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

Moderator: Welcome to Conversations on Healthcare, with Mark Masselli and Margaret
Flinter , a weekly s how where we speak to the top thought leaders in health
innovation, health policy, care delivery and the great minds who are shaping
the healthcare of th e future. This week Mark and Margaret speak with Dr.
Colleen Kraft, P resident of the American Academy of Pediatrics, she talks
about the effects of trauma on kids being separated from their parents at the
border a nd other important protocols for vaccines, screen time and
childhood health.

Lori Robertson also checks in, the Managing Editor of FactCheck.org. She
looks at misstatements spoken about health policy in the public domain,
separating the fake from the facts. W e end with a bright idea that’s
improvin g health and wellbeing in everyday life. If you have comments please
email us at [email protected] or find us on Facebook or Twitter. We
love hearing from you. Y ou can also find us on iTunes or Stitcher or w herever
you listen to podcast. P lease feel free to leave us a review there. Now stay
tune for our interview with Dr. Colleen Kraft on Conversations on Healthcare.

Mark Masselli : We are speaking to Dr. Colleen Kraft, P resident of the American Academy of
Ped iatrics 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 Direc tor of the Health Network by Cincinnati
Children’s, she is co - author of the book Managing Chronic Health Conditions
in Child Care and Schools. She earned her medical degree from Virginia
Commonwealth University, where she also completed her residency in
pe diatrics . Dr. Kraft, welcome to Conversations on Healthcare.

Colleen Kraft: T hank you so much for having me.

Mark Masselli: O bviously you have been in the news and the larger story in the news ha s
certainly been the separation of immigrant children from t heir parents at the
border, which ha s led to hue and cry across the country to end the practice
from a wider ray of sectors including your organization, the American
Academy of Pediatrics. Y ou personally were given access to a shelter holding
some of these children’s so you have firsthand experience of how it’s
impacting . I am wondering if you could share with our listeners, what you
witnessed and what you yourself have called government - sanctioned child
abuse.

Colleen Kraft: Sure, so at the American Academ y of Pediatrics we keep our eyes and our
lens on the children and what’s right for child health. A s I was invited to come
to one of these shelters, I came in and the shelter itself was one of the tender
age shelters, was very homey looking, there were beds and cribs and books
and toys . I walked into the toddler room , if you have ever been in a room full
of toddlers, they are a rampant [inaudible 00:03:04 ] . And these kids were
not, they were qui e t 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, was trying to give her a toy, was trying to

Dr Colleen Kraft

give her a book, but this child was crying and the staff person couldn’t pick
her up and couldn’t hold her , she was not allowed to do that. W e all knew in
that room that what th ese children needed w ere their parents that because
their parents were nt there they were suffering from toxic stress a nd their
behavior was so abnormal for toddlers.

Margaret Flinter: D r. Kraft these are heart - wrenching images you shared 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, set s a 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
what, 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.

Colleen Kraft: W hat this separation does is it creates in th ese very young children a rush of
their stress hormones, of Cortisol, of Epinephrine and the se hormones when
they are not buffered by a loving and caring adult cause something called
toxic stress where the neurons don’t develop normally, they don’t have the
synapses with other neurons. T his actually developed disruption in the brain
architecture of th ese young children. W hat they don’t develop is speech and
language ; they don’t develop their ability to bond social , emotionally with
adults and with others a nd down the road that actually leads to school
failure, to use of substances, to anxieties an d depressions, to chronic health
problems like diabetes or morbid obesity or heart disease.

Mark Masselli: Dr. Kraft, I know the court has order ed the government to reunite the
families and obviously there are some road blocks I think we all read where a
n umber of parents have already been deported to their country of origin. But
I understand that your organization has taken an active role on addressing
the situation joined by some of your professional colleagues at the American
College of Physicians, the A merican Psychiatric Association, to try to figure
out how to resolve this . I am wondering if you could share with us about your
efforts that are underway with the American Academy of Pediatrics simply to
help facilitate the reuniting of th ese families.

