The mistreatment or disregard of American and foreign children at the hands of the United States is not a new problem, but 2018 may well be the worst year yet. When issues from guns to immigration to health care to foreign affairs are viewed through the lens of how they affect children, it becomes clear the young are an afterthought when it comes to public policy.

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“In my 20 years here, I couldn’t think of a year as bad for kids. It’s totally across the board,” said Bruce Lesley, president of First Focus on Children. “Name an issue, and literally we’re leaving kids worse off.”

The latest example came in the past two weeks with the deaths of two Guatemalan migrant children, a 7-year-old girl and an 8-year-old boy, while in U.S. custody after crossing the southern border. On Saturday, President Trump drew criticism for politicizing their deaths by blaming Democrats.

Also, this week The Washington Post published a haunting examination of the psychological trauma endured by more than 4.1 million U.S. children whose schools went into lockdown at least once in the 2017-2018 school year over fear of a school shooter. This year was the deadliest yet for school shootings.

Then there was the Trump administration’s implementation of a policy that separated migrant parents and their children at the border. After a federal judge ruled that the families had to be reunited, federal officials struggled in many cases to locate the parents. A government official involved in the policy deliberations testified in Congress that he had personally warned that separating children from their parents could result in long-term psychological harm, but the Trump administration went ahead with it anyway.

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U.S. immigration policy hurts children in myriad ways: the terrible living conditions of the tents and detention cells where migrant children are held; the reversal of the Obama-era policy to allow undocumented immigrants brought to America as children to stay in the country; the deportation of adults who leave behind children and grandchildren; the change in public-charge rules that adds health programs such as Medicaid to the list of government benefits whose use could get an immigrant denied permanent status; and the travel ban on some Muslim-majority countries, which is also a form of family separation.

On Saturday, a 2-year-old boy died in California, where his father, a U.S. citizen, had brought him for medical treatment. His mother, who is Yemeni, could not come because of the travel ban. She tried for a year to get travel documents and got a waiver only after the news media picked up the story. By then, her son was on life support.

“I believe there were people whose hearts were breaking [over family separations] and who still thought the separations were worth it to stop what they saw as ‘illegal’ immigration,” said Gina Adams of the Urban Institute. “Perhaps they decided that the impact on children was worth the trade-off for this other social goal they had."

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“I also think it is sometimes hard for people to make caring for children a policy priority because the cost of the damage we are doing often doesn’t become evident until sometime in the future, and so can be easier to ignore,” she added.

The rash of school shootings and the effects of immigration policies are glaring examples of direct harm to children, but there are a host of less visible issues that also are devastating to children.

The Trump administration’s encouragement of states implementing Medicaid work requirements, for one, means that in some instances a mother with young children would be forced to find a job or lose her health insurance. What isn’t considered is who will pay for child care if the mother works. Unlike in other countries, there is limited government aid to help American parents offset the cost of child care.

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Rates of child abuse and neglect are up, largely because of the opioid epidemic, which has resulted in an increase of children placed in foster care. More children and teens are attempting or dying by suicide. Infant mortality rates in the United States remain higher than in other wealthy nations. For the first time in a decade, the rate of uninsured children went up in 2017.

Federal funding for programs that benefit children is declining, according to an Urban Institute report released in July. The authors estimate that by 2028 the percent of the federal budget spent on children will drop from 9.4 percent to 6.9 percent. The report also notes that the United States has the second-highest child poverty rate among 29 developed countries. It “also ranks poorly on measures of birth weight (23rd); preschool enrollment rates (26th); the share of 15- to 19-year-olds participating in education, employment, or training (23rd); and a composite measure of child well-being (26th, in the company of Lithuania, Latvia, and Romania),” the authors write.

Adams said it’s not that people don’t care about children, “but they vary on which kids they care about, and vary on whether they really understand the cost to kids.”

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Several years ago, GOP pollster Frank Luntz moderated several focus groups on behalf of First Focus to determine how much voters cared about children as an issue. When asked to name the top issues they cared about, only one person in each group mentioned something related to children. So Luntz asked them why they didn’t care about kids. The participants, many of them parents and grandparents, pushed back but conceded that they don’t connect children’s needs and politics.

So, that’s Lesley’s mission heading into 2019. He’s heartened by the record number of women who will be serving in Congress next year — women are generally better on children’s issues than men, he said — and that the next generation of men are taking a more prominent role in raising their children.