Dr. Colleen Kraft, President of the American Academy of Pediatrics, on Separating Immigrant Families at the Border and the Impact of Toxic Stress
Dr. Colleen Kraft
[Music]
Female: Welcome to C onversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health policy, health innovation and technology and the great
minds who are shaping the health care of the future. This week with
the leadership changes at Homeland Security, Mar k and Margaret
decided to revisit their 2018 conversation with Dr. Colleen K raft,
P resident of the American Academy of Pediatrics who spent time with
migrant children separated from the ir parents at the border and the
impact of such toxic stress on children. She also discusses the
importance of vaccines reducing harm from gun violence and limiting
access to screen time for better mental health and development for
kids.
Lori Robertson als o checks in Managing Editor of F act Check.org looks
at misstatements spoken about health policy in the public domain
separating the fake from the facts . We end with a bright idea that’s
improving health and well being in everyday lives. If you have
comments , please email us at [email protected] or find us on
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C onversations on Health Care . Now, s tay tuned for our interview with
Dr. Colleen K raft, P resident of the American Academy of Pediatrics on
C onversations on Health Care.
Mark Masselli: We're speaking to Dr. Co lleen K raft , P resident of the American
Academy of Pediatrics, an organization of 67, 000 pediatricians
dedicated to the physical, mental and social health of America's
children. Dr. Kraft is the founding pediatric program director at the
Virginia Tech Carilion School of Medicine. She was also the Medical
Director of the Health Network by C incinnati Children's . She is co -
author of the book Managing Chronic Health Conditions in Child Care
and S chools. She earned her medical degree from Virginia
Commonwealth University where she also completed her residency in
pediatrics . Dr. Kraft , welcome to C onversations on Health Care .
Dr. Colleen Kraft: Well, thank you so much for having me.
Mark Masselli: Yeah , a nd , you know, obviously you've been in the news a nd the
larger story in the news is certainly been the separation of immigrant
children from thei r parents at the border, which has led to a hue and
cry across the country to end the practice from a wide array of
sectors, including your organization the American Academy of
Pediatrics . Y ou personally were given access to a shelter holding some
of these children so you have firsthand experience of how it's
impacting . I’m wonder ing if you could share with our listeners what
you witnessed, and what you yourself have called government
sanctioned child abuse.
Dr. Colleen Kraft
Dr. Colleen Kraft: Sure. A t the American Academy of Pediatrics, we keep our eyes and
our lens on the children and what's right for c hild h ealth. As I was
invited to come to visit one of these shelters, I came in and the shelter
itself was one of the tender age shelters a nd was very homey looking,
there w ere beds and cribs, and books and toys . I walked into the
toddler room a nd if you've ever been in a room full of toddlers, they
are rambunctious and loud and these kids were not. They were quiet
and scared and looking at you.
T here was one child in the mid dle of the room who was just
uncontrollably sobbing. T he staff person next to her wanted to help
her out , w as trying to give her a toy , was trying to give her a book , b ut
this child was crying . The staff person couldn’t pick her up and
couldn't hold her sh e was not allowed to do that. W e all knew in that
room that what these children needed w ere their parents , t hat
because their parents weren't there, they were suffering from toxic
stress , a nd their behavior was so abnormal for toddlers
Margaret Flinter: We ll, Dr. K raft t hese are heart wrenching images you share and we
know the kids were suffering in the moment. But we also know as
clinicians that the impact of early childhood trauma and toxic stress
sets the stage for really lifelong negative impacts. Maybe you could
share with us what the science tells us about these adverse childhood
experiences of trauma and separation, fleeing disasters, and the
effect of this trauma on health into adulthood . W hat kind of
interventions are called for to mitigate some of the worst effects from
these experiences, obviously mitigating the effect of what's happened
to these kids ?
