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Developmental pediatrician Fiorella Castillo discusses her article, “Advocating for immigrant children: a doctor’s perspective.” Fiorella shares her firsthand experiences supporting immigrant families as they navigate developmental disabilities like autism and ADHD in a climate filled with fear of deportation and family separation. She explores the emotional and behavioral toll on children—ranging from anxiety and PTSD to struggles with social skills—and stresses the critical need for systemic change to protect these vulnerable communities. Fiorella offers actionable insights, such as supporting organizations like the Immigrant Legal Resource Center or The Legal Aid Society, and contacting elected officials to push for policies ensuring family unity and immigrant rights. Join us to discover how healthcare professionals and advocates can drive meaningful change for immigrant children and their families.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Fiorella Castillo. She’s a developmental pediatric fellow. Her KevinMD article is “Advocating for immigrant children, a doctor’s perspective.” Fiorella, welcome to the show.
Fiorella Castillo: Thank you so much for having me here today. It’s so nice meeting you.
Kevin Pho: All right, thank you so much for joining us. So, tell us a little bit about yourself, and then tell us about the article on KevinMD for those who didn’t get a chance to read it.
Fiorella Castillo: Sure, so I am a third-year developmental and behavioral pediatrics fellow over at the Children’s Hospital in Montefiore, and I was actually born and raised in Peru. And I moved to the U.S. in my early teens and went straight to high school. When I arrived, I didn’t speak any English, and I learned all of that here. So, growing up as an immigrant in the U.S., I am no stranger to the health, economic, and educational disparities affecting our communities. And I became a pediatrician with the hopes to help children and their families, in particular—particularly those with developmental disabilities.
Kevin Pho: Wonderful. So tell us about your article. It’s titled “Advocating for immigrant children, a doctor’s perspective.” What’s your article about?
Fiorella Castillo: So, my article touches on what are recent events that have created a toxic environment of fear and uncertainty for immigrant communities. We know that, whether direct or indirect, interacting with the immigration system is an adverse childhood experience, and this poses developmental and socioeconomic harm to children and their families. We know that about 1 in 12 children risk losing a loved one to deportation, and this leads to long-term trauma and adversity, along with what is the related economic, educational, and social disruptions in their lives.
Now, in addition to that, immigrant children face compounding developmental and personal threats, including detention in unsafe, unsanitary, and developmentally inappropriate conditions. Even what were once safe spaces, such as churches, schools, and hospitals, are now subject to immigration activities. We think of children with legal status maybe being a little bit better off, but these children still experience developmental harms, which affect their mental health, as immigration status is often precarious, and sometimes this changes day by day. So, this situation overall is a source of confusion, anxiety, and harmful stress to everyone.
I’m here in the Bronx, instead of a very large immigrant community, and in my article, I discussed the case of a patient of mine with whom I was having a phone call. All of a sudden, she tells me that ICE is at her door, and in a very desperate voice, she asked me, “What do I do?” I mentioned I’m not a lawyer, I’m not a social worker, I’m a physician, and even here in our clinic, we try our best to guide and help our patients, but sometimes it’s way more beyond what we can do. So we need to partner up with organizations that can better help our communities.
Recently as well, all of this situation has caused a lot of stress, not just with our patients but also with our providers here. As we hear, for example, not that long ago there was a raid at a nearby high school here in the Bronx. A lot of our staff are local, so they are thinking about their own children, and they’re thinking about the families they serve. This is essentially what my article is discussing, as well as advocating for policies that lead to the prevention of family separation and detention. These are developmentally harmful and need to be avoided. We really need systemic changes to our immigration policy to stabilize what otherwise is a precarious legal status, and we really need high-quality, culturally and linguistically responsive mental health care. This is essential to support the well-being of our children and their families impacted by these issues. So this is, in a nutshell, what I talked about.
Kevin Pho: So for those who aren’t familiar with developmental pediatrics, you mentioned that interactions with immigration authorities can lead to adverse childhood events and developmental issues. Specifically, for those who aren’t familiar with those, what exactly are some of the adverse events that we could see in our children?
Fiorella Castillo: When we discuss adverse childhood experiences, we’re talking about experiences that can lead to trauma, one of them being, for example, the death of a loved one or family separation—whether it’s through divorce or other means. We talk about chronic health issues, having a parent in jail, or being a victim of abuse, whether physical or psychological. Those are some of the examples that comprise what we define as adverse childhood experiences.
Kevin Pho: And the impact of these traumas and adverse childhood experiences—they’re lifelong.
Fiorella Castillo: Exactly, yes. When we think about the effects of adverse childhood experiences, it’s not just related to mental health conditions. We talk about a much higher risk of things like diabetes, hypertension, and other chronic health conditions, and even an overall deterioration of health—not just mental health conditions like depression, anxiety, or suicidality.
Kevin Pho: You mentioned, of course, that you’re seeing this in your clinic in the Bronx. Tell us about some of those conversations. You don’t have to go into a specific one—of course, protect privacy—but in general, what are some of those conversations like? What are some of the fears that the families are expressing to you in the exam room?
