The Pediatrician Moms Standing up For Children in Immigration Detention

This article was originally published in The 19th.

This story was originally reported by Barbara Rodriguez of The 19th.

Dr. Lara Jones still remembers her visceral reaction to the image of Liam Ramos. It wasn’t the most famous one, of the 5-year-old boy in a blue bunny winter hat and superhero backpack with ICE officers behind him. It was one from days later, of Liam slumped in his father’s arms while both were in custody in Texas.

“He looked pale, he looked sickly. He looked like a completely different child,” she said. “When I saw that image, my doctor brain turned on. I was like, this kid is sick. He needs medical attention.”

Jones, who is double board-certified in pediatrics and pediatric critical care medicine, can quickly assess a lot based on a child’s appearance.

“I can tell in the first 10 seconds that I look at you from the door, before I even put my hands on you, before I put a stethoscope on your chest — I can look at you, and I can know right away, you are going to be fine, or you are really sick and you need attention,” she added. “He looked very sick.”

Jones couldn’t sleep that night. Liam’s well-being consumed her while at work the next day at a California hospital. After a round of patient visits, she went into a private room and “broke down and cried.” She needed to do something.

Since then, Jones has become part of a trio of doctors — all pediatricians, all mothers — collectively calling on the U.S. Department of Homeland Security (DHS) to immediately release all children in immigration detention out of concern for their health. They warn that the detention of these children is causing severe and lasting harm to their mental and physical health, and say that emerging reports of kids allegedly facing delayed and inadequate medical care under DHS demands urgency and transparency.

“We are traumatizing children, and we are putting them in dangerous environments,” Jones said.

These doctors are bringing public awareness to known cases of sick children in detention, raising funds to help families in need of emergency assistance and meeting with members of Congress to demand accountability so that children who remain in custody receive evidence-based standards of care.

“We are mothers of young children, and we are doing all of this in between shifts, after working night shifts, during nap time,” Jones said. “We are just doing as much as we can, in the time that we have, while we are working full time and being full-time moms.”

Just weeks ago, Jones and the other women — Dr. Ashley Marie Cozzo of Connecticut and Dr. Anita K. Patel of Washington, D.C. — did not know each other personally. Now they’re in contact daily through a group text that pings at all hours of the day. They use the chat to think through advocacy ideas, to troubleshoot potential challenges and to align their priorities.

“We’re trying to figure out every day in our brainstorming, ‘What’s next? What’s next?’” said Cozzo, who is double board-certified in pediatrics and neonatal-perinatal medicine. “I love a group project, and this is such a unique situation.”

Patel, who is double board-certified in pediatrics and pediatric critical care medicine, said the quick camaraderie among the women has “reinvigorated” her after years of online campaigns around unrelated advocacy issues.

“You have three critical care doctors for kids, and there are certain qualities inherent in pediatric critical care specialists — we will not stop until we have either saved a kid or we know that there is no chance of saving them,” she said. “We all have that personality, because literally that’s what we do in our jobs.”

Liam’s story propelled their cause. As the image of Liam seemingly in a lethargic state ricocheted across the internet, the women shared their outrage with medical peers. Jones and Cozzo circulated a small online petition calling for Liam to be returned home, and amid the national outcry, a judge ordered the federal government to release the boy and his father. (The Ecuadorian family has an active asylum case, and it’s unclear for now whether they will be able to permanently stay in the United States.)

The doctors then connected with Patel, and the three agreed to work together to bring more awareness to other children in detention. Patel said the power of imagery catapulted Liam’s story.

“If he was an older kid, or even if he was Liam without the bunny hat — the outcry may not have come,” Patel said. “And all I could think was Liam deserved that outcry, and every single kid in detention needs that outcry.”

The trio has fixated on the Dilley Immigration Processing Center, the facility near San Antonio that houses families, in part because they are in frequent communication with a journalist, Lidia Terrazas, who has been reporting on people impacted by detention.

When Terrazas highlighted in early February the story of a 2-month-old baby named Juan Nicolás, the case crystallized the doctors’ urgency. The boy had been in respiratory distress while at Dilley, but had allegedly received delayed care as his condition worsened. He was sent by ambulance to a hospital on February 16, according to Patel, after an unresponsive episode where detention officials could not wake him. DHS later deported the baby, his mother and other family members, including a 16-month-old, to Mexico.

Jones was able to connect by text with Mireya López Sánchez, Juan Nicolás’ mother. The postpartum mother said that her milk had dried up while at Dilley. Patel is still nursing her toddler; the parallels — the universal urge a mother has to feed her baby — linger for her.

When Patel nurses her own child, “I think of Mireya, whose milk dried up because she was so stressed and nutritionally deficient that she couldn’t breastfeed, and then when she couldn’t breastfeed, then she couldn’t afford clean water that wasn’t brown or smelled like chlorine to make formula.”

According to the advocacy organization Each Step Home, which has partnered with the doctors to raise money for commissary funds, detainees at Dilley have to spend $40 to buy a four-pack of large water bottles and $35 for a 12-pack of small water bottles.