Col leen 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 are in custody in the United States,
children should have ac cess to healthcare. The American Academy of
Pediatrics has offered our assistance to the federal government 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 th ese 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

Dr Colleen Kraft

released from federal custody. W e have recommended that the Office of
Refugee Resettlement 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 relea sed from its custody to
those sources of care. That way we can provide th e physical and mental
health care that these kids and families need as they are being reunited.

Margaret Flinter: G osh there is so many challenges for children’s health these days, we
wonder if you could talk to us a little bit about another issue that’s both been
in the news and the one that I think we thought maybe if we were past
worrying about and that’s the whole issue of supporting breastfeeding as a
vital contributor to the heal th of children, to long - term health that’s been
supported by your organization that ’s certainly been supported by the World
Health Organization as the best way to support sound nutrition . B ut we have
had quite a bit of controversy recently of when the admi nistration pushed
back against the protocol that was being recommended. You have got some
pretty clearly defined guidelines on breastfeeding recommendations at the
American Academy of Pediatrics. What are those guidelines and why is it so
important for ear ly childhood health and development?

Colleen Kraft: We kno w the science of infant feeding and that breastfeeding is meant for
human children , t hat breastfeeding supports brain development, it supports
optimal nutrition, it helps to promote optimal growth b ut also to prevent
obesity and allergies and other infections. And for the mothers it actually
helps to get them back to normal weight gain, it helps to prevent breast
cancer , base d on this the American Academy of Pediatrics is aware of this
that the U.S. Government thought to weaken the resolution supporting
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 are 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. Kraft you r bio
has an interesting note that y ou are a graduat e at one of the first Head Start
programs in the country and sort of want to connect back to our history back
in 1972 . O ur first program initiative was with our local Head Start program
and they do such important work. And that experience s haped your
professional and personal quest to illuminate health disparities . Y ou have
really translated that into the type of training that you are trying to g ive to
medical students at Virginia Tech. Also to take the poverty challenge to help
them underst and what it’s like to live on just a few dollars a day, if 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 .

Colleen Kraft: I f 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

Dr Colleen Kraft

children in our country are insured by either Medicaid or the Children’s
Health Insurance Program. Almost ha lf of our children are living under 200%
of the federal poverty level. But for pediatricians, it really is important to
understand what that means to a family, so Head Start was an amazing
opportunity for me as a 5 year old . W hen I went to Head Start and I could
read, the first thing that my teacher said to me was that “you are so smart
that you could be a doctor when you grow up” and th at stuck and those
words to a young child who is ready to learn are so motivating . T he CHIP
program and then supplemental nutrition, anything that we can take these
kids who are 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 ne xt
generation .

T he poverty challenge a nd this is something that all residency programs in
pediatrics are doing. We now have a required month called Community and
Advocacy. I had my residents live on $4.50 a day, they could not take
anything , but public tra nsportation and they could not use their
smartphones, 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 and you
develop that compassion and insight for those families who come to see you
as patients.

Margaret Flinter: Dr. Kraft you made and are marking so many contributions to the
health of children in the country, but one of them is that you have co -
author ed a book that covers a topic that we take very seriously in our
organization , t hat is managing and improving and building upon Childhood
Health in the school setting . W e have many school based health centers
around our state that provides integrated behav ioral health and medical care
really in dozens of schools and your book, Managing Chronic Health
Conditions in Child Care and in Schools offers guidelines for how to manage
chronic health 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.

Colleen Kraft: When I see a patient in my office, I see them for 15 minutes , but they live in
the community. And the only way to really be affective in managing their
health is to inform and educate and being advocate within the community.
T his book was written so that anybody who works in child care or who works
in sc hool can understand what a tracheostomy tube is or a 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 make s sense for somebody who
doesn’t have medical training. Secondly you need to know who is on their
treatment team, because that way you can call a nurse or a doctor if you
have got questions about that child. Third, you need to know what the
emergencies are, so when is it an emergency for a child who may have a

Dr Colleen Kraft

seizure disor der 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 are already better prepare d to handle something that maybe
going on. T he more our school and child care 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 them.