Dr. Colleen Kraft: W hat th e separation does is it creates in these very young children, a
rush of their stress hormones of cortisol of epinephrine. T hese
hormones when they're not buffered by a loving and caring adult,
ca use something called toxic stress, where the neurons don't develop
normally , t hey don't have the synapses with other neurons. T his
actually develops disruption in the brain architectu re of these young
children. W hat they don't develop is speech and language , t hey don't
develop their ability to bond social ly and emotionally with adult s and
with others . Down the road that actually leads to school failure , to use
of substances , to anxieti es and depression, to chronic health
problems like diabetes or heart disease.
Mark Masselli: Dr. Kraft I know the court has ordered the government to reunite the
families a nd obviously there are some roadblocks, I think we all read
where a number of parent s have already been deported to their
country of origin. But I understand that your organization has taken
an active role in addressing the situation joined by some of your
professional colleagues at the American College of Physicians, the
American Psychia tric Association, to try to figure out how to resolve
Dr. Colleen Kraft
this . I'm wondering if you could share with us about your efforts that
are underway with the American Academy of Pediatrics that will lead
to help facilitate the reuniting of these families.
Dr. Colleen Kraft: T he mission of the American Academy of Pediatrics is to protect the
health and wellbeing of all children regardless of where they or their
parents were born. F rom the moment that they're in our custody in
the United States, children should have acc ess to health care . T he
American Academy of Pediatrics has offered our assistance in
reuniting families and supporting their needs. Pediatricians across the
country are prepared to provide care for these immigrant children as
they enter our communities. We play an important role in caring for
these children and families and connecting them with other
resources, like trauma informed care.
But right now, our pediatricians don't currently have a way of
knowing when a child is released from federal custody. W e have
recommended that the Office of R efugee R esettlement and the
Department of Health and Human Services create a mechanism to
identify willing medical and mental health providers and connect
these children and families being released from its custody to t hose
sources of care. That way we can provide the physical and mental
health care that these kids and families need as they're being
re united.
Margaret Flinter: But you know, gosh, there’s s o many challenges for children's health
t hese days . W e wonder if y ou could talk to us a little bit about
another issue that's both been in the news a nd one I think we thought
maybe we were past worrying about and that's the whole issue of
supporting breastfeeding as a vital contributor to the health of
children to long t erm health that’s been supported by your
organization . It 's certainly been supported by the World Health
Organization a s the best way to support sound nutrition. But we've
had quite a bit of controversy recently, when the administration
pushed back against the protocol that was being recommended.
You've got some pretty clearly defined guidelines on breastfeeding
recommendations at the American Academy of Pediatrics. What are
those guidelines? W hy is it so important for early childhood health
and development ?
Dr. Colleen Kraft: W e know the science of infant feeding, and that breastfeeding is
meant for human children and that breastfeeding support s brain
development, it supports optimal nutrition, it helps to promote
optimal growth, but also to prevent obesity , and allergies and other
infections. F or the mothers that actually helps to get them back to
normal weight gain, it helps to prevent breast cancer. B ased on this,
the American Academy of Pediatrics is aware of this that the US
government sought to weaken the resolution supporting
Dr. Colleen Kraft
breastfeeding at the recent World Health Assembly. But based on the
science, we encourage all countries to promote and protect and
support breastfeeding for the health of all children.
Mark Masselli: We're speaking today with Dr. Colleen Kraft, P resident of the
American Academy of Pediatrics, an organization of 67,000
pediatricians dedicated to the physical, mental and social health of
American children. Dr. K raft your bio has an interesting note that
you're a graduate of one of th e first H ead Start programs in the
country. I sort of want to connect back to our history back in 1972 ,
our first program initiative is with our local Head Start program, and
they do such important work . T hat experience shape d your
professional and persona l quest to eliminate health disparities. Y ou've
really translate that into the type of training that you're trying to give
to medical students at Virginia Tech. Also to take the poverty
challenge, help them understand what it's like to live just a few doll ars
a day . I f you could talk about that approach to training medical
professionals, as well as why you believe programs like Head Start the
CHIP program are so vital to ensuring better outcomes.
