do we understand a child who says they’re hearing voices after a severe trauma?” Dr. Gerson said. In an adult, the diagnosis might be psychosis, but this may be how a child describes flashbacks or intrusive thoughts, common symptoms of PTSD.
In older school-age children and adolescents, she said, “depression can often look like irritability, a child who seems angry all the time, not necessarily sad and mopey.” Caretakers should watch for any evidence of self-injury, and again, be alert for behavioral changes as well as any expressions of despair. And all of this is more complicated if there are language barriers.
Gov. Andrew M. Cuomo toured a residential facility housing some of the children, where an official said: “They have trouble sleeping, sometimes they’re anxious, depressed, crying, primarily.”
The doctors speaking at Bellevue said that there are probably more of the children separated from their families coming in for care than have been identified. “We don’t ask about people’s immigration status here because we want families and children who are concerned about their immigration status to feel safe coming here,” Dr. Gerson said, “because our mission is to provide treatment.”
At the news conference, Dr. Katz called providing care for these children “a phenomenal use of Health & Hospitals” to “be here for people, whatever the crisis,” and Chirlane McCray, the first lady of New York City, thanked the clinicians at the city’s hospitals who are treating these children “how every child should be treated.”
“We’ve just tried to show these kids kindness,” Dr. Kaufman said. That means language and cultural competency — they are able to speak to the children in Spanish — but it also means trying to do a little extra for both the children and their caretakers. “We let them know they are welcome here, even though they’ve experienced such trauma, we have toys and books and gifts and we give as much as we can to the children and to the families caring for these children.”
“My biggest priority is to have people realize that developmental regressions, giant tantrums, sleep problems, hearing voices, can be a totally natural response to trauma,” Dr. Gerson said. “We need to get these kids back with their families.”
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