The decision by the U.S. Department of Homeland Security, in collaboration with the Justice Department, to separate children and parents at the border is a practice that has the potential to cause significant, lifelong harm to the children involved. The National Association of Pediatric Nurse Practitioners (NAPNAP) calls upon the Administration to focus on the physical and mental health, safety and security needs of the vulnerable children involved. NAPNAP appreciates the Justice Department’s goal to prevent child trafficking and to protect our borders. However, the inadvertent traumatization of children who are unlikely to understand their parental separation creates a humanitarian crisis. The United Nations’ Office of the High Commissioner for Human Rights called on the Trump administration to "immediately halt" the separations, saying "detention is never in the best interests of the child and always constitutes a child rights violation." We urge immigration officials to use the quickest means possible to determine family relationships, immediately cease separation of children from their families, and reunite those who have been separated to date. This call to action includes families seeking asylum or immigrating.

The U.S. Customs and Border Protection reports more than 650 children were separated from parents during a two-week period in May. It is unclear how many children have been affected by this practice but reports in the media and confirmed by the administration indicate it is likely thousands over the past six months.

We urge immigration and law enforcement agencies responsible to immediately consider the following concerns:

• Many of these children have traveled for days through dangerous terrain without adequate protection, food or water. Many fled violent, traumatic environments in their home country. Comprehensive pediatric health screenings and care for chronic and acute disease are needed to address urgent public health and individual physical and mental health needs.
• Research clearly shows that traumatic life experiences in childhood, especially those that involve loss of a caregiver or parent, cause lifelong risk for cardiovascular and mental health disease. Additionally, there is evidence that toxic stress in childhood may cause “turn on” genes that increase disease risk in affected individuals and this risk may be passed to future generations.
• Care should be taken during immigration proceedings to minimize emotional trauma. Adequate provision of interpreter services and legal representation during immigration proceedings is essential. Trauma-informed practices are grounded in child development and ensure that children are treated as children and not small adults.
• For more than a century, child development experts have underscored the negative effects that institutional living environments have on children. These are highly stressful for children and do not provide needed social-emotional support and security. Research shows that overcrowded, institutional environments heighten children’s risk of physical, mental or sexual abuse.  Every effort should be made to ensure children’s safety while in shelter residence and minimize the time children reside in border shelter facilities.

We urge state and federal leaders to respond swiftly and compassionately to the health and emotional security needs of these vulnerable children and provide them just due process. We encourage our members to contact their state and federal representatives to voice our shared concern and expertise. We stand with our physician, nursing and other healthcare colleagues who have already denounced this damaging practice. NAPNAP and many of its 50 chapters in the U.S. signed on to a joint letter opposing this administrative action, which was dated June 7, 2018 and directed to Kirstjen M. Nielsen, secretary of the Department of Homeland Security.

Approved June 11, 2018

Edit: On June 19, NAPNAP signed a joint letter from the Nursing Community Coalition directed to Kirstjen M. Nielsen, secretary of the Department of Homeland Security, urging the department and the overall administration to protect the health and wellness of immigrant children.