Dr. Colleen Kraft: If you look at the children in the United States today, 43% of children
live under 200% of the federal poverty level. I know that because 43%
of the children in our country are insured by either Medicaid or the
Children's Health Insurance Program. Almost half of our children are
living under 200% of the federal poverty level. But for pediatric ians it
really is important to understand what that means to a family. Head
S tart was an amazing opportunity for me as a five year old. When I
went to a Head Start , and I could read, the first thing that my te acher
said to me was that you a re so smart that you could be a doctor when
you grow up. T hat's -- those words to a young child who's ready to
learn are so motivati n g .
T he CHIP program, and then supplemental nutrition, anything that we
can take these kids w ho were living in struggling families, to get them
to be able to eat nutritious food, and to have access to quality early
childhood education is only going to help to support the health and
wellbeing of the next generation, th e poverty challenge. T his is
s omething that all residency programs in pediatrics are doing, we now
have a required month called C ommunity and A dvocacy , and so I had
my residents live on $4 and 50 cents a day . T hey c ould not take
anything but public transportation, and they could not us e their smart
phones, they had to only use computers in the clinic or in the public
library. Y ou learn a lot when you don't have access to anything but
public transportation when you have a limited amount of money to
live on. Y ou develop that compassionate insight for those families
who come to see you as patients.
Margaret Flinter: W ell, Dr. K raft you've made an -- are making so many contributions to
Dr. Colleen Kraft
the health of children in the country. But one of them is that you've
co - authored a book that covers the to pic that we take ver y seriously
in our organization, and th at is M anaging and I mproving and B uilding
Upon Childhood Health in the S chool S etting. We have many school
based health centers around our state that provides integrated
behavioral health and medic al care really in dozens of schools . Y our
book Managing Chronic Health Conditions in Child Care and in S chools
offers guidelines for how to manage chronic conditions that can
impact learning for a growing number of children and certainly set the
stage for adolescent and adult health. Maybe you could share with us
some of your recommendations for how to best manage chronic
conditions in the learning environment.
Dr. Colleen Kraft: When I see a patient in my office, I see them for 15 minutes that they
live in the community. T he only way to really be effective in managing
their health is to inform and educate and be an advocate within the
community. T his book was written so that anybody who works in
childcare, or works in school can understand what a tracheosto my
tube is or gastrostomy or ADHD or asthma or food allergies. Y ou first
have to understand what that child has, and understand it in a way
that makes sense for somebody who doesn't have medical training.
Secondly, you need to know who's on their treatment team, b ecause
that way you can call a nurse or a doctor if you've got questions about
that child .
Third, you need to know what the emergencies are. W hen is it an
emergency for a child who may have a seizure disorder or a child who
may have diabetes, and w hat to know in terms of their treatment plan
for those certain types of things going on there. Because overall, if
you understand their condition, you understand who to call for help,
you're already better prepared to handle something that may be
going on. T he more our school and childcare workers are comfortable
with these settings, the better they are in terms of being able to care
for these kids and not to be afraid of t hem.
Mark Masselli: And Dr. Kraft, I was thinking as you were talking about the numbe r of
children who are growing up in poverty, and we know from the
statistics t hat zip code is going to determine so much about your
health . But there are also other social trends impacting childhood
health c ertainly this generation of school children is fi rst to deal with
the issue of gun violence. Also, the spread of smart phones in the
world has led to an increase in depression and anxiety, even addictive
behaviors. Y our organization now has analyzed the impact of these
more recent phenomena on childhood health. I'm wondering if you
could talk about the guidelines that both pediatric clinicians and
parents should be embracing to mitigate the harm from some of
these troublesome social trends .
