The following communication from CNS President Jonathan W. Mink, MD, PhD was approved by the CNS Executive Committee on June 20 for transmission to President Donald Trump, Attorney General Jeff Sessions, Secretary of Health & Human Services Alex Azar, Secretary of Homeland Security Kirstjen M. Nielsen, Senate Majority Leader Mitch McConnell and Speaker of the House Paul Ryan.

I am writing on behalf of the 2000 physician members of the Child Neurology Society (CNS) to express our collective professional opposition to the Administration’s policy of separating children from their parents at our nation’s border.  I write to draw your attention, based on our clinical expertise, to the truly dangerous outcomes this policy can have on the lifelong mental and physical wellbeing of the children who have been and continue to be targeted and incarcerated by the Administration. 

Child neurologists are specially trained physicians who have followed up their four-year medical school education with a five-year post-graduate training regimen consisting of two years training in pediatrics, one year in general neurology, and two years in pediatric neurology. There are over 70 university-based training programs in child neurology in the United States and Canada, and over 2000 child neurologists in the CNS.

The research and practice is clear –adverse childhood experiences are closely connected to decreased physical health.  Adverse childhood experiences (or ACEs) are defined as “stressful or traumatic events, including abuse and neglect.” ACEs are “strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse.”

There is a significant body of research that has examined the relationship between ACEs and known risk factors for disease, disability, and early mortality. A landmark study conducted by the Division of Violence Prevention at the Centers for Disease Control and Prevention (CDC) in partnership with Kaiser Permanente (’95-’97) found that:  1) ACEs are common, 2) ACEs cluster, and 3) ACEs have a dose-response relationship with many health problems.  In fact, the CDC refers to ACE as an “important public health issue” that has been linked to risky health behaviors, chronic health conditions, low life potential, and early death.  Further, according to SAMHSA, “Research has demonstrated a strong relationship between ACEs, substance use disorders, and behavioral problems. When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning or ability to cope with negative or disruptive emotions may be impaired.”

As the full spectrum of news media have amply documented and the Administration in response has defiantly confirmed, children—some as young as infants—are not only being separated from their parents or other family members, they are also being detained in detention facilities or shelters operated by the Department of Health and Human Services (HHS). According to the Administration’s own reports, thousands of children have been separated and detained since May of this year in direct response to the publication of a new “zero-tolerance policy" for illegal border crossings. The HHS’ Office of Refugee Resettlement (ORR) charged with overseeing the "care and placement" of unaccompanied migrant children reports that thousands of children have been so detained or sheltered, adding in apparent, but preposterous, justification that such “children spend fewer than 57 days on average” at the shelters.

Such stress imposed on these children can be especially harmful.  In a 2017 study, “New insights into early-life stress and behavioral outcomes,” researchers Jessica L. Bolton, Jenny Molet, Autumn Ivy, and Tallie Z. Baram found that ”adverse early-life experiences, including various forms of early-life stress, have consistently been linked with vulnerability to cognitive and emotional disorders later in life.”  Serious outcomes ranged from “hippocampus-dependent memory deficits to emotional consequences such as anhedonia and depression.”  The study specifically analyzed separation of offspring from parents and found a high correlation of this particular type of stress to such later disorders. 

Knowing, on the basis of our collective research, analysis, and clinical experience, the long-lasting, potentially devastating mental and physical harm that can result from the forced separation of children from their parents, we strongly urge you to reverse this medically flawed and ethically unconscionable policy before more damage of this kind is inflicted upon innocent children under the auspices of defending our borders.

Jonathan W. Mink, MD PhD, FAAN, FANA, FAAP
President, Child Neurology Society