Regardless of how children enter our country we have a moral obligation to protect them

Regardless of how children enter our country we have a moral obligation to protect them
© Getty Images

The second time I held another parent’s dying child as the child passed was just before sunrise. As the light of the coming day danced weightless over Lake Michigan just outside her Chicago hospital room, I felt her last breaths against my chest in the same place where my own child’s head often rested. 

As a pediatric critical care doctor, taking care of this four-month-old patient, I also felt the weight of the story I’d witnessed the day before, the one that brought her here. Her father had paced her hospital room begging her to live, recounting the experience of witnessing many of his family killed in a conflict-torn region in Africa before fleeing to this country.


He was sobbing over her bed as he told me and my medical team who stood around the perimeter of her room that he could not bear to watch the meningitis with sepsis that had taken over her body, now take her life. 

I felt I had to take the burden off this man who had witnessed so much in his life but who was finally broken by the death of his child, here, in this country, that was supposed to set them free.

My profession is caring for the very sickest children; seeing death is inevitable. Each death touches you in different ways. But, the death of a child who should have lived also ignites you to change the conditions that allow it to happen.

The impact of early life toxic stress on children’s future mental health and development of chronic health conditions is well-documented. As was this case with this child, traumatic conditions lead families to flee their home environments and present to immigration authorities.

This child died of overwhelming infection. While I cannot know for sure whether her response to infection was impacted by the experiences of her family, we are learning through emerging research, that exposures to traumatic environmental stressors, experienced by both parents and children, can make it more likely to become critically ill and die from conditions like asthma and overwhelming infection.

This is because trauma can alter the body’s response to stress over time, changing how the body is then able to respond to stress during periods of critical illness. The experience of ongoing toxic stress can literally lead to children having a higher risk of dying than other children who are not exposed to similar circumstances.

But what awaits many of these children if and when they arrive at the borders seeking asylum, may also further harm them. Systematic continuation of traumatic experiences in detention centers increases their likelihood to suffer untoward consequences on their mental health and later development of chronic conditions.

Prolonged detention and separation from parents create conditions of toxic stress. Many observers have described the variable conditions in detention centers; some violate minimum standards for children and are not optimal for healthy child development. Other reports claim lack of adequate facilities for children to meet their minimum needs, including lack of adequate health care.

Most distressing is the lack of parental contact for young children, who may be most susceptible to the impact of lack of attachment at their young age. 

This week marks the final deadline for public comment on the notice of proposed rule-making for the 1997 settlement of the United States Supreme Court case of Reno v. Flores.  The case involved Jenny Lisette Flores, a 15-year-old girl from El Salvador, who tried to enter the country illegally in 1985 to be with her aunt.

The Flores settlement aspired to address these issues of detention, requiring the government to release children preferentially with parents or other family, or if unavailable, the next least restrictive setting and to establish standards for the care and treatment of children in custody.

Despite failed previous attempts to overturn the Flores decision, the Trump administration recently announced renewed interest to alter the agreement in ways that erode these protections for immigrant children.

A group of critical care doctors, including myself, submitted comments to strongly oppose efforts to reverse the decision. Our comments stem from knowledge about conditions in detention centers; longstanding knowledge about the impact of adverse experiences on children’s physical and mental health as they grow and emerging knowledge specifically about the impact of adverse experiences on the trajectory of illnesses that can lead to critical illness and death.

The case serves as a reminder to renew all efforts to attend to the physical and mental health needs of immigrant children living in detention centers and to ensure enforcement of the Flores agreement. 

Regardless of how children enter our country, when they are here, the state has a moral obligation to protect them. Some may claim priority for children born within our borders whose own experience of less than optimal environments and toxic stress places them at similar risk.

Are we not obligated to protect both groups of children, neither of which has a voice to advocate for themselves?

Others will argue that the state’s obligation in protecting the interests of immigrant children must be balanced against rational immigration policy. Even if, as the Court ruled initially in the Flores case, the state’s legal obligation to protect these interests is altered by its competing interest for rational immigration policy, it is not eliminated. The Flores agreement acknowledges this balance. 

The moral obligation to act in a child’s best interest remains paramount. 

Those who bear witness to lives that end too soon, should implore the government to improve its compliance with the Flores agreement to avoid ongoing toxic stress in immigrant children.

The experience of the children in the caravan is similar to that of those children living in detention centers. Yet, despite the traumatic experience of the caravan, many of these children flee even worse circumstances to seek a better life. There is an opportunity here to do it better, to do what is right for these children.

It is imperative to improve conditions for children living in detention. Efforts to reunify children with the trusted loved ones with whom they can form attachments need to be increased. Releasing them to less restrictive settings as soon as possible is urgent.

The United States must be accountable to its citizens for the impact policies may have on children who could lead healthy and productive lives. We owe this to all children and the families left broken when their lives are lost. 

Erin Paquette is a pediatric critical care doctor and lawyer, an assistant professor of pediatrics at Northwestern University’s Feinberg School of Medicine and adjunct professor at NU’s Pritzker School of Law. She is a Public Voices Fellow through The OpEd Project.