It’s time to put children’s unique health needs first – Hartford Courant

“I do not know what to do.”

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

Pediatricians have a saying in our line of work: “Children are not just small adults.” As they develop, children’s bodies work in ways that are different from adults’ bodies. From head to toe, inside and out, children have unique healing needs. So why do we so often treat children involved in 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 how they prioritize the well-being of these youth and their families. It’s time to put the unique health needs of children first and remember that children involved in the justice system are just that – children.

Recent advances in the developmental and cognitive sciences have highlighted the difference between childhood misbehavior and adult-like punishment. As I recently wrote with my colleagues in pediatrics and social work for JAMA Pediatrics, “The typical stage of neurodevelopment of young children is such that they typically cannot form criminal intent, understand, or meaningfully participate in legal proceedings, and there is little likely to benefit from punitive juvenile justice interventions ”, making the use of these tools ineffective and inappropriate for children. Additionally, adolescence is an important period of identity development, and involvement in the youth 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 fix for behavior that some might think. They actively harm 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 may bring.



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Instead of burdening children and families with excessive incarceration, disruptive and time-consuming court appearances, and prohibitive court fees, juvenile justice should instead focus on the child’s health and intervene before he or she is swallowed up by a system designed to to punish, not to heal.

One crucial step that some states have taken — and the American Academy of Pediatrics has endorsed — is to ensure that younger children are kept out of the juvenile court system. As of May 2022, only 26 states have laws specifying a minimum age for participation in the system. Of these, only seven countries set the minimum age at 12 or older.

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

For youth of all ages, the focus should be on preventing involvement in the system. This should come as no surprise – we know that children do better when they are surrounded by family and involved in their communities. Instead of arresting and incarcerating youth, we need to invest in them, as the Connecticut Justice Alliance calls for in its #InvestInMeCT campaign. For example, we must ensure that all schools have the resources to provide high-quality education, mental health care is widely available in 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 much greater likelihood of positive health outcomes than a prison cell.

By keeping youth out of prison and investing in alternatives that are developmentally appropriate for children, policymakers have the opportunity to reshape the youth justice system in a way 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 children. I will also remind them one last time – children are children; not just little adults.

Dr. Destiny Tolliver is a general pediatrician and health services researcher who completed the National Clinical Fellowship Program at Yale School of Medicine.

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