Susette is 4 years old. She and her mom live in Venezuela. Her dad, Renato, a customer service agent in Venezuela's main communications company, Cantv, took a bus to Peru in last July of 2018 in the hope of landing a job so he could send money home to feed his left-behind family.
(The family, and others interviewed for this story, asked that their last names not be used to protect the privacy of their children given their sensitive situation.)
Her mother says the little girl cried for four days after her father left. Now the child sees a therapist who offers free counseling. Susette has good days and bad days. On a phone call in September, the mother heard the child tell her dad, "You don't love me. You'd be here if you did."
Venezuelan mental health specialists call her behavior "migratory mourning." And there are a lot of migratory mourners like Susette.
The country's economic meltdown has triggered an astounding exodus – 3 million refugees and migrants as of November, according to the United Nations Office for the Coordination of Humanitarian Affairs. They are fleeing the poverty, hunger and lack of access to proper medical care that has become a hallmark of daily life. And many of them have left children behind.
"It occurs especially in poor Venezuelan families that don't have the economic conditions to migrate as a whole," says Fernando Pereira, founder of Community Learning Centers (Cecodap in Spanish), a nongovernmental agency that promotes children's rights in Venezuela.
After surveying 1,000 homes with the assistance of private pollster Datanálisis, Cecodap concluded that at least 600,000 children and teenagers have seen one or both parents move to other countries for economic betterment. The children are typically cared for by grandparents, close relatives, friends and neighbors.
This phenomenon is not exclusive to Venezuela. Verena Knaus, senior policy adviser on migration at UNICEF, lists many examples around the globe, like the estimated 9 million children "left behind" in the Philippines with one or both parents working abroad.
"We are looking at millions and millions," Knaus says.
Studies from other countries have shown a mixed bag of impacts on left behind children. In some ways they are better off than their peers because of the money sent home. Knaus says they may have "an edge over children of non-migrants in terms of physical health," for example. (Although if they're left in the care of poorly educated grandparents, that may not be the case, she says.)
And there are definitely psychological consequences, particularly if the mother is absent.
The left-behind children in Venezuela are often depressed and hostile, says Irma Pena, a psychologist who sees dozens of children whose parents have moved to other countries. She works in the Pediatric Specialties Hospital in Maracaibo, a city of 3 million in northwest Venezuela.
At a university seminar in November, she estimated that 3 out of every 10 young patients who come to the hospital to see her are there because one or both parents have migrated.
"That number is way higher nowadays," she told NPR in February.
These children, she says, may lose interest in school or personal hygiene. She has seen children who are biting their nails, having crying spells and even wetting their pants. They may evince sudden mood changes or become disobedient, Pena says.
María Alejandra Ramírez, a psychologist and family therapist, adds that the kids may start to fight with school friends and even the person taking care of them in their parents' absence.
Meanwhile, teachers and social workers "may not necessarily be trained or sensitized to their needs," says Knaus of UNICEF.
Technology that allows for regular contact is extremely helpful, she says. But only up to a point, especially in countries where electricity and internet services are unreliable, like Venezuela.
Eleven-year-old Emmanuel, his 5-year-old brother Jesus David and their 15-year-old sister Maria Valentina now live with their grandmother, Oneida, a laboratory assistant.
Their dad left two years ago for Peru, then Ecuador and now Chile, hoping to find work so he could send home money for medicine, food, clothing and toys. Their mom joined him there a year ago.
Their grandmother's mobile phone, an old Blackberry, is the virtual link to their parents. The children use it daily to make video calls or send voicemail through message services like WhatsApp.
"It doesn't feel the same without them despite how much we love our grandma," says Maria Valentina, who enjoys making anime sketches and listening to K-pop. "We're not used to being apart [from] them."
"I cry when I think about them," says Emmanuel.
The separation is also tough on their parents. Jhon, a former employee of the Lago Maracaibo Country Club, says, "I had a good job and a decent income but inflation got so harsh that the money wasn't enough and I had to leave. It's been three years since I saw my kids for the last time. It's been so long since I kissed them goodnight. This is horrible."
For Jhon's family a happy ending is in sight. The boys will travel to Chile to join their parents in mid-April; Maria Valentina will join them in June after she finishes 10th grade.
But that's not always the case. And in a country where the health-care system is widely viewed as in crisis, there are limited options to support these children.
Many mental health professionals have migrated, making it difficult for those who remain to handle the number of cases and organize support networks for themselves and for the left-behind children, Ramirez says.
Then there's the matter of fees in a country reeling from its economic meltdown. Free consultations for kids are only possible in public hospitals and through a handful of organizations that work with children, like Cecodap, Profam and Fundana.
By contrast, in other countries that frequently deal with parents leaving the country for work, like the Philippines, there are counseling services set up to help families before a parent or parents depart and manuals for schools to make teachers aware of the issues these children face, says Knaus of UNICEF.
In every country, of course, the children hope for a reunion. Susette, the 4-year girl whose father is in Chile, often imagines that her dad sends her so much money that her mother and she can buy a helicopter to fly all the way to Chile.
But when the separation has gone on for a long time, the kids may not want to reunite if it means leaving their homeland.
Consider the complicated situation of Amanda and Andrea. The teenage sisters live in Venezuela with their grandparents. Their parents are divorced. Their father is in the country but their mother has been working in Chile for the past four years. She's now making travel arrangements so the girls can join her. Even though they love their mom very much, they're not eager to go.
"It hurts to be apart from mom," says Amanda, "but we're even more hurt thinking about being away from our [father], grandfathers, uncles and aunts."
Gustavo Ocando Alex is a freelance writer in Venezuela who has contributed to BBC World News and the Miami Herald.