Fiorella Castillo: At the Children’s Hospital at Montefiore, I work at the Rose F. Kennedy Center Evaluation and Rehabilitation program for children with developmental disabilities. I particularly see children who have autism, ADHD, and other neurodevelopmental conditions. Some of these conditions may be more severe than others. No two children are exactly the same. We do have children with severe impairments, and it’s particularly some of those families who are the most worried, as something like separation can really affect their children who are severely impaired.
Some of the questions that I get are like, “If I’m not here, who’s going to take care of my child? My child doesn’t speak. They have severe autism and an intellectual disability, and they cannot care for themselves, and I am the only caregiver. What’s going to happen?” Other families worry not just about the children with developmental disabilities, but also some of their siblings or other family members who may be dependent on them. Every day, this conversation comes up. We are able to provide certain guidance in terms of how to best protect themselves and how to get everything in order, but if we’re not having those conversations, then these families really are left in the air with very little guidance and support otherwise. They’re just fearful of speaking about this issue. So we become a safe space for them, a trusted source of information as well.
Recently, I had a patient of mine tell me, “I didn’t know that my neighbor, who lives a few blocks away, had gotten deported until I saw a ‘for rent’ sign on their front door.” She asked the landlord what happened to that family, and they told her they had been deported and needed to rent the space to somebody else. These are things that we hear every single day, essentially, and not only that, but also the raids that go on in our neighborhoods.
Kevin Pho: You mentioned some guidance that you can offer in the exam room. Tell us a little bit about that guidance, in terms of what you tell patients, and what are some other specific things that you can do as a physician in the exam room? I know that you mentioned earlier about immigration policy, but on a more individual level, what are some specific ways that you could support these families?
Fiorella Castillo: We have developed essentially a listing of immigration lawyers who may provide pro bono services. Also, I believe the Immigrant Legal Resource Center has produced these red cards that have specific information about people’s rights and contact information for who to reach out to when encountering an immigration officer.
Kevin Pho: Now how about outside the world of developmental pediatrics, because these issues are affecting all of our patients, I’m sure. Primary care physicians like myself in internal medicine—we don’t see it as often as you do, but I’m sure that these are very common in the families we see. Tell us about some of the things that we can do in the exam room. Maybe some resources that we can share with our patients outside the world of developmental pediatrics.
Fiorella Castillo: Yeah, similar to what I mentioned, having resources ready if a family is willing to disclose some of their concerns about what to do in the case that they encounter an ICE agent, or what happens when a family member gets detained. Having that information ready on next steps or who to contact based on the state where they’re located would be really useful, and also letting patients know about their rights when being detained or when an immigration agent comes in and speaks with them.
Kevin Pho: In your article, you mentioned two organizations: the Immigrant Legal Resource Center and the Legal Aid Society, as options. Tell us more about those.
Fiorella Castillo: They are local community-based organizations, and they provide pro bono services to immigrant families. They also cover other legal issues as well, but those have been the most supportive and vocal about working with immigration-related issues in this day and age.
Kevin Pho: What do you see in the foreseeable future? Because the political climate probably isn’t going to change for the next few years. So what do you see in the foreseeable future regarding this issue?
Fiorella Castillo: I don’t think I can speak in terms of what specific policies may be implemented or how this may evolve, because things have been rather unpredictable in many areas lately. But one thing that is very glaring to me is that these types of situations really affect the mental health of our children, whether they have developmental disabilities or not. In addition to the work that I do as a developmental pediatrician, I also study things related to school disengagement and how it intersects with mental health. Just adding extra stress—an extra adverse childhood experience—to what is already a very disengaged community of school-aged children will make things much worse. It creates such an unstable and toxic environment, and I can see it affecting not just mental health but also education. Later on, as these children grow, they will become adults who carry trauma, and we will see that not just in mental health but in other chronic conditions.
Kevin Pho: You mentioned earlier that there’s also a tremendous amount of stress on the staff members as well, and on your colleagues and fellow clinicians. Talk more about that—how you are supporting each other and some of the things that you could do from a mental health standpoint among the staff.
Fiorella Castillo: Because of the place that we work in, we establish very deep connections with our families. Some of us also have children with developmental conditions, so we really relate and get very close to our families. When we hear that patients are struggling with these specific situations, it really affects our mental health too. We’ve had discussions here. We’ve had a town hall. We’ve had debrief sessions when we encounter, for example, families that have gotten deported. In terms of what we can do to help ourselves, we have a very robust wellness initiative here at Montefiore. Also, we talk about how prepared we can be to help other families as these things keep unfolding.
Kevin Pho: We’re talking to Fiorella Castillo. She’s a developmental pediatric fellow. Today’s KevinMD article is “Advocating for immigrant children, a doctor’s perspective.” Fiorella, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Fiorella Castillo: Like I mentioned in the article as well, policies that lead to family separation and detention are so developmentally harmful and really need to be avoided. We need to be a safe space for our families so they can feel comfortable asking for support, and we need to have information ready to give them in case they encounter immigration agents or other authorities. We really need systemic changes to our immigration policy to stabilize what otherwise are precarious legal statuses, and one thing that I feel very strongly about is that we need better quality, culturally responsive mental health care to support the well-being of our children—not just those with developmental disabilities and those impacted by these immigration policies, but also everyone around them.
Kevin Pho: Fiorella, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Fiorella Castillo: Thank you so much for having me.