Dr. Colleen Kraft
Dr. Colleen Kraft: Okay, so let’s start with gun violence. None o f us want our children to
die from an unintentional gun injury, or from suicide. W hat we know
is that 12 children teens and young adults under 21 died from gun
violence every day. We know that pediatricians play that unique and
vital role in preventing gun violence because we can talk with families
about safe storage , about trigger locks, about not having firearms
anywhere where children are . V ery young children don't understand
that if they were able to shoot a gun that it could actually fatally hurt
someb ody. T ackling an epidemic, like gun violence requires very
comprehensive solutions at every level of government in partnership
for all of us who take care of kids, and that all of our children needs to
feel safe, where they live and learn and play. We have the tools we
need to stop this public health epidemic, and we just need the
political will to enact them.
With regard to media and smart phones and computers, we actually
have two policy statements, one on the media use in school aged
children and adolesc ents, and media in young minds. W e know that
today's generation of children and adolescents is growing up
immersed in the media, and that three quarters of teenagers these
days own a smart phone . 24% described themselves as constantly
connected to the Inte rnet, and 50% of them feel addicted to their
phones. W hat we tell our families to do is this, first of all, create a
family media plan, like you have to do with any other diet and
knowing that this media plan should start early and apply to all family
memb ers , b ecause a lot of times we see our parents on smart phones
when they should be interacting with their children , so c utting back
will help . S et stream limit times , have things like family meal times
where you put your phones and your iPads away, have ce rtain times
during the day for connection. P articularly with very, very young
children , t hey learn best from people and not from screens. In teract
with your children, talk and sing and read a book and do those things
that we have science that tells us buil d children's brains.
Margaret Flinter: Well, Dr . Kraft I'd like to touch on another subject that's not exactly
new, but it seems to be a growing trend. T hat's the trend of parents
refusing to vaccinate their children against a variety of diseases that
are preventable. Then, of course, we've seen some m easles
outbreaks, pertussis or whooping cough outbreaks. Can you share
with us the vaccine guidelines recommended by the American
Academy of Pediatrics?
Dr. Colleen Kraft: Absolutely. I mmunizations have been a significant public health boost
to us in preventing vaccine preventable diseases. I n 2009, that birth
cohort routine childhood immunization will prevent about 42,000
early deaths and 20 million cases of diseases and saving about $13
billion in direct cost . But we have parents who've not ever seen these
diseases. S ome of the messages that are not science based are really
Dr. Colleen Kraft
making parents be concerned about vaccines. Our message here is
that vaccines are safe and they're effective.
S erious disease can occur if you and your child and family are not
immunized. The best way to answer this is with talking with your
child's pediatrician , b ecause most parents who are hesitant about
vaccines are not opposed to immunizing their kids, but they're
unsure. W e are open min ded about answering questions , b ut making
sure that parents know that the safety of vaccines is better than it's
ever been. T he diseases are out there a nd w i ll come back if we don't
keep our kids immunized.
Mark Masselli: W e're speaking today with Dr. Col l een K raft , P resident of the
American Academy of Pediatrics. You can learn more about their work
by going to aap.org or yo u can follow them on Twitter
@Ameracadpeds. Dr. Kraft thank you so much for your c larion voice
and your dedication to the health and we llbeing of children and for
joining us on C onversations on H ealth C are today.
Dr. Colleen Kraft: You're welcome and thank you for the opportunity.
[Music]
Mark Masselli: At C onversations and Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori R obertson is an award - winning journalist and managing
editor of F act C heck . org a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US politics . Lori
what have you got for us this week?
Lori Robertson: Acting W hite House Chief of Staff , Mick Mulvaney said that all of the
c ongressional republican health care plans had , quote, covered
preexisting conditions. Senator Ber nie Sanders, m eanwhile, who is
runni ng for the d emocratic presidential nomination said , President
Donald Trump's idea for health care is , quote, doing away with the
protections that the ACA has for preexisting conditions. The GOP
health care plans which were debated in 2017 offered some
pree xisting condition protection, but they were not as comprehensive
as those in the Affordable Care Act. Mulvaney and Sanders made their
comments in TV interviews in reaction to questions about the Trump
A dministration's decision to side with plaintiffs in a Texas court case
and ask federal courts to find the ACA unconstitutional.
