Patients Without Borders

Patients Without Borders 150 150 Dave Ghose

Immigrant children represent the fastest growing segment of the U.S. population. What can pediatricians do to help these vulnerable patients?

James Duffee, MD, MPH, watched the immigrant population change dramatically during his 15 years as a community health pediatrician and child psychiatrist in Springfield, Ohio. When he founded the Rocking Horse Community Health Center in 1999, he treated patients at migrant camps in the surrounding rural areas. By the time he left the federally qualified center in 2014, the immigrant population was more permanent and four times as big, creating a number of unique health care challenges.

“One of the most heart-wrenching situations in community practice is to have a child born in the United States who has health care, but the older siblings do not,” says Dr. Duffee, who now works for The Center for Family Safety and Healing at Nationwide Children’s Hospital.

Dr. Duffee’s experience mirrors what is happening across the country. Immigrant children (defined as foreign-born or living with at least one parent born outside the United States) represent the fastest-growing segment of the U.S. population. They tend to be poorer (30 percent below the federal poverty line, compared to 19 percent of children with U.S.-born parents), nearly twice as likely to be uninsured and are dispersed throughout the country, with the largest growth in percentage occurring in North Carolina, Nevada, Georgia and Arkansas, according to a 2013 policy statement of the American Academy of Pediatrics.

They’re also a diverse group. They include the well-to-do offspring of accomplished foreign-born professionals and the tens of thousands of unaccompanied minors from Central America who drew international headlines when they crossed the Texas border last year. Nearly 90 percent of immigrant children are U.S. citizens, making them eligible for public programs such as Medicaid and the Children’s Health Insurance Program, or CHIP. Yet many don’t take advantage of the opportunities. Waiting periods, lack of awareness and fear of deportation may contribute to the phenomenon.

How can pediatricians break down these barriers? In its 2013 policy statement, the American Academy of Pediatrics called for extending public insurance to undocumented children.

“At the Academy, we’ve become very bold in our position that all children in the United States deserve health insurance, regardless of their immigration status,” says Ricky Choi, MD, MPH, an Oakland, California pediatrician who chairs the AAP’s Immigrant Health Special Interest Group. He also calls for expanding access to interpreters to help reduce language barriers.

“It’s expensive to get interpreters,” Dr. Choi says. “It’s time-consuming, and there need to be provisions where physicians can get reimbursements for interpreter services.”

Bold policy reforms aren’t likely in gridlocked Washington, D.C., at the moment. But Dr. Duffee says pediatricians still can improve their immigrant care by becoming more culturally informed through resources such as the AAP’s Immigrant Child Health Toolkit.

“Understanding the cultural values of the family and providing skilled interpreters are essential elements of high quality care for children in immigrant families,” he says.


  1. Council on Community Pediatrics. Immigrant child health toolkit. American Academy of Pediatrics. 2015.
  2. Council on Community Pediatrics. Providing care for immigrant, migrant, and border childrenPediatrics. 2013 Jun, 131(6):e2028-34.