Disrupting Immigrant and Pediatric Care

In June 2025, there were 51.9 million immigrants living in the U.S. (https://tinyurl.com/2zejpytd). Factor in the U.S.- born children of these immigrants, and that number doubles. Immigrant-led families represent a major sector of today’s patient population, and the ENT field is no exception. Unfortunately, over the past year, otolaryngologists and other clinicians have had a front-row seat to the unfolding impact of current immigration policy on immigrant-led families when it comes to accessing and maintaining much-needed otolaryngological healthcare.

Some physician leaders are understandably reluctant to comment officially on this topic for fear of attracting unwanted attention that conceivably could affect funding and hurt their organizations and patients further. Off the record, however, many acknowledge the alarming effects of current policy on their patients, especially pediatric patients. Emerging data from a national survey of 691 healthcare workers across 30 states validate those concerns (https://tinyurl.com/38c6vhwm). Results of the survey, conducted March through August 2025 by the Physicians for Human Rights (PHR) and the Migrant Clinicians Network (MCN), paint a disturbing picture of decreased patient visits, dwindling benefit enrollments, health-threatening diagnosis delays, inadequate preventive healthcare and chronic disease management, and an increased need for mental healthcare to cope with the current climate.

Policy Stokes Fear, Thwarts Care

Immigration policy changes in the past year have been swift and dramatic. In July 2025, the U.S. Senate approved a $170 billion budget reconciliation measure that, among other things, raised Immigration and Customs Enforcement (ICE) detention funding by 265%, enabling the detention of at least 116,000 people daily (https://tinyurl.com/3893xxea). A January 2026 report from the American Immigration Council (AIC) noted that the number of people held in ICE detention on any given day increased by more than 75% in just one year (https://tinyurl.com/5xfa568a).

Per the AIC report, this is in part due to the expansion of so-called “at large” arrests, an operation that many Americans have watched play out on their TV and mobile device screens. Under new policy enforcement practices, areas once considered too sensitive for immigration enforcement activity, such as schools and hospitals, now appear to be fair game. Among immigrant families, the primary response to this new reality is fear and avoidance. Even though most immigrant children are in fact U.S.-born (https://tinyurl.com/n476vhu2) and, as such—with rare exception—designated U.S. citizens, this does not eliminate the possibility of enforced detainment and/ or separation during a simple visit to the pediatrician.

New liberties taken during such arrests raise serious questions, said one pediatric otolaryngologist currently practicing in Boston. “Such publicity may discourage families from attending their visits and might compromise patient safety,” they said.

The impact of such practices on children should be everyone’s concern, emphasized Laszlo Madaras, MD, MPH, chief medical officer of the MCN, a national nonprofit organization dedicated to improving healthcare access and outcomes for migrant and immigrant communities across the U.S. The work of MCN centers on equity, dignity, language access, and culturally responsive care. “As health providers, we’re all trying to protect children, whether or not they have paperwork,” he said. “They deserve our care because we are the adults, and they are the kids. It’s an important part of a civilized society to have compassion and to care for our children.”

Impossible Choices

Today’s immigrant parents have been placed in an untenable position, as they question the wisdom of bringing their children to local healthcare facilities and risking confrontation and possible family separation and/or detention due to immigration enforcement activity on or near the premises. As a result, reports of appointment no-shows and cancellations are plentiful and growing. Last fall, health policy organization KFF and The New York Times, building on previous work, surveyed immigrant adults about their health and healthcare experiences since January 2025; 30% of parent respondents reported that children’s healthcare was delayed or skipped throughout this period (https://tinyurl.com/4y8r9dkc).

Siva Chinnadurai, MD, MPH, is a pediatric otolaryngologist and medical director of ear, nose, and throat, facial plastic surgery, and audiology at Children’s Minnesota, the largest freestanding pediatric health system in the state. Recent events in the region provide a vivid illustration of how increased federal immigration activity can adversely affect residents. According to Dr. Chinnadurai, disruptions to schools, businesses, and everyday life in Minnesota became evident shortly after Operation Metro Surge (the immigration enforcement operation initiated by the Department of Homeland Security) commenced in the Twin Cities area in December 2025.

