A pair of migrant families from Brazil pass through a gap in the border wall to reach the United States after crossing from Mexico in Yuma, Ariz., Thursday, June 10, 2021, to seek asylum. The families are part of an influx of asylum-seekers entering the U.S. in the Yuma area from South America and other continents. Credit: Eugene Garcia / AP

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Deanna Behrens is a pediatric critical care physician in Chicago, a fellow of the American Academy of Pediatrics and a member of the Refugee Immigrant Child Health Initiative as part of the academy’s Illinois chapter. She wrote this column for the Chicago Tribune.

A 3-year-old toddler died this month in Illinois while on a bus on the way to her new home in Indiana. An 8-year-old child with sickle cell anemia died of influenza in May in Texas, as did a 17-year-old boy in Florida. These three children were all in the care of the United States. They all fled violence in their home countries. They were all asylum-seekers.

Jismary Alejandra Barboza González should have been celebrating her fourth birthday. She was one of the children sent away by Texas Gov. Greg Abbott’s Operation Lone Star. She fled with her family through five countries in Central America and in Mexico but died just a few hundred miles from her destination.

As a pediatric critical care physician, I have witnessed the heartache caused by the sudden death of a child. It takes years of specialized training to recognize the differences between a sick child and a sick adult. Children have different physiology than adults: They use more energy, their heart beats faster, they breathe faster and they are more likely to get severely dehydrated. Because children have different vital signs at baseline from adults, it can be more difficult for a provider to recognize when they are sick.

To the average person, it is hard to tell when a child is critically ill. I spent four years after medical school in a combined residency program taking care of children and adults, another three years training during a fellowship specifically to take care of critically ill children and a decade as an attending physician. And it is still often difficult to tell when a child is unwell — that is the reason they need to be monitored so closely in the intensive care unit. For adults, the course is often more indolent. They can tell us that they do not feel well; they often have a slow but steady decline. But children often appear well until they are critically ill.

As a pediatrician, I also know that there are many childhood diseases that require constant, specialized medical treatment. Children with asthma, cancer, congenital heart disease, sickle cell anemia and many other illnesses deserve prompt, specialized care, especially when they get sick. What might be a bad cold in one child can turn deadly in another, as was the case with Anadith Danay Reyes Alvarez, the 8-year-old who died in May. A report from U.S. Customs and Border Protection identified many opportunities for intervention that might have saved her life, including referral to a pediatric specialist earlier in her illness.

Some deaths cannot be prevented, no matter what. We do not know yet what happened to Jismary. We do not know if her fate could have been different. We do not know if she would have survived if she were in an intensive care unit. But we know she was put at risk — she was one of thousands of people, including hundreds of children, who have been sent out of states such as Texas on buses to sanctuary cities and states, including New York, Chicago, Philadelphia, Denver, Los Angeles and Washington. Additionally, children face danger in Texas from floating buoys, razor wire and other mechanisms designed to deter asylum-seekers from crossing the southern border.

Since August 2022, Chicago has taken in more than 12,000 people, including thousands from Texas. I am proud of our city and state for welcoming these individuals. I am proud we are a sanctuary city. Gov. J.B. Pritzker signed a disaster declaration to unlock resources for asylum-seekers. We are one of at least 10 states that extend government-sponsored insurance to low-income children regardless of immigration status, though we did recently scale back coverage for adults in similar circumstances.

Illinois is going to provide a funeral and burial for the 3-year-old asylum-seeker who died on that bus. But she should not have been there in the first place. How many more vulnerable children need to be buried in the United States before things change? Before these children have access to needed pediatric care and pediatric subspecialists? Before we can ensure that parents are listened to, and help is called when necessary?

We need to speak out at the state and federal level against policies that harm children. And we need to continue to show support for the policies that make our community a sanctuary for these children and provide them with necessary and appropriate medical care.

Immigrant families come to the United States in search of a better, safer life. They should not be in more danger here than in the country they fled.