Pediatric Annals

Editorial Free

The Separation of Children from Their Parents and Toxic Stress

Joseph R. Hageman, MD

Recently, I was babysitting my 15-month-old grandson, Logan, while his parents and my wife were working. We spent the morning with activities that he enjoys like walking (he is a novice walker as he started approximately 1 month ago) around the house and up and down the staircase and in and out of our rooms, some of which have books and toys for all six of my grandchildren. We had a good time and he was comfortable spending time with one of his grandfathers, who he knows and trusts. His parents went to work knowing they would return later in the day to see their son. Although Logan is just a toddler, he can sense when he is separated from his mother and father, and he also knows who his regular caretakers are outside of his parents.

Now, think about the unsettling images and stories of the migrant children who have been separated in recent months from their parents due to a zero-tolerance immigration policy introduced by the administration of President Donald Trump.1 Many clinicians, caretakers, parents, and providers, as well as Dr. Colleen A. Kraft, the president of the American Academy of Pediatrics (AAP), have expressed grave concerns about the implementation of this policy and the tremendous short- and long-term effects it will have on the children and their families.2

I also refer you to a couple of the countless articles2,3 about how these experiences bring on toxic stress, and the concern about the negative lifelong consequences on the physical, psychological, and emotional status of these children; many of whom have yet to be returned to their parents.4 It is our responsibility as pediatric providers to support the termination of this policy, and to do our best to recognize children who come to us for care who may have experienced the trauma of separation.

We need to provide ongoing support and clinical services for any migrant children who present and for any child who has experienced toxic stress.2,3,5–8 The AAP Immigrant Child Health Toolkit, created by the AAP Council on Community Pediatrics Immigrant Health Special Interest Group, can be a valuable resource; it identifies effective clinical practices, strategies, and community resources to address common matters related to immigrant child health.9 It also provides practical information to help us better understand the child's journey and how to support healing.9


  1. Rizzo S. The facts about Trump's policy of separating families at the border. Accessed August 9, 2018.
  2. Miller D. AAP, a leading voice against separating children, parents at border. Accessed August 22, 2018.
  3. Bucci M, Marques SS, Oh D, et al. Toxic stress in children and adolescents. Adv Pediatrics. 2016;63:403–428. doi:. doi:10.1016/j.yapd.2016.04.002 [CrossRef]
  4. Shapiro L, Sharma M. How many migrant children are still separated from their families? Accessed August 22, 2018.
  5. Yogman M, Garfield CFCommittee on Psychosocial Aspects of Child and Family Health. Fathers' roles in the care and development of their children: the role of pediatricians. Pediatrics. 2016;138(1):e20161128. doi:. doi:10.1542/peds.2016-1128 [CrossRef]
  6. Wade R, Shea JA, Rubin D, Wood J. Adverse childhood experiences of low-income urban youth. Pediatrics. 2014;134(1):e13–e20. doi:. doi:10.1542/peds.2013-2475 [CrossRef]
  7. Dowd MD. Intimate partner violence and pediatric practice. Pediatr Ann. 2017;46(12):e438–e440. doi:. doi:10.3928/19382359-20171127-01 [CrossRef]
  8. Stolbach BC, Anam S. Racial and ethnic health disparities and trauma-informed care for children exposed to community violence. Pediatr Ann. 2017;46(10):e377–e381. doi:10.3928/19382359-20170920-01 [CrossRef]
  9. American Academy of Pediatrics. Immigrant child health toolkit. Accessed August 22, 2018.

Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:


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