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Why the unique medical needs of children aren’t met at border detention centers

After a second immigrant child died in U.S. custody, DHS Secretary Kirstjen Nielsen announced that Coast Guard medical personnel would be deployed to screen people crossing the Mexico border. Yamiche Alcindor speaks with Dr. Colleen Kraft, president of the American Academy of Pediatrics, about harmful conditions at migrant detention centers and the specific medical needs of children.

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  • William Brangham:

    U.S. Coast Guard medical personnel will now be deployed to the Mexican border to help screen immigrants. That's according to an announcement today from Homeland Security Secretary Kirstjen Nielsen.

    These stepped-up measures come after an 8-year-old Guatemalan boy died in Border Patrol custody on Christmas Eve. He was the second child to die this month in U.S. custody.

    The secretary also asked the Centers for Disease Control to investigate the source of what she characterized as an uptick in sick children crossing the border illegally.

    Yamiche Alcindor has more.

  • Yamiche Alcindor:

    For more on this case and the efforts to better meet the medical needs of immigrant children being held in U.S. custody, I'm joined by Dr. Colleen Kraft. She is the president of the American Academy of Pediatrics.

    Earlier today, Dr. Kraft spoke by phone with officials from U.S. Customs and Border Protection about these concerns.

    Dr. Kraft, thank you so much for joining me.

    We are still waiting to learn more about the death of 8-year-old Felipe Alonzo-Gomez, but from what you have heard, what does his death — what kind of questions does his death raise in terms of the way that his case was handled by the system?

  • Dr. Colleen Kraft:

    I think the greatest question is, what is the level of pediatric care and expertise around the care of these children in these facilities?

    We don't know what kind of screenings, who saw him, when the decision was made to take him to the hospital or send him home. And we continue to have questions about this.

  • Yamiche Alcindor:

    I want to talk to you about the way that the U.S. Customs and Border Protection is now handling this.

    They said that they're going to have secondary checks on all children within their custody and that they're also going to be partnering with your organization.

    Can you tell me a little bit more about those checks and what they're doing to get experts to deal with these children?

  • Dr. Colleen Kraft:

    I can't tell you specifically what their checks look like now.

    What I can tell you, though, is that the medical needs of children are very different than the medical needs of adults. A child who is severely ill may just have some very subtle changes from a child who's mildly ill. There are things like an increased heart rate, respiratory rate, or decreased capillary refill that can differentiate a child who's very ill from a child who's mildly ill.

    And you need specific pediatric expertise to be able to know the difference and manage these children correctly.

  • Yamiche Alcindor:

    What did the agency tell you about these secondary checks and their partnership with your organization?

  • Dr. Colleen Kraft:

    When I spoke with Commissioner McAleenan earlier today, he is very interested in improving the care of the children in CBP custody.

    And the American Academy of Pediatrics has reached out to the Department of Homeland Security to tell them that we're really interested in the monitoring, in the training of personnel, in working with them to ensure that these children are managed medically correctly, and that they have optimal health.

  • Yamiche Alcindor:

    You were just talking about the commissioner.

    I want to play for you what he told CBS earlier today. Listen to this.

  • Kevin McAleenan:

    Our stations are not built for that group that's crossing today. They were built 30, 40 years ago for single adult males, and we need a different approach. We need help from Congress. We need to budget for medical care and mental health care for children in our facilities.

  • Yamiche Alcindor:

    Dr. Kraft, what do you make what he's saying there? And what do you think needs to change to improve the facilities for these kids?

  • Dr. Colleen Kraft:

    His words really resonate with what the American Academy of Pediatrics has published in our policy on detention of immigrant children.

    We know these facilities are not good for children. They're cold. They have lights on 24/7. They have open toilets. They are places where children can get sick and get sicker.

    So we agree that something needs to change and be done to monitor and teach and look at the care for the children in these facilities.

  • Yamiche Alcindor:

    Before Felipe died, 7-year-old Jakelin Caal Maquin died. What's happening here with children in these facilities, that we're now seeing two deaths this close together?

  • Dr. Colleen Kraft:

    The problem is that we don't know what's happening here.

    And when it comes to the medical care of children, if you're not trained in pediatric care, you don't know what you don't know. So, these children are getting sick. And the personnel, who may be very caring, aren't realizing how sick these children are. So they're going on to die.

  • Yamiche Alcindor:

    And lastly, Dr. Kraft, can you talk to me a little bit about what you think overall is going to happen now that we have seen these changes kind of going into effect?

  • Dr. Colleen Kraft:

    We think the outreach from the commissioner is very good initial news. The devil is in the details, though. So we need to be able to partner and have unfettered access to these facilities.

    We need to bring in the pediatric training. We need to bring in the pediatric monitoring. And we need to make sure that children in our custody are being cared, so that their health is optimized and that their health is not put at risk.

  • Yamiche Alcindor:

    Dr. Colleen Kraft, thank you so much.

  • Dr. Colleen Kraft:

    Thank you.

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