A spokesperson for DHS did not respond to a request for comment from The 19th, but the agency has disputed allegations of malnourished or mistreated children and claims people in detention have access to medical care and adequate food. Emergency crews were called to the facility at least 11 times since September for children with symptoms including bronchitis, respiratory distress and fever, according to NBC News.

CoreCivic, a private company that runs the Dilley facility, deferred questions to DHS but added in a public statement that claims of inadequate medical care are inaccurate and “directly contradicted by the comprehensive, around-the-clock care delivered by our licensed physicians, dentists, advanced practice providers, nurses and mental health professionals.”

Jones doesn’t buy that when it comes to Juan Nicolás, whose mother reportedly told officials that her newborn was having difficulty breathing and was vomiting. Mireya said that instead of being seen by a medical professional, guards at the facility monitored the newborn for two days before he was sent to the hospital in distress.

“I don’t know what they were assessing, but they’re not assessing it through the lens of a pediatric expert,” Jones said. “They’re not doing the appropriate medical workup. So that case alone is proof of delayed care and denied appropriate care, because the appropriate care for a 2-month-old with difficulty breathing and vomiting is to go to the emergency department.”

Cozzo noted that several children died in 2018 and 2019 while in immigration custody, detention or after being released. In 2023, an 8-year-old girl died while in Border Patrol custody — reportedly after her mother repeatedly sought medical care for her.

“We have a precedent of the highest degree of loss: children’s lives,” Cozzo said. “It has happened before, the things that these women are worried about — it’s only going to be a matter of time before we don’t learn from the mistakes of the past and another child dies.”

As the doctors circulated Juan Nicolás’ story online, they connected with a charity to help raise money for the family. They also helped secure a hotel room for Juan Nicolás’s family amid their deportation to Mexico. They are now raising money for commissary funds for other families. As they hear of specific cases, including those of a woman who was deported while eight months pregnant and a family living in their car in the aftermath of their detention, they try to spring into action by either raising public awareness or funds.

The medical community has long expressed alarm about how children’s health can deteriorate in immigration detention. Researchers in 2019 concluded that children’s mental health suffers and there’s a cascade of ripple effects, including anxiety disorders, depression and developmental regression and delays. The issue has been examined in immigration enforcement practices abroad, with similar outcomes.

There are also standards of care for immigrant children in detention, and a 1997 legal agreement states that children should not be detained for more than 20 days. But the Marshall Project reported in December that some children are being held in detention for much longer — weeks or months. The publication estimated at the time that at least 3,800 children under 18 had been booked into ICE since President Donald Trump, who campaigned on mass deportation, returned to office. More than 1,300 children were held last year for longer than 20 days.

The American Academy of Pediatrics (AAP) has repeatedly reaffirmed its call for limited exposure of children in DHS facilities. Dr. Sural Shah is chair of AAP’s Council on Immigrant Child and Family Health. She said the council, which was very responsive during the first Trump administration’s family separation policy, has been accelerating its work in recent months.

“We’re always active, always sharing information. But the era that we’re in now — it’s been a heightened sense of need, of urgency, of hey, this is happening, and we need to do something about it,” she said. “We need to figure out how to band together, how to lift up voices, how to gather health care professionals and folks that care about children’s health to stop these practices because they’re so harmful to children.”

Shah added that she’s not surprised that pediatricians are leading organic advocacy efforts.

“It is something that is deeply woven into the fabric of who pediatricians are,” she said. “We have a deep understanding of the range of factors that affect children and their families.”

Over the past few weeks, the trio of doctors began drafting and circulating a letter, which was later signed by thousands of medical professionals, to be sent to DHS officials and several key senators with roles in immigration enforcement oversight. The letter, dated February 26, alleges unsanitary detention conditions and inadequate access to food and clean water. It also expresses concerns of a measles outbreak within the Dilley facility. Infants are typically too young to be vaccinated against measles.

Kristi Noem’s ouster as head of DHS last Wednesday doesn’t alter the demand for accountability, said Cozzo.

“I actually don’t necessarily think that changing the face changes anything, because it’s just a complete system that is broken,” she said.

All three agreed that the letter is a start.

“This letter is day one of a marathon,” said Patel, who was a guest of Democratic Rep. Joaquin Castro at the recent State of the Union address, with the goal of elevating the issue. “The point of the letter was to clearly and succinctly as possible, dictate what has been documented as known medical negligence or medical harm or human rights violations.”

They want to grow public pressure while helping as many children and their families as possible. Jones said their advocacy is about the health and well-being of children. She doesn’t see that as political.

“This is an issue about child welfare,” she said. “I feel like if we can continue to stand our ground about the fact that we are causing preventable, measurable, well-studied, predictable harm to children that is not justified. There’s no context in which that is justified, and so I think we just have to continue to get that message across — to the public, to lawmakers. There will be challenges at every step of the way, no doubt, but I think the truth and what’s right is on our side.”