Mark Masselli: Dr. Kraft I was thinki ng as you were talking about the number of children who
are growing up in poverty and we know from the statistics that the zip code is
going to determine so much about your health, but there are also other
social trends impacting childhood health certainly this generation school
children’s, the first to deal with the issue of gun violence, also the spread of
smartphones in the world has led to an increase in depression and anxiety,
even addictive behaviors . Y our organization though has analyzed the impact
o f th ese more recent phenomena on childhood health. I am wondering if you
could talk about the guidelines that both pediatric clinicians and parent
should be embracing to mitigate the harm from some of these troublesome
social trends.

Colleen Kraft: Let’s s tart with gun violence ; none of 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 die 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 coul d actually
fatally hurt somebody. So tackling an epidemic like gun violence require s very
comprehensive solutions at every level of government and partnership for all
of us who take care of kids a nd that all of our children need to feel safe
where they liv e and learn and play. We have the tools we need to stop this
public health epidemic and we just need the political rule to enact them.

With regard to media and smartphones and computers we actually have two
policy statements, one on the media use of school age children and
adolescents and media and young minds. W e know that today’s generation
of children and adolescents is growing up immersed in the media a nd that
three quarters of teenagers these days own a smartphone, 24% describe
themselves as constantly connected to the internet and 50% of them feel
addicted to their phones. So what 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 . K nowing
that this media plan should start early and app ly to all family members,
including our parents , because a lot of time we see our parents on
smartphones when they should be interacting with their children. So cutting
that will help, set screen limit times, have things like family meal times where
you pu t your phones and your iPads away. Have certain times during the day
for connection and particularly with very, very young children they learn best
people and not from screen. I nteract with your children, talk and sing and

Dr Colleen Kraft

read a book and do those things t hat we have science that tells us build
children’s brain.

Margaret Flinter: Dr. Kraft I would like to touch on another subject that’s not exactly
new , but it seems to be a growing trend and that’s the trend of parents
refusing to vaccinate their children a gainst a variety of diseases that are
preventable then of course we have seen measles outbreaks, pertussis or
whooping cough outbreaks, can you share with us the vaccine guidelines
recommended by the American Academy of Pediatrics.

Colleen Kraft: Absolutel y, so immunizations 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 is saving ab out $13 billion in direct cost. But we
have parents who have not ever seen these diseases and some of the
messages that are not science based are really making parents be concerned
about vaccines.

O ur umbrella message here is that vaccines are safe and the y are effective,
serious disease can occur if you and your child or family are not immunized .
T he best way to answer this is with talking with your child’s pediatrician,
because most parents who are hesitant about vaccines are not opposed to
immunizing the ir kids but they are unsure. W e are open - minded about
answering questions, but making sure that parents know that the safety of
vaccines is better than it’s ever been. T he diseases are out there and will
come back if we don’t keep our kids immunized.

Mark Masselli: We are speaking today with Dr. Colleen Kraft, P resident of the American
Academy of Pediatrics. You could learn more about their work by going to
AAP.org or you can follow them on Twitter @AmerAcadPeds . Dr. Kraft, thank
you so much for your clario n voice and your dedication to the health and
wellbeing of children and for joining us on Conversations on Healthcare,
today.

Colleen Kraft: You are welcome and thank you for the opportunity.

[Music]

Mark Masselli: At Conversations on Healthcare, we want o ur audience to be truly in the
know, when it comes to the facts about healthcare reform and policy, Lori
Robertson is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit consumer advocate for voters that
aim to reduc e the level of deception in U.S. politics. Lori, what have you got
for us this week ?

