“How do we understand a child who says they’re hearing voices after a severe trauma?” Dr. Gerson said. In an adult, the diagnosis might be psychosis, but this may be how a child describes flashbacks or intrusive thoughts, common symptoms of PTSD.
In older school-age children and adolescents, she said, “depression can often look like irritability, a child who seems angry all the time, not necessarily sad and mopey.” Caretakers should watch for any evidence of self-injury, and again, be alert for behavioral changes as well as any expressions of despair. And all of this is more complicated if there are language barriers.
While the Department of Homeland Security said on Saturday that more than 500 of the children had been reunited with their parents, it was not clear exactly how many children separated from their parents had come to New York or how many remain. Mayor Bill de Blasio said last week that 239 of them were in the care of Cayuga Centers in Harlem, one of a group of social service agencies that contract with the federal government to take in unaccompanied minors and place them in temporary foster care.
Gov. Andrew M. Cuomo on Thursday toured a residential facility housing some of the children, where an official said: “They have trouble sleeping, sometimes they’re anxious, depressed, crying, primarily.”
The doctors speaking at Bellevue said that there are probably more of the children separated from their families coming in for care than the 12 who have been identified. “We don’t ask about people’s immigration status here because we want families and children who are concerned about their immigration status to feel safe coming here,” Dr. Gerson said, “because our mission is to provide treatment.”
At the news conference, Dr. Katz called providing care for these children “a phenomenal use of Health & Hospitals” to “be here for people, whatever the crisis,” and Chirlane McCray, the first lady of New York City, thanked the clinicians at the city’s hospitals who are treating these children “how every child should be treated.”
“We’ve just tried to show these kids kindness,” Dr. Kaufman said. That means language and cultural competency — they are able to speak to the children in Spanish — but it also means trying to do a little extra for both the children and their caretakers. “We let them know they are welcome here, even though they’ve experienced such trauma, we have toys and books and gifts and we give as much as we can to the children and to the families caring for these children.”