Dr. Destiny Tolliver: It’s time to put children’s unique health needs first

“I don’t know what to do.”

My 12-year-old patient’s caregiver said this with tears in her eyes as she described her child’s challenging history of trauma and subsequent behavioral health problems. Due to these developmental issues, the caregiver voiced her fear that an outburst or behavioral health episode could land her now-adolescent child in the juvenile justice system, where his underlying health needs might go unmet. As a pediatrician, I share her concerns. Our current juvenile justice system too often fails to take kids’ unique health needs into account, instead simply resizing punitive measures used for adults and causing children’s behavioral health issues to worsen.

Pediatricians have a saying in our work: “Kids are not just small adults.” As they develop, children’s bodies work in ways distinct from adult bodies. From head to toe, inside and out, kids have unique treatment needs. So why, then, do we so often treat children involved with our justice system like small adults?

As lawmakers in Connecticut and across the country propose reforms to our broken juvenile justice system, I urge them to rethink the way they prioritize the well-being of these youths and their families. It is time to put children’s unique health needs first, and remember that kids involved in the justice system are just that — kids.

Recent advances in developmental and cognitive sciences have underscored the disconnect between childhood misbehavior and adultlike punishment. As I recently wrote alongside my colleagues in pediatrics and social work for JAMA Pediatrics, “Young children’s typical neurodevelopmental stage is such that they generally cannot form criminal intent, comprehend or meaningfully participate in court proceedings, and are unlikely to benefit from punitive juvenile justice interventions,” making the use of these tools ineffective and inappropriate for children. Further, adolescence is an important time for identity development, and involvement with the juvenile justice system for young children and adolescents can lead them to form a “criminal identity,” leading to higher rates of recidivism.

Punitive interventions are not the quick behavioral fix some might think they are. They are actively harming children — whose brains are still developing the ability to weigh long-term consequences — with children of color facing disproportionate impacts that far outweigh any benefits these policies might carry.

Instead of burdening kids and families with overincarceration, disruptive and time-consuming court appearances, and unaffordable legal fees, juvenile justice must instead center the health of the child and intervene before they are consumed by a system designed to punish – not heal.

One crucial step that some states have taken — and the American Academy of Pediatrics has endorsed – is ensuring that younger children are kept out of the juvenile justice system altogether. As of May 2022, only 26 states have laws providing a minimum age for system involvement. Of them, just seven states set the minimum age at 12 or above.

As a pediatrician, I see this as an important step – nothing in my experience of treating children or researching pediatric health leads me to believe that incarcerating young adolescents provides any worthwhile benefit to them or their communities.

For youths of all ages, focus must be placed on preempting involvement with the system. This should come as no surprise — we know kids do better when surrounded by family and involved with their communities. Rather than arresting and incarcerating youth, we should invest in them as the Connecticut Justice Alliance calls for in its #InvestInMeCT campaign. For example, we should ensure that all schools have the resources to provide high quality education, mental health care is widely available within communities and schools, all families have access to basic needs such as housing and food, and all children have access to positive social networks. Each of these methods provides a far greater likelihood of positive health outcomes compared to a prison cell.

By keeping adolescents out of confinement and investing in alternatives that are developmentally appropriate for children, policymakers have the opportunity to recreate the juvenile justice system in a manner that is informed by evidence and centered around children’s health.

As we have a national conversation about juvenile justice, I urge lawmakers to listen to pediatricians, who are dedicated to promoting evidence-based care for kids. I will also remind them one last time – kids are kids; not just small adults.

Dr. Destiny Tolliver is a general pediatrician and health services researcher who completed the National Clinician Scholars program at Yale School of Medicine.