Lori Robertson: As President Donald Trump often tells it, the Department of Veterans
Affairs could not fire unruly or underperforming employees before he signed
a bill ove rhauling the agency’s procedures in 2017. He’s wrong about that.
Going back to 2006, the VA fired more than 2,000 employees each year
before Trump took office, according to data the agency reported to the Office

Dr Colleen Kraft

of Personnel Management. In late June 2017, Trump signed into law the
bipartisan Veterans Affairs Accountability and Whistleblower Protection Act ,
which aims to make it easier for the VA secretary to remove empl oyees by,
among other things, shortening the firing process and expediting the appeals
process for senior executives. And it’s true that the number of terminations
for performance and disciplinary reasons increased by 24% during Trump’s
first year, accordi ng to OPM figures. Even so, it’s still the case that 1,178, or
nearly 36% of all those firings in 2017 occurred in the five full months before
Trump signed the legislation into law last year in late June.

The VA has more than 382,000 total employees. The p resident has claimed
that the law enabled the VA to say, “ You’re fired” to any employees who
“mistreats or neglects or abuses our great veterans and their time of need . ”
He said “Before, there was nothing you could do,” at other times Trump has
claimed th at before the accountability law, “you couldn’t fire anybody in the
VA” that’s simply not true . A nd that’s my factcheck for this week, I am Lori
Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy f rom the country’s
major political players and is a project of the Annenberg Public Policy Center
at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we wil l have FactCheck.org’s Lori
Robertson, check it out for you, here on Conversations on Healthcare.

[Music]

M oderator : Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Childhood obesity is a
national epidemic but in the south it’s far more prevalent. In Louisiana for
example over half of the children are either obese or overweight with many
experiencing symptom such as high blood pressure, high cholesterol, and
pre - diabetes. Louisiana St ate University researcher Dr. Amanda Staiano has
been studying protocols to tackle childhood obesity, tapping into readily
available resources that make it easier for kids to adopt better exercise and
activity habits. And since videogames are ubiquitous in children’s lives, she
thought that would be a great place to start.

Amanda Staiano: Videogames are still very popular and kids spend hours on in playing
these games. So with th ese new active videogames that require physical
activity to play, I thought thi s might be an innovative way to make physical
activity and exercise fun, but also to help th ese children to lose weight.

Margaret Flinter: Her team at the Pennington Biomedical Research Center at LSU,
developed an intervention called Game Squad, giving pres criptions for playing
movement videogames for a full hour, three times a week.

Amanda Staiano: In addition to giving the kids these extra games, we gave them a
challenge book and this would help them to gradually increase the intensity
of their physical ac tivities. We gave them a fitness coach that they would talk

Dr Colleen Kraft

to over their videogame and the coach would check them with the parent
and child once a week and physically 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.

Margaret Flinter: K ids were encourage to have other family members joining them in
the movement videogames, like this young 12 year old boy who enjoyed
gaining a competitive edge over his mom, wh o was often dancing right along
side him.

Kid: I get to speak to our coach, he motivates me, my mom motivates me . I have
to say like 60% of the time I would be there, I love to do disco , Boogie
Wonderland with my mom.

Margaret Flinter: Dr. Staiano says, du ring the six months GameSquad trial, over 90% of
the kids who were given videogame prescriptions and a fitness coach
intervention, stayed active throughout the study and the gaming group
reduce their BMI by about 3% while the control group saw an increase in
theirs, cholesterol was reduced by about 7% . Staiano says the added bonus
was the kids gained confidence and improve self - esteemed with their new
found activity. GameSquad, an effective intervention to increase exercise in
sedentary and overweight kids leveraging already existing videogames that
are design ed to get kids up and moving, improving health and fitness for kids
in a fun engaging and sustainable way.

Kid: When this is all over, I start doing, we will keep on continuing doing the
game.

Margaret Flinter: Now that’s a bright idea.

Mark Masselli: You have been listening, Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Peace and health.

Moderator: Conversations on Healthcare is recorded at WESU at Wesleyan University,
streaming live at www. chcradio.com , iTunes or whatever you listen to
podcast. If you have comments please email us at [email protected]
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