One in four children in the United States have at least one immigrant parent and 1 in 33 are foreign-born themselves. Immigration policy remains a key factor in shaping the health and well-being of children and their families. My experience as a pediatrician caring for immigrant children is consistent with what evidence tells us: punitive and restrictive immigration policies are harmful to children’s health. Yet for too long we’ve seen federal immigration policies that take this approach. 

It is for this reason that I welcome recent federal developments (detailed below) that seek to protect the rights of immigrants and their families and ensure they can access public benefits for which they are eligible. However, as the upcoming midterm elections make for an uncertain legislative landscape, there is still much more work to do to meet the needs of immigrant families and ensure that they can thrive. 

Recent federal immigration policy changes that affect children

In late August, the Department of Homeland Security (DHS) announced that it would act to “preserve and fortify” the Deferred Action for Childhood Arrivals (DACA) policy, and the final rule takes effect at the end of this month. This 2012 policy allows children who arrived in the United States as young children—affectionately nicknamed “Dreamers”—to access a renewable work permit, protecting them from deportation. In the 10 years since its inception, over 800,000 people have been granted DACA. It was terminated in 2017, but in 2021 President Biden committed to reimplementing and strengthening it.

PolicyLab experts and immigration advocates have championed DACA as a policy that directly promotes the health of DACA recipients and their children, bolsters the health care workforce and protects public health. Studies show that when compared with DACA-ineligible individuals, those who were eligible had decreased undesired pregnancies, increased school attendance, decreased psychological distress, and in some settings, improved self-reported overall health. It’s clear from this growing body of evidence that the stability, improved mental health, and access to health services supported by the DACA policy enables children and their families to be healthier. 

Separately, DHS issued a final rule (effective in late December) on Public Charge Ground of Inadmissibility, which clarifies that noncitizens requesting admission to the U.S. or applying for lawful permanent residence will not be penalized for utilization of most health-related benefits (e.g., most benefits under Medicaid and the Children’s Health Insurance Program[CHIP]) and many government services (e.g., the Supplemental Nutrition Assistance Program [SNAP], pandemic assistance, housing benefits). This amends a 2019 change to the public charge rule that stated that immigrants applying for visas, admission and adjustment of status would be penalized if it was deemed they had a high likelihood of utilizing government benefits. 

These changes are also important steps forward in promoting children’s well-being. The public charge rule has been around for a long time, but the particular changes made to it in 2019 have been criticized, including by PolicyLab experts, as a threat to the health of immigrant families. Concerns about the harms of discouraging families from accessing health care, food, or other benefits for which they are eligible were unfortunately realized as immigrant families chose to forego these benefits for fear of jeopardizing their immigration status, a phenomenon known as the “chilling effect."

The social safety net programs families are choosing to forego have been shown to improve children’s health, decrease child poverty and food insecurity, and promote access to other basic needs like housing and education. While I welcome the progress made by these recent changes, I share concerns of other PolicyLab experts that the chilling effect may likely endure, and therefore require significant efforts to rebuild trust among these communities and create longer-lasting policy solutions to protect families in the future. 

The need for ongoing support for immigrant children and families  

While the policy changes mentioned above are welcome and will have direct positive impact on the immigrant children and families that I care for, I continue to see opportunities to roll back harmful immigration policies and improve the health and well-being of this population. Below are some areas I would prioritize as part of a comprehensive policy agenda for immigrant families: 

• Expanding public insurance coverage to all immigrant children. Research shows that over 2 million foreign-born children are income-eligible for Medicaid and CHIP, but due to federal restrictions, state-level policy variation and barriers to enrollment, almost half of them are not enrolled. Health care coverage improves access and health of children, and policies expanding insurance for all income-eligible immigrant children, including those who are undocumented, should be adopted
• Investing in mental health services for children in immigrant families. Children in immigrant families and immigrant children have higher rates of anxiety, depression, and post-traumatic stress disorder due to the stress of resettlement, structural racism, and in many cases, poverty. Facing compounding stressors from the COVID-19 pandemic, these children need accessible mental health supports in their language in schools and in communities to foster their healthy growth and development. 
• Ending policies that perpetuate family separations and trauma experienced by immigrants. Policies like Title 42, a 2020 order that closed the border to migrants and asylum seekers, also pose threats to immigrant children’s well-being. This policy has been condemned by public health experts, human rights advocates, and the American Academy of Pediatrics as xenophobic, cruel and contributing to family separations. 

I often witness first-hand the resilience, courage and brilliance that immigrant children bring to our communities. It is for this reason that I strongly encourage voters and elected officials to continue advocating for policies that advance health equity for immigrant children and protect their ability to thrive. 

Lauren Palladino, MD, is a former affiliate trainee at PolicyLab.