Concerns about immigration enforcement are keeping some children from medical care, according to a new survey of more than 1,600 pediatricians. Forty percent of the physicians surveyed said that, during the past year, patients in immigrant families had avoided seeking care for a child because of concerns about the immigration status of someone in the household. The survey was conducted from April through June by researchers with the American Academy of Pediatrics and published Tuesday. Pediatricians reported that, on average, about one-quarter of their patients were members of immigrant families. Thirty-one percent said families had avoided applying for government assistance, including Medicaid, the Children’s Health Insurance Program and food stamps. Just over one in five reported that families had kept children out of school because of immigration-related concerns. The academy said the findings may underestimate the problem because they reflect what doctors observed rather than the experiences of every affected family. Clinicians have separately reported seeing children arrive with more advanced illnesses, missed preventive care and postponed surgeries. The effects varied by practice setting. Nearly half of pediatricians working in urban, inner-city practices said families had pulled back from seeking care, compared with 32% of rural pediatricians. About 45% of pediatric subspecialists reported the same pattern. The survey comes amid changes to federal immigration policy. In January 2025, the Trump administration withdrew earlier limits on immigration arrests in locations generally considered protected, including hospitals, clinics and schools. Health care workers have warned that the change could make families less willing to seek help, even when children need urgent or routine treatment. Doctors are also concerned about a federal policy scheduled to take effect Friday that expands immigration officers’ discretion when reviewing some green-card, visa and admission applications. The policy allows officers to consider use of certain public benefits—including housing and food assistance, Medicaid and CHIP—under the federal “public charge” standard, which can be used to determine inadmissibility. “Pediatricians have long spoken out against changes to the public charge policy because we know that it leaves families fearful of accessing programs and services that are critical for their health and well-being,” Dr. Sural Shah, chair of the American Academy of Pediatrics’ Council on Immigrant Child and Family Health, said at a news conference last week. Nationwide, one in four children lived in an immigrant family in 2024, meaning they had at least one parent born outside the United States. The share differs from state to state, but pediatricians say fear-driven decisions about health care can affect children regardless of their own citizenship or immigration status.