Will the nightmare that these children at the border face truly end?

Will the nightmare that these children at the border face truly end?
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The nightmarish piercing cries of traumatized young children broadcasted through streaming audio feeds have now been heard around the world.

While the abominable policy of separating young children from their parents and placing them in inhumane institutional conditions has for now been discontinued, a reported 2,300 children, including infants and toddlers, were forcibly separated from their parents.


They are confined in mass detention facilities with no clear plans for being returned to their families. The chaotic environment of a detention facility, developed in haste seemingly without humane conditions, adequately trained staff and appropriate programming, is a dangerous place for children. It’s a set-up for injury, neglect, and further traumatization on top of the hardship of their migrant journey and the unimaginable pain of being torn away from their parents.

This much we know, but what lies ahead for these children? Will this nightmare ever truly end for them? What can be done?

Some of these children will be reunited with their parents in family detention, while others will be placed in shelters across the country or in foster care. Many children will be deported with their parents to their home country, and either remain there or migrate again.

Some children and parents may get asylum in the U.S. Other children, whose parents are deported, may be placed in foster care or with relatives. Some of these children may not see their parents for years or ever again.

Firstoff, nothing is more important to these children than being reunited with their parent(s). Immediate efforts must be made to locate their parents and for the children to be able to talk with them. Although no child wants to be in detention, family detention would be preferred over remaining apart from parent(s). For young children, every hour of not knowing the whereabouts and safety of their parents perpetuates unimaginable emotional distress and increases the risk of long-term consequences.

Secondly, small community based therapeutic programs are certainly more appropriate than mass detention, as they could provide these children with much needed intensive social and emotional support.

These temporary placements must provide essential components of trauma-informed child care which include continuous relationships with compassionate staff caretakers carefully trained to understand the developmental needs of children and committed to build trusting relationships with them. The children must be given opportunities to express their feelings and worries and the caretakers should be prepared to acknowledge and validate their experience of victimization.

Thirdly, all of these children have been put in cruel circumstances which can forever impact them, emotionally, developmentally, and medically. Emotionally, being without the protection of a parent in a chaotic environment leads young children to experience prolonged states of unmodulated helplessness and terror which can causes long term damage to their developing brains. For the rest of their lives, these children may experience sudden episodes of emotional dysregulation triggered by experiences and sensations that remind them of their original traumatic experience.

For example, one of these children 40 years later might have sudden panic attacks in ordinary situations when they see a person in uniform, hear an announcement on a PA system, or see a chain link fence.

Sudden disruption of a young child's attachment with family and the experience of being neglected, undermines a sense of basic trust which is necessary for many aspects of child development including the ability to maintain healthy relationships, to maintain hope in the context of adversity, and to believe in the goodness of oneself and others.

These issues set the stage for alcoholism and drug use, poor-self care, loneliness, despair, and further victimization.

It has been clearly demonstrated that adverse experiences during childhood, including disruptions of attachment relationships and other forms of child abuse cause mental and physical health consequences decades later.

Each of these 2,300 children are now set up for higher rates of depression, suicide, substance abuse, health risk behaviors, ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

Even if they are placed in some kind of foster care, the outcomes can still be profound — the multigenerational impact of the shameful American policy in the late 18th and early 19th century of removing children from Native American families for placement in boarding schools continues to haunt these communities to this day.

Can anything be done to mitigate these risks? Returning them to their families and to the “normal” routines of childhood will certainly help. Wherever they land, their parents or caregivers should be appropriately informed about how to help these children recover from this terrible odyssey, through culturally appropriate parenting strategies for at-risk traumatized children.

For many this will not be enough. They will show persistent behavioral problems which will cause trouble at home or in school now or years later. Many will need careful assessment and appropriate psychosocial or pharmacological interventions.

Some short and long term trauma-focused psychotherapy models are effective in helping children to heal after trauma and to reduce mental health symptoms including triggered episodes of anxiety, depression, and self-medication with drugs of abuse. Some, such as those with depression or post-traumatic stress disorder, may benefit from medications. Others will need family therapy or mental health treatment for their parents or caregivers whose own suffering can interfere with parenting and cause intergenerational transmission of mental health problems.

The problem for these children is that in many localities, in low and middle income countries, and in low resource settings in the U.S., access to child and family mental health services is very limited.

To address this shortfall, our government must now do the right thing by providing support and assistance to other national governments, local governments, and/or community based agencies, to ensure that these children have access to the social and mental health services that many will need now and likely for years to come.

Lastly, we should acknowledge the resilient capacities of children, families and communities to cope with trauma and adversity, which can help them to heal and grow. We hope that many will recover and go on to lead productive and satisfying lives, but even resilient children and families needs support from communities, health and mental health care, schools, and government agencies.

This is not the first time that the U.S. government has wronged children and families. However, this latest nightmare still presents an opportunity to do the right things to mitigate the wrongs committed with this White House policy.

Barry Sarvet, M.D., is professor and chair of psychiatry at University of Massachusetts Medical School-Baystate and medical director of the MA Child Psychiatry Access Program. Stevan Weine, M.D., is the director of global medicine and professor of psychiatry at the University of Illinois at Chicago and author of "Testimony after Catastrophe."