Creating a safe space
Some direct questioning yielded my answer from Hua. She was quite fluent in English. She was, in fact, shut down.
I started by asking how she has found her time in the United States. She remarked with indifference: a shrug of her shoulders and a curt, "It's okay."
"Are you making friends at school?" I asked.
She was quiet. Then she replied, "They call me stupid because I am slow to speak English."
"Have you told your parents?" I questioned.
"Is there any adult you talk to?"
Her face flushed, as if emotions were pressing to get out. I could feel her sadness as my throat ached from squelched tears.
She explained: "I miss my grandma."
We tossed around options of Facetiming Hua’s grandma regularly and me arranging for that with her mother. But that didn't give her any resolve. These are the visits where time becomes less relevant; I cannot force a young girl's pain to rise to the surface.
"You know this is a safe space." I explained. "You can feel feelings here and nothing bad will happen to you." Slowly her face reddened and tears reluctantly made their way out. Her silence resumed. I breathed through the discomfort.
"Do your parents tell you they love you?" I asked softly.
She shook her head.
"Do they give you hugs?"
She shook her head. More tears came out.
I began to understand why talking to her grandmother would not resolve the perceived lack of love she was feeling from her parents.
With her permission I called her mom in with the translator.
Hua's face was still flushed, and it was apparent she was crying.
Her mom looked concerned but cautiously distant, as if waiting for someone to come console her daughter. This revealed another piece of the puzzle. Something was disconnected between these two.
I later learned that Hua's family previously lived in the Philippines. She was the oldest of four children. Once the fourth sibling came along, Hua was sent to live with her grandmother.
"My husband worked all the time and it was too much for me to manage four kids by myself," her mom explained.
“When immigrant families struggle to make ends meet, establish their communities, wrestle with new languages and learn to navigate new systems, the emotions of the children sometimes can get pushed to the side.”
Immigrant children and abrupt transitions
Hua, in turn, spent most of her early elementary years with her grandmother in China. She enjoyed her time there and felt bonded with her school friends. Simultaneously she felt like her parents didn't love her and that is why she was sent back to China while her three younger siblings stayed on with her parents. Her entry to the United States, like so many immigrant children, had been an abrupt transition.
When immigrant families struggle to make ends meet, establish their communities, wrestle with new languages and learn to navigate new systems, the emotions of the children sometimes can get pushed to the side. There are too many competing forces.
Sometimes we, the pediatricians, can play in important role by stretching open the space for the child to feel. Emotionally available parents often follow in kind.
That is what I saw with Hua's mom. She didn't know what to do, but she wanted to do something. Her mom said she didn't hug because it "wasn't part of her culture." So, I hugged her mom.
Hua’s mom then started to cry. She told me she had never been hugged! And now she knew how healing a safe hug can be.
Unbreakable bonds of extended family
I am still learning about Chinese culture. I wanted to understand why a parent's solution would be to send their young child to another continent, so I discussed this with a Chinese colleague. I am learning about the major role that extended family, particularly the grandparents, play in raising children. The parent remains ever present, popping in and out as they go to work. It is a natural instinct for them to continue to rely on the grandparents even though they are far away.
"A child is yours by blood, and the assumption is that bond will never break. We tell ourselves the child will understand the sacrifices we have made when they are older," my colleague explained.
Every culture has a logic. It may not be my logic. But trying to understand it allows me to connect with compassion rather than judging and assuming. Inevitably I learn with and respect each culture in kind. They all have a logic. I just have to take the time to understand and honor it. Only then can I be of service to families.
I feel like immigrant parents are learning the same thing: inevitably, their children acculturate to American norms. They have to reconcile these differences. Accepting families where they are builds the trust required to navigate unexpected turns of raising children in a new country.
Hua and her mom are getting reacquainted with each other. On the follow up visit Hua told me that her mom still doesn't hug or say "I love you" much, but she had no doubt she loved her. Mom's relaxed, cordial demeanor coupled with Hua’s warm greeting was all the confirmation I needed to see. I feel confident that this new leg of their journey as mother and daughter in American will continue to strengthen.
*Editor’s note: The name and some identifying details of this story have been changed to protect patient privacy.
** The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Varsha Mona Puri, DO, FAAP, a member of the American Academy of Pediatrics Section on Osteopathic Pediatricians, practices at the at the Children's Hospital of Los Angeles. Dr. Puri is a LEND (Leadership Education Neurodevelopmental and Related Disabilities) graduate, Volunteer Faculty at Children’s Hospital Los Angeles/USC (University of Southern California) and a member of the USC Physicians for Human Rights Asylum Clinic. She predominantly works with immigrant families in the Federally Qualified Health Care Center setting.