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AAP calls for urgent changes in care of migrant children following latest border visit :

July 12, 2019

From left to right: AAP Immigrant Health Special Interest Group Co-Chair Marsha Griffin, M.D., FAAP; Texas Pediatric Society Vice President Mark Ward, M.D., FAAP; AAP President-Elect Sally Goza, M.D., FAAP; and AAP President Kyle E. Yasuda, M.D, FAAP, outside of Catholic Charities Humanitarian Respite Center in McAllen, Texas.

After a visit to two border facilities in Texas in late June, AAP leaders are calling for urgent, permanent changes in how the U.S. treats immigrant children when they arrive in our country. In addition, pediatric-trained medical providers need to be on hand to care for them wherever they are being held.

“I want our members to know that we are committed to making sure this issue stays in the spotlight until we have solutions to some of these issues,” said AAP President-Elect Sally Goza, M.D., FAAP. “We need humanitarian care for these children, and (U.S.) Customs and Border Protection (CBP) facilities are not where they need to be.”

Dr. Goza made the trip with AAP President Kyle E. Yasuda, M.D., FAAP; Marsha Griffin, M.D., FAAP; Mark A. Ward, M.D., FAAP; and others. They toured a holding facility in the city of Donna and a Catholic Charities Humanitarian Respite Center (called “Ursula”) in McAllen. Both locations are in the Rio Grande Valley, which has seen a significant surge of migrants from Central America.

“Our role was to tour and see with our own eyes what’s going on in these facilities and what’s happening with children in these facilities,” Dr. Goza said.

Desperate conditions

AAP President-Elect Sally Goza, M.D, FAAP, listens to the lungs of a 2-year-old girl at Catholic Charities Humanitarian Respite Center in McAllen, Texas. After the toddler was released from Customs and Border Protection custody, she was sent to the emergency room where she was diagnosed with a congenital heart defect and started on treatment.

In an email to all AAP members on the day of the border visit, Dr. Yasuda expressed the need for specific changes in the treatment of immigrant children, a message later reinforced by personal observations.

The delegation found children exhibiting signs of physical and emotional stress. Many of them were lethargic, sleeping or crying, or appeared exhausted.

A stench of urine, feces and perspiration hit the group when they entered one of the facilities. Also prominent was the sight and sounds of crinkling Mylar blankets, which Dr. Goza called “a sea of silver.” Lights remain on 24/7, and the migrants sleep on mats on the floors in metal cages. The rooms are cold. Port-a-potties allow users to be covered only from shoulders to knees. A guard tower stands watch.

“It was really shocking,” recalled Dr. Goza. “No matter what you see in pictures and what you hear on the news, to actually be there and see it … those blank stares and the bloodshot eyes and the eyes that are just wide open … I think that’s because they are on such red alert on what’s going to happen next. …”

One image she can’t erase from her mind is that of two sisters, ages 3 and 5. They were seated on a bench while a guard removed their tennis shoes and put on different footwear. Dr. Goza noticed the girls showed no emotion. She learned they were unaccompanied minors.

“I looked back at them again, and the one thing that struck me was those two sisters were holding hands so tightly their knuckles were almost white, but they were not going to let go of each other. I think that will haunt me: that blank stare in their faces but clutching each other because they didn’t want to lose each other,” she said.

On July 2, a watchdog report from the Office of Inspector General warned of dangerous conditions in several facilities and ports of entry in the Rio Grande Valley. The report recommended the Department of Homeland Security “take immediate steps to alleviate dangerous overcrowding and prolonged detention of children and adults in the Rio Grande Valley.”

“The report states that the current situation on the southern border represents an acute and worsening crisis,” said Dr. Yasuda. “Our own observations in these facilities reinforced the AAP position that children should not be separated from their parents or guardians. They should not be housed in detention facilities, and wherever they are held, pediatricians should be allowed to care for them.”

Next steps

This trip marked the fourth AAP delegation to visit border facilities. Recently, the Academy provided a training video to CBP — including how to identify signs of serious illness — but has advocated that much more is needed. This week, Dr. Goza visited Capitol Hill to share her recent observations. The Academy also is asking members to support the Ruiz bill (H.R. 3239,, which seeks to guarantee basic standards of care for children in CBP custody.

“We just have to keep focusing on what we know is right for children,” Dr. Goza said. “(The AAP) … is for the health and well-being of all children. We can’t turn our back on this.”

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