In his co mments Mulvaney said, quote, the debate about preexisting
conditions is over. Both parties support them, and anyone telling you
anything different is lying to you for politi cal gain. But that debate
isn't over. U nder the ACA insurers can't deny coverage or charge more
based on health status. That protection primarily impacted the
individual market where those without employer coverage by their
Dr. Colleen Kraft
own insurance, and were before t he ACA denials or higher premiums
for those with medical conditions were commonplace. The GOP
health plans didn't offer the same level of protection. The American
Healthcare Act, a bill proposed by House Republicans in 2017 required
insurance companies to offer coverage regardless of preexisting
conditions. However, states could get a waiver to allow insurers on
the individual market to charge higher premiums based on medical
status for one year to those who had a 63 day gap or more in
coverage.
The Senate Better Care Reconciliation Act would have allowed
insurers to s ell noncompliant plans on the individual market outside
of the market places such as healthcare.gov. Those non compliant
plans could deny coverage or charge more based on medical
conditions. An other s enate b ill the Graham - Cassidy L egislation also
would have allowed states to enable insurers on the individual market
to price premiums based on health status . States would have to
describe how they intended to maintain affordable access to coverage
to those with preexisting conditions. T hat's my fact check for this
week. I'm Lori Robertson, Managing Editor of FactCheck.org.
Margaret Flinter: F act C heck.org is committed to factual accuracy from the country's
major political players and i s a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that y ou'd
like checked, email us at chcr adio.com , w e'll have FactCheck.org’s Lori
Robertson check it out for you here on C onversations on H ealth C are.
[Music]
Margare t Flinter: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Childhood
o besity is a national epidemic , but in the south i t’ s far more prevalent.
In Louisiana for example, over half of the children are either obese or
overweight, with many experiencing symptoms such as high blood
pressure, high cholesterol, and prediabetes. Louisiana State University
R esearcher Dr. Amanda Staiano h as been studying protocols to tackle
childhood obesity, t apping into readily available resources that make
it easier for kids to adopt better exercise and activity habits. S ince
video games are ubiquitous in children's lives, she thought that would
be a great place to start
Dr. Amanda Staiano: V ideo games are st ill very popular. W ith these new active video
games that require physical activity to play, I thought this might be an
innovative way to make such productivity and exercise fun.
Margaret Flinter: Her team at the Pennington B iomedical R esearch Center at LSU
developed an intervention called G ame S quad, giving prescriptions for
playing movement video games for a full hour three times a week.
Dr. Colleen Kraft
Dr. Amanda Staiano: In addition to giving the kids these extra games, we gave them a
fitness coach that they would talk t o over their video game. T he coach
would check in with the parent and child once a week and basically
help hold them accountable. W e also gave the kids a step tracker so
that they could keep track of their physical activity throughout the six
months .
Marga ret Flinter: Kids were encouraged to have other family members join them in the
movement video games like this young 12 year old boy who enjoyed
gaining a competitive edge over his mom .
Male: I get t o speak to our coach, he motivates me -- my mom , motivate s
me . I have to say like 60% of the time I beat her, I love to do disco ,
Boogie Wonderland with my mom.
Margaret Flinter: Dr. S taiano says during the six month G ame S quad trial, over 90% of
the kids who are given video game prescriptions and a fitness coach
intervention stayed active throughout the study and the gaming
group reduce their BMI by about 3% while the cont rol group saw an
increase in theirs. G ame S quad an effective intervention to increase
exercise in sedentary and overweight kids, leveraging alre ady existing
video games that are designed to get kids up and moving, improving
health and fitness for kids in a fun, engaging and sustainable way.
Now that's a bright idea.
Mark Masselli: You've been listening C onversations on Health C are. I'm Mark
Massel li.
Margaret: And I'm Margaret Flinter.
Mark Masselli: Peace and health.
Female: C onversations on Health Care is recorded at W ESU at Wesleyan
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