“Soon afterward, we began to see rising levels of uncertainty, fear, and reluctance among families to come into the clinic for care,” Dr. Chinnadurai said. “Although we don’t have complete clarity of the specific reasons, we observed our patient no-show and cancellation rate climb significantly. Notably, in our Minneapolis clinic, missed appointments rose to over 35% in late December 2025 and early January 2026. In the week following the death of Renee Good, missed appointments jumped as high as 49%. We have also noticed a significant drop in outpatient volume, and many requests to shift surgeries and clinic appointments to our suburban locations.”

Throughout the country, doctors have seen patients go into hiding, change their phone numbers, and avoid the hospital because they no longer regard it as a protected space. Surgeries are canceled, and children with chronic medical conditions fail to appear for their needed ongoing care.

Immigrant parents are not only faced with the impossible decision of whether it is safe to bring their child to the clinic on any given day; they may also worry about whether it is even safe to sign up for or renew the medical benefits they need to afford services. In 2025, the Centers for Medicare and Medicaid Services announced that it would begin sharing Medicaid data it receives from states with ICE for enforcement purposes (https://tinyurl.com/ywkr5f2n). Although this practice is still prohibited in some states and is being challenged in the courts (https://tinyurl.com/fdpvdrsj), the partially successful effort to target individuals in this manner discourages immigrant families from filing for needed benefits. Thus, children may be kept away from medical care due to a lack of benefits—benefits for which they, as U.S.-born children, are legally eligible.

Health Consequences for Children

Pediatric ENTs express great concern about the effects of delayed, reduced, or cancelled appointments and procedures on their young patients’ health and futures. “We recently had a child with profound hearing loss who was scheduled for cochlear implantation,” Dr. Chinnadurai said. “His family became afraid to submit the paperwork to renew benefits, his coverage lapsed, and the surgery couldn’t happen.”

The Boston-based pediatric otolaryngologist recalled one young patient with a submandibular mass and unrelated hearing loss whose father was being deported back to Cambodia. “Even though the children are U.S. citizens and don’t have connections in Cambodia, they are unable to stay in America without their father,” they stated. “So, this child will be unable to follow our recommendations for monitoring his mass, and no workup is possible given impending deportation, so we can’t tell if it’s worrisome or not. We printed his notes and hoped that he would get the care he needed overseas, but without being able to confirm appropriate follow-up.”

In another case in Boston, a baby had a cleft palate that needed to be repaired within a specific time window to support normal speech development. “However, due to impending deportation of the family, we needed to adjust that baby’s surgery date, which resulted in an earlier-than-normal repair,” the ENT said. “Typically, in such a case, we would place tubes to restore normal hearing, but we will be unable to do this as we won’t be able to follow the tubes post-operatively. So, this child will get less complete care than if they were able to stay in the U.S.”

Routine surgeries performed as preventive care, such as putting in ear tubes or taking out tonsils and adenoids, are not normally associated with dire consequences, but the conditions they are designed to prevent can be extremely dire. Ear tubes, for example, are recommended because the child is having too many ear infections—not treating this can spread infection and/ or lead to permanent hearing loss. When you don’t treat conditions early on, they can give rise to bigger problems— possibly sleep apnea, hearing loss, speech delays, head and neck tumors, and thyroid disease, as examples.

There is also the important issue of vaccinations, a key aspect of preventive care. As a family medicine physician, Dr. Madaras emphasized that despite recent changes in vaccination recommendations, many essential vaccines are still advised. He highlights one vaccine that is particularly critical in the ENT field. “Since the 1990s, we’ve not had cases of Haemophilus influenzae B because we had the HiB vaccine that is given at well child checkups,” he said. “I was a student in the late 1980s, and we used to see epiglottitis due to this strain of the H. flu bacteria, which necessitated antibiotics and steroids, and sometimes we needed to open a patient’s airways. Now, due to this vaccine, I haven’t done a cricothyrotomy in almost 20 years.” Dr. Madaras expressed concerns about parents now balancing their desire to have their child vaccinated with the risk of an ICE encounter. “Preventable diseases may become problematic and more common, causing unnecessary suffering,” he said.

Circumstances within detention centers pose additional risks. “If you round up a bunch of folks—whoever they are, immigrants or non-immigrants— and put them together in detention centers in close circumstances with locked doors and windows, you risk their health. For example, if one person has active tuberculosis, many of them will soon have TB as well,” Dr. Madaras said. “We are already seeing this with an even more rapidly contagious infection: measles.”

Anne Messner, MD, professor at Baylor College of Medicine and chief of pediatric otolaryngology at Texas Children’s Hospital in Houston, shared experiences of seeing patients held at ICE detention centers. “Several kids have been brought to us for hearing loss. Some of these kids would greatly benefit from hearing aids, and we do our best to obtain aids for them, but we are not always successful,” she said. “This is especially the case because often, by the time we get the appropriate aids, the children are no longer in the area.”

Dr. Chinnadurai summed it up: “The medical consequences of limited clinical access are difficult to quantify, but the underlying issue is clear: Fear restricts safe and timely engagement with the healthcare system. This leads to preventable delays in care, missed treatment, and an increased risk of adverse health outcomes, particularly for children with time-sensitive conditions.”

Impacts on Well-Being

Activity based on the current immigration policy not only affects patients’ physical health. Of the 1,805 immigrants who participated in the KFF/The New York Times 2025 Survey of Immigrants, 18% said that their child/ children have experienced at least one of the following impacts: problems sleeping or eating; changes in school performance or attendance; and behavior problems.

Since January 2025, there have been increased reports of children with severe anxiety due to fear of family separation and, with actual detainment, cases of emotional trauma in children. A July 2025 report published in the journal Psychiatric News cites research leading to the following conclusion: Immigration policy in the U.S. is a source of chronic fear, instability, and trauma for millions of immigrants, with the expansion of enforcement mechanisms transforming daily life for families and children (https://tinyurl.com/2estcu7p).

According to the cited research, the psychological and behavioral impacts among students affected by immigration enforcement include sleep disturbances, appetite changes, behavioral problems, heightened anxiety, depression, and symptoms consistent with post-traumatic stress disorder. Counseling for these youths is in short supply, especially for those without the insurance benefits to fund professional mental health support.

Overall, the mental health consequences of today’s immigration policy on children are even more difficult to isolate than those of physical health, Dr. Chinnadurai said, because they occur “within a broader context of instability. Many of the most vulnerable families are now living with profound social isolation, food insecurity, and disrupted access to education,” he said. “When delays in essential medical care are layered onto these stressors, the cumulative burden becomes unimaginable.

“Childhood is made by everyday adventures of making friends, learning, playing, and using one’s imagination to think of new and wonderful things, rather than imagining the danger outside your door,” he continued. “There is profound loss in taking that childhood away.”

Providing Care in a Challenging Environment

Healthcare providers are often called upon to do their jobs under difficult circumstances. Certainly, the challenges of caring for patients during the COVID-19 epidemic are fresh in most of their minds. However, in today’s unique climate concerning immigration and enforcement, they are clearly facing a uniquely daunting challenge. Moreover, the ability of healthcare systems, hospitals, and individuals to minimize the adverse effects of immigration policy on patients and families appears limited.

It is a core tenet of a physician’s mission to provide care to anyone regardless of race, religion, nationality, or gender ideology. Thus, to have the ability to provide the best available healthcare impeded by a government policy and its effect on a significant sector of a physician’s patient base, is bound to wear on them emotionally.

“Every missed appointment hurts,” Dr. Chinnadurai said. “When a child doesn’t show up, or a parent calls from the parking lot, too afraid to come inside, our teams feel it. We see fear and uncertainty come between our patients and us, and there is only so much we can do to bridge the gap.”

Moreover, as is true across the country, many members of the staff at Children’s Minnesota are immigrants themselves or the children of immigrants. “They arrive each day balancing the responsibility of caring for others’ children while quietly carrying concerns about their own safety and the security of their families,” Dr. Chinnadurai said. “Tomorrow, like every day this month, many members of our team will get ready for work. And before they head out the door, [they] check to make sure they have their keys, their wallet, and their passport.”

Linda Kossoff is a medical journalist based in Los Angeles.