t was just another day at the pediatrics clinic where I work. My next patient was a 7-year-old, here for his annual checkup. As I walked into the exam room, he was perched precariously at the edge of the examining table, staring at the ground. He didn’t make eye contact with me or his mother, who was sitting nearby.
After logging onto the computer, I turned to him, adjusted my stool to his eye level, and asked him how school was going. He briefly acknowledged my presence with a glance, then went back to staring at the floor. Other break-the-ice questions didn’t elicit any response.
His mom asked him a question in Spanish, but she didn’t get an answer, either. She tried to shrug off her son’s apathy, but looked dejected herself.
I asked more pointed questions, like how he’d been eating and what he likes to do for fun.
“He hasn’t been eating,” his mother said.
After a long pause I asked, “Why?”
“He just won’t eat. And he does not want to play.”
“Why? What’s going on?”
Her eyes found the same spot on the ground her son was staring at. “His father was just deported to Mexico,” she sighed.
Then there was silence, for what felt to me like an eternity. I offered my condolences. His mother nodded slightly, but they both just continued staring at the ground. I asked my patient if missing his dad was what was bothering him. He nodded yes.
I turned to the computer screen, ostensibly to find the next question to document in the electronic health record but mostly to avert my gaze from the painful situation. Doctors are expected to know what to say, but in that moment I had no idea what to say. I mumbled my way through the rest of the checkup and connected them to a therapist.
I went on with my day through the grind of residency, which offered nothing more than a brief pause to reflect on my patient’s deep suffering.
I have cared for numerous depressed adolescents and adults, but never someone that young. According to the American Academy of Pediatrics, many immigrant children live in homes where there is a threat of deportation, often without notice. This has numerous health effects, including anxiety, depression, disruptions in eating and sleeping, and poor school performance.
Those are just the beginning of a broader range of physical and mental health issues that have lifelong implications. If childhood shapes who we eventually grow up to be, and forms the foundation of our health as adults, then a childhood with the threat — or reality — of deportation is extremely damaging to individual health and the health of our nation.
That incident took place in the winter of 2015. At that time, I had heard only a few colleagues mention similar stories. But as the presidential and other campaigns moved into full swing, the loudest voices were claiming that millions of immigrants needed to be deported. As I stood, transfixed, watching one such call on a hospital cafeteria television, all I could think about was my 7-year-old patient and how his family had been ripped apart.
A 2015 Migration Policy Institute report showed that between 2003 and 2013, 25 percent of the 3.7 million people deported from the US left behind at least one child. If 11 million people were to be deported, nearly 3 million children would lose a parent.
Some deportations happen quietly, out of the view of children. Others involve immigration agents entering homes with guns drawn. Witnessing the violent and forceful removal of a parent from their own home can sow in a child the seeds for lifelong trauma.
Deportation has other adverse effects on children’s health. The family member deported is often the family’s sole breadwinner. That forces the family to seek assistance so they don’t starve or become homeless. Yet many such families are afraid to reach out for resources, fearing more repercussions. This threat of exposure caused undocumented immigrants in Flint, Mich., to choose between giving their children leaded water or risk being deported if they sought to get bottled water.
Deportation, and even the threat of it, has tremendous health implications for the most vulnerable populations among us. Children are unfairly shouldering these burdens, ranging from lack of access to food or water, and extending to lifelong psychologic trauma. In medicine, to “first do no harm,” we must step outside the hospital and look at the environments in which children are being raised and stand up for the voiceless.
To a crowd of thousands of pediatricians at a recent national conference, Dr. Benard Dreyer, the president of the American Academy of Pediatrics, emotionally and emphatically proclaimed, “We must take care of all children.” The audience wholeheartedly agreed.
I think back to my 7-year-old patient and still wonder what to say. What would you tell a child who only wants his father back?
Chethan Sarabu, MD, is a pediatrician and a fellow in clinical informatics